CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(03): 284-288
DOI: 10.1055/s-0041-1729665
Original Article

Sagittal Maxillary Fracture: Diagnosis and Management

Umesh Kumar
1   Department Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Pradeep Jain
1   Department Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
› Author Affiliations

Abstract

Background The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures.

Method This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization.

Result Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications.

Conclusion Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault.

Supplementary Material



Publication History

Article published online:
02 August 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Rowe NL, Killey HC. Fracture of the Facial Skeleton. 2nd edition. Baltimore: Williams & Wilkins 1968
  • 2 Le Fort R. Experimental study of fractures of the upper jaw. Revue de Chirurgie(Paris) 1901; 23: 208-227
  • 3 Manson PN. Some thoughts on the classification and treatment of Le Fort fractures. Ann Plast Surg 1986; 17 (05) 356-363
  • 4 Morgan BD, Madan DK, Bergerot JP. Fractures of the middle third of the face–a review of 300 cases. Br J Plast Surg 1972; 25 (02) 147-151
  • 5 Manson PN, Glassman D, Vanderkolk C, Petty P, Crawley WA. Rigid stabilization of sagittal fractures of the maxilla and palate. Plast Reconstr Surg 1990; 85 (05) 711-717
  • 6 Hendrickson M, Clark N, Manson PN. et al Palatal fractures: classification, pattern and treatment with rigid internal fixation. Plast Reconstr Surg 1999; 103: 1287-1307
  • 7 Manson PN, Clark N, Robertson B. et al Subunit principles in midface fractures: the importance of sagittal buttresses, soft-tissue reductions, and sequencing treatment of segmental fractures. Plast Reconstr Surg 1999; 103 (04) 1287-1306, quiz 1307
  • 8 Chen CH, Wang TY, Tsay PK. et al A 162-case review of palatal fracture: management strategy from a 10-year experience. Plast Reconstr Surg 2008; 121 (06) 2065-2073
  • 9 Park S, Ock JJ. A new classification of palatal fracture and an algorithm to establish a treatment plan. Plast Reconstr Surg 2001; 107 (07) 1669-1676 discussion 1677–1678
  • 10 Melsen B. A histological study of the influence of sutural morphology and skeletal maturation on rapid palatal expansion in children. Trans Eur Orthod Soc 1972; •••: 499-507
  • 11 Hoppe IC, Halsey JN, Ciminello FS, Lee ES, Granick MS. A single centre review of palatal fractures: etiology, patterns, concomitant injuries and management. Eplasty 2017; 17: e20
  • 12 Karthik R, Cynthia S, Vivek N. Prashanthi G, Saravana Kumar S, Rajyalakshmi V. Open reduction and internal fixation of palatal fractures using three-dimensional plates. Br J Oral Maxillofac Surg 2018; 56 (05) 411-415
  • 13 Quinn JH. Open reduction and internal fixation of vertical maxillary fractures. J Oral Surg 1968; 26 (03) 167-171
  • 14 Rimmell F, Marentette LJ. Injuries of the hard palate and the horizontal buttress of mid face. Head Neck Surg 1993; 109: 499
  • 15 Gruss JS, Mackinnon SE. Complex maxillary fractures: role of buttress reconstruction and immediate bone grafts. Plast Reconstr Surg 1986; 78 (01) 9-22
  • 16 Cientuegos R, Sierra E, Ortiz B, Fernandez G. Treatment of palatal fractures by osteosynthesis with 2.0mm locking plates as external fixator. Cranio Maxilla Fac Trauma Reconstr 2010; 3: 223-230