Treatment of Palatal Fracture According to the Fracture Pattern.

Ock, Jae Jin; Park, Sang Hoon

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 1999;26(5):883-889.
Published online September 1, 1999.

Treatment of Palatal Fracture According to the Fracture Pattern.

Jae Jin Ock, Sang Hoon Park

Abstract

The palatal fracture results in deformity of the midface, as well as change in occlusion. However, no report was found on the incidence, treatment and results of palatal fracture in Korea. A retrospective review was done over 6 years and 11 patients(6.5%) with palatal fracture were determind out of 168 patients who had midfacial bone fractures without nasal bone fracture. According to the Hendrickson's classification, the number of patients with specific types of palatal fracture was described as follows; sagittal (2 cases), parasagittal (2 cases), para-alveolar (3 cases), transverse(3 cases) and complex(1 case). Le Fort I (6 cases), Le Fort II (7 cases) and mandible (6 cases) fractures were also associated. Open reduction and internal fixation was applied to all patients. Internal fixation consisted of pyriform or alveolar ridge stabilization and maxillary buttress stabilization. The rigid palatal vault stabilization was applied in one patient with midline split of the palate. The duration of intermaxillary fixation was shortened to less than 3 weeks from 4 to 6 weeks with rigid fixation. The palatal splint was used temporarily before internal fixation. All the patients showed good bony union and satisfactoryocclusion postoperatively. Open reduction and internal fixation showed satisfactory results from the aspects of stability, occlusion, patient convenience and final aesthetics. The following treatment model for palatal fracture according to the fracture type is proposed; 1) Alveolar type - close reduction or open reduction and selective alveolar ridge fixation and selective application of palatal splint, 2) Sagittal type - open reduction and internal fixation of the alveolar ridge, maxillary buttress and palatal vault. 3) Parasagittal type - open reduction and internal fixation of the pyriform aperture and maxillary buttress, as well as selective fixation of the palatal vault. 4) Para-alveolar type - open reduction and internal fixation of the alveolar ridge and maxillary buttress. 5) Complex type - open reduction and internal fixation of the alveolar ridge, maxillary buttress, pyriform aperture and continuous use of a palatal splint to bony union. 6) Transverse type - open reduction and internal fixation of the alveolar ridge and maxillary buttress.

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