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The maxillary tuberosity can fracture during extraction of a molar tooth. If a small bony fragment is affected, the extraction of the tooth and tuberosity continues; however, a conservative approach is advised if the bony fragment is large. In a modified blind surgical technique, the tooth is removed without the fractured bone.
In the period of 3 years, from 1984 to 1986 in the Department of Maxillofacial Surgery, Institute of Stomatology, Medical Academy in Warsaw 230 patients were treated for maxillary fractures. Late results of this treatment were assessed in 102 patients coming for control examinations in 1988. In the assessment of the therapeutic results the following features were considered: facial symmetry, proportions of three facial segments, functions of the visual system and stomatognathic system, nasal patency, and sensory disturbances in the area innervated by the infraorbital nerves. On the basis of this late assessment of the results of treatment of these fractures it was found that the definite morphological-functional and aesthetic results were unsatisfactory in cases of Le Fort III and II type maxillary fractures. This points out that the therapeutic methods used as yet are not sufficiently satisfactory and other methods should be evolved.
Aberrant tooth development following facial fractures is unusual. It is commonly reported that tooth buds involved in the line of a mandibular fracture will continue to develop normally and erupt sequentially. Few cases have been cited regarding developing teeth in the line of maxillary fractures. In the case reported, the normal growth and position of a maxillary third molar can be seen to be retarded at the position of a maxillary fracture, sustained by a child in the mixed dentition phase of dental development.
In a period of 3 years, from 1984 to 1986 in the Department of Maxillofacial Surgery, Institute of Stomatology, Medical Academy in Warsaw 442 patients were treated for zygomatico-maxillary fractures, in 101 cases the treatment was conservative, and 341 were treated surgically by various operative methods. The aim of the study was assessment of late effectiveness of the surgical methods used most frequently in zygomatico-maxillary fractures with reposition of skeletal fragments either with one-pronged hook introduced percutaneously or from the side of the lumen of the maxillary sinus. The criterion of effectiveness of both methods was accepted to be functional assessment of the visual system and the stomatognathic system, and the condition of sensory function in the area of innervation by the suborbital nerve. Control examinations were done 2-5 years after operations confirming the both methods were successful in 90% of the treated group. A more detailed analysis of these methods is not possible since the qualification for these operations differentiated essentially both groups of patients.
PATIENT: A case report of a 39-year-old man complaining of complex dysfunction of occlusion and mastication is presented. The patient came to Iwate Medical University Hospital following urgent hospitalization and treatment at a local hospital after catching his head in a forklift. The patient consulted the Second Prosthetic Department with the purpose of occlusal examination in April, 1994 and he was diagnosed with a malunited maxillary fracture. Afterwards, surgical correction was performed, but complex dysfunction of occlusion and mastication remained. Fixed prosthesis treatment was then planned and a dental prosthesis was set in April, 2000. His prognosis has since remained favorable. DISCUSSION: At the commencement of treatment, both surgery and orthodontic treatment were considered, but the patient desired early social rehabilitation. Therefore, a dental prosthesis was used to restore facial asymmetry and mandibular function. CONCLUSIONS: Rehabilitation of occlusal function was achieved by using a dental prosthesis. This facilitated early social rehabilitation and helped improve the patient's quality of life. Since there have been few reports of cases in which a dental prosthesis was used to correct occlusal disharmony after surgical correction due to maxillary fracture, long-term follow-up will be needed for this patient in order to increase knowledge about treatment strategies for such cases.
PURPOSE: To present cases where passive repositioning of maxillary fractures was not achievable during surgery, and a method to provide passive occlusal positioning in those cases. PATIENTS AND METHODS: Over a 10-year period, the maxillae of 24 patients with fractures of the maxilla could not be passively repositioned during surgery. In these cases, a Le Fort I osteotomy was performed in addition to reduction and fixation of the other midfacial fractures. RESULTS: All patients had passive restoration of their pretrauma occlusion during surgery. All patients except 1 had maintenance of their pretrauma occlusion at the last follow-up visit (6 weeks or more) following surgery. CONCLUSION: When passive positioning of the maxilla is not possible, a concomitant Le Fort I osteotomy can provide passive positioning of the occlusion.
The last decade has witnessed a tremendous evolution in the management of maxillary fractures--an evolution that mirrors an overall more aggressive contemporary approach to complex maxillofacial trauma. This article briefly reviews past contributions to the current management of these fractures, the author's approach to management, and the future of this continually improving field.
A simple, closed method for zygomatico-maxillary fracture treatment is described i.e. replacement by the use of a traction bone-hook. After X-ray and clinical examination had excluded undisplaced fractures, blow out fractures and comminuted fractures, the postreduction stability was assessed peroperatively and again one week after. Sophisticated preoperative fracture-classifications predicting postoperative stability appeared redundant. In the present study, this procedure could be performed in 55.4% of the total fractures which needed to be reduced. At re-evaluation, two to eight years later, the results remained satisfactory. The method appeared, in addition to its simplicity, to require less complicated postoperative care and, therefore, a short hospitalization.
We performed a prospective study of 100 consecutive patients presenting to our unit with complex maxillary fractures. Fracture severity was assessed according to the alpha-numeric scoring system of Cooter and David and correlated with outcome. Regional maxillary and total fracture scores demonstrated a positive correlation with complication rates, with correlation coefficients of 0.89 and 0.98 respectively. Ocular and orbital complications were most commonly seen with these complex injuries, but occlusal problems were much less common. Despite close consultant-led supervision in a specialised centre, these injuries frequently result in long term problems.
The diagnosis and treatment of a fractured maxillary first molar are described in this case report of a 28-year-old male. Successful treatment of the retained palatal root of the fractured molar, referred to as premolarization, ensued from integration of endodontic, orthodontic, periodontic, and fixed prosthodontic care.
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