MAXILLARY

FRACTURES
 SURGICAL ANATOMY
(MIDDLE THIRD)
 Maxillae -2
 Zygomatic -2
 Zygomatic process of Temporal bones - 2
 Palatine bones -2
 Nasal bones -2
 Lacrimal bones -2
 Inferior conchae -2
 Vomer -1
 Ethmoid -1
 Sphenoid -1
 (Pterygoid plates)
 CLASSIFICATION
 LeFort I ( Low level fracture)
 LeFort II ( Pyramidal fracture)
 LeFort III (High Level/ Transverse
fracture)
 SIGNS AND SYMPTOMS
 EXTRA ORAL
• INSPECTION
• PALPATION
• PERCUSSION
 INTRA ORAL
• INSPECTION
• PALPATION
• PERCUSSION
 SIGNS AND SYMPTOMS
EXTRA ORAL
• INSPECTION
• Odema / Lacerations
• Lengthening of face
• Dish shaped appearance of face
• Nose
• epistaxis

• flat nasal bridge

• CSF rhinorrhea (tram lines) ( salty taste)

• Eye
• Peri orbital Ecchymosis (Panda Faces)

• Sub conjunctival hemorrhage

• Traumatic Telecanthus

• Diplopia

• Hooding of the eyes

 CSF RHINORRHEA
 Seen in NOE, LeFort II, III
 CSF leak through nose by # of cribriform plate of Ethmoid bone
 “Tram line” sign
 Hallow sign
 Hanker chief test ( non sticky)
 INVESTIGATIONS
• Colorimetric test- CHO in csf >Blood
• Intr Thecal Flurocien dye in csf
 TREATMENT
• Gradually Reduce / no nasal packing
• Antibiotics - crosses blood brain barrier -- chlorophenicol
• Reduction of Fracture
• Dural repair
 TRAUMATIC TELECANTHUS
 Normal Intercanthal Distance
• Males 29 to 34.5mm
• Females 28.5 to 33 mm
 Furness test
 Bow string test
 SIGNS AND SYMPTOMS
EXTRA ORAL
PALPATION
• Step deformity (At Sutures)
• FN ,FZ , IO, ZB.
• Tenderness
• Abnormal Mobility
 SIGNS AND SYMPTOMS
INTRA ORAL
INSPECTION
• Gagging of occlusion (Ant open bite)
• Ecchymosis buccal sulcus /palate
• Mid palatal Split
• Palpation
• Cracked pot sound
• mobility teeth
 RADIOGRAPHIC EXAMINATION
• Water’s view
• Lateral view face
• CT
• 3D
 TREATMENT
• Reduction
• Fixation
• Immobilization

• Reduction Immobilization
• Reduction Fixation
 REDUCTION
 Close Reduction
 Open Reduction
 CLOSE REDUCTION
• Max Rowe’s disimpaction forceps
• Assessment
• Occlusion
• Infra Orbital margin continuity
• FZ suture-continuity
 Reduction
Close Reduction Open Reduction
•IMF •IMF

Immobilization Fixation
 Plating
• Suspension Wiring

Maintain IMF Release IMF

(Resilient/ Mov) (Rigid/ NO mov)
 IMMOBILIZATION

Suspension Wires(Max sandwitch between

•

mand and frontal bone )

• Fronto-Mandibular suspension - LeFort 3
• Circumzygomatic suspension - LeFort 2
• Infraorital-mandibular susp - LeFort 1
• Pyriform aperature-manidibular
Susp- LeFort 1
Cranio mandibular/craniomaxillary
•

• POP head cap

• Halo frame
 OPEN REDUCTION
• Incison & Mucoperiosteal Reflection
• Assessment
• Visual Assessment
• Occlusion
 FIXATION - ORIF
(open reduction & internal fixation
 Mini plates /Transosseous wiring
• High level
 Fronto zygomatic III
 Fronto nasal II & III
• Mid level
 Infra orbital margin II

 Zygomatic buttress II

• Low level
 Alveolar I
 Mid palatal I
Support

• Antral pack
• Antral balloon
FRACTURED MAX
TUBEROSITY
 FRACTURED MAX
TUBEROSITY
TREATMENT
Fixation with Immobilization(IMF)
Surgical Extraction
Wait for Healing then surg Ext
 SEQUENCE OF RX
IN MULTIPLE FRACTUES
 Rule
• Inside to outside & bottom to up
 Rule
• outer ring – to inner ring
• Example- In poly trauma patient
• Extraction
• Arch bars/splints fixed
• oral lacerations Stitched
• max fracture reduced- IMF
• Incisions at FZ suture, ZM suture,
• Plating
• Naso ethmoidal injuries
• skin lacerations - stitched
 COMPLICATIONS
(IMMEDIATE )
 AIRWAY
 NASAL HEAEMORRHAGE
 OPTHALMIC
• RETINAL ARTERY SPASM
• RETRO BULBAR HAEMORRHAGE
• INJURY TO OPTIC NERVE
MALOCCLUSION
INACCURATE RDUCTION/FIXATION
SUSPENSION WIRE INACCURATE
 COMPLICATIONS (LATE)
 INFECTION
• Max SINUSITIS
 NON UNION (RARE)
 FACIAL PROFILE DEFECT
• LONG FACE OR DISH FACE
 MALOCCLUSION
• ANT OPEN BITE
• GAGGING OF MOLARS
 NASAL
• DEVIATION
• ANOSMIA
• CSF RHINORRHOEA –DELAYED ONSET
 ORONASAL FISTURLA
 COMPLICATIONS (LATE)
 OPHTHALMIC
 DIPLOPIA

 ENOPTHALMOS

 EPIPHORIA

• NEUROLOGIC
 Injury to infra orbital nerve

 SUPERIOR ORBITAL FISSURE SYND

• Opthalmoplegia
• DIPLOPIA
• PTOSIS
 OPTIC NERVE

• BLINDNESS