Mid face fractures#2 /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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Mid face fractures#2 /certified fixed orthodontic courses by Indian dental academy

  1. 1. Part –II Management of MIDFACE FRACTURES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Treatment Goal is functional & cosmetic restoration Reestablish:    Mid-facial height and projection (most important) Occlusion Integrity of nose and orbit Provide structural support for proper soft tissue contour www.indiandentalacademy.com
  3. 3. Treatment must be indivisualised Factors affecting treatment stratigies  Multi-trauma  Concomitant mandibular Injury www.indiandentalacademy.com
  4. 4. Principles of Treatment (Rodrich & Shewmake,1992) Early 1 stage repair Exposure of all # sites Precise Anatomic reduction & semirigid fixation Immediate bone grafting if needed Definitive soft tissue repair www.indiandentalacademy.com
  5. 5. Timing of Operative repair Initial concept - 5th -8th day www.indiandentalacademy.com
  6. 6. Surgical Approaches Maxillary vestibular incision Lower eyelid incision Transconjunctival Subciliary Lower lid incision Coronal Approach www.indiandentalacademy.com
  7. 7. Reduction of Midface Fractures Most imp step. Universal rule of mechanics Reduction:  Manual reduction : Fresh #, Non impacted Hand manipulation Dental compounds (1951) Rubber cathaters (1966) Special instruments www.indiandentalacademy.com
  8. 8. Special Instruments Rowe’s Maxillary Disimpaction Forceps www.indiandentalacademy.com
  9. 9. www.indiandentalacademy.com
  10. 10. www.indiandentalacademy.com
  11. 11. Hayton Williams Forceps www.indiandentalacademy.com
  12. 12. Lefort II & III – When inadequate alignment results, individual segments are reduced separately. Direct reduction: Elevator, bone hook or wire inserted through the fragment. Traction using elastic bands applied to maxillary and mandibular arch bar can be used for reducing fraction. www.indiandentalacademy.com
  13. 13. Immobilization of mid-face fractures: A) Internal fixation a..Direct osteosynthesis : Miniplates Transosseous wiring. High level (fronto-zygomatic and fronto-nasal) Mid level (orbital rim/ zygoma buttress). Low level (Alveolar / midpalatal). www.indiandentalacademy.com
  14. 14. b..Suspension wires (Skeletal fixation). A)Frontal : Central (LeFort II & III ; Unstable mand.) Lateral ( LeFort II & III ; Stable mand) b) Circum-zygomatic c) Zygomatic-fronto d) Infra-orbital rim. e) Pyriform aperture. f) Buttress, transnasal g) Perialveolar wire www.indiandentalacademy.com
  15. 15. B) External fixation: 1) Cranio-mandibular Box frame Halo frame. Plaster of paris head cap. 2) Craniomaxillary: Supra-orbital pins. Zygomatic pins. Halo frames. Levant Frames. www.indiandentalacademy.com
  16. 16. Lateral frontal wire: www.indiandentalacademy.com
  17. 17. BOX FRAME www.indiandentalacademy.com
  18. 18. Central frontal wire: www.indiandentalacademy.com
  19. 19. 2) Circum zygomatic: www.indiandentalacademy.com
  20. 20. 3) Zygomatic buttress and pyriform: www.indiandentalacademy.com
  21. 21. Infra-orbital wiring. www.indiandentalacademy.com
  22. 22. Various – Plaster of paris. Halo frame. Box frame. Levant frame. Indication – Presence of anteroposterior instability of the facial skeleton (i.e. concomitant B/L condylar # of mandible). Disadvantage: Appliances are cumbersome, conspicuous is lead to lengthen the period of hospitalization. Contraindicated : Presence of mental confusion, cerebral irritation, epilepsy and alcoholism. www.indiandentalacademy.com
  23. 23. Halo Frame. www.indiandentalacademy.com
  24. 24. BOX FRAME www.indiandentalacademy.com
  25. 25. LEVANT FRAME www.indiandentalacademy.com
  26. 26. Internal Fixation - Michelet first introduced miniplate in facial # 1972. Monocortical semi-rigid fixation with plates or screws:    Provides three diamenssional stability resists antero-posterior and rotatory bony movements. Allows primary bony healing www.indiandentalacademy.com
  27. 27. Different configuration X,H, L,T and Y shapes. Various material like Stainless steel Titanium Vitallium (Cobalt-chromium and molydenum) Resorbable bone plates and screws (Polylactide, polyglycolic copolymer) www.indiandentalacademy.com
  28. 28. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. www.indiandentalacademy.com
  31. 31. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Management ABCDE Reduction & fixation Closed v/s Open www.indiandentalacademy.com
  32. 32. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I fractures ORIF plates Intra oral approach Fixation of plates after reduction Pyriform rim Zygomatic buttress GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  33. 33. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort II fractures ORIF plates Nasal #s Infra orbital rim Zygomatic buttress GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  34. 34. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort III fractures ORIF plates Fronto-zygomatic Fronto-nasal Zygomatic buttress GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  35. 35. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I, II & III fractures CLOSED Reduction & Fixation Suspension wires to mandible Frontal: Central & lateral Circum zygomatic www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  36. 36. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I, II & III fractures CLOSED External fixation Cranio-mandibular Box, Halo frames POP head cap www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  37. 37. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com