eMedicine Specialties > Plastic Surgery > Facial Fractures

Facial Trauma, Maxillary and Le Fort Fractures: Follow-up

Author: Kris S Moe, MD, FACS, Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine; Clinical Associate Professor of Surgery, Division of Head and Neck Surgery, University of California, San Diego
Coauthor(s): Patrick Byrne, MD, Assistant Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University; David W Kim, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Director, Division of Facial Plastic and Reconstructive Surgery, University of California at San Francisco; Adel R Tawfilis, DDS, Assistant Clinical Professor, Department of Surgery, Division of Plastic Surgery, University of California at San Diego Medical Center
Contributor Information and Disclosures

Updated: Dec 19, 2008

Outcome and Prognosis

A lack of prospective studies on trauma patients makes assessment of outcome measures for patients treated for maxillary fractures difficult. Repair of simple maxillary fractures typically restores bony aesthetic contour and function; however, complex fractures often leave the patient with some long-term cosmetic and functional deficits. Early and meticulous surgery is most likely to produce results that restore the patient to the pretrauma state.

Future and Controversies

The continuing trend in facial fracture repair is toward rigid osteosynthesis with miniplates and screws. The advantage of this technique is that a higher degree of stability is gained, allowing for earlier removal of MMF and return to mastication.

Opponents of this technique who favor suspension techniques cite the disadvantage that anatomic realignment must be perfect at the time of surgery. Whereas suspension techniques allow postoperative adjustment of segments by changing the MMF to compensate for slight deviations from perfect reduction, rigid techniques are much less forgiving. Unrecognized displacement of midface or mandibular segments results in inevitable malunion. Also cited are the higher cost of the materials, the difficulty in contouring plates to the surface of the bone, and increased surgical time. Despite these disadvantages, rigid techniques are gaining in popularity. As long as surgical technique is proficient, rigid osteosynthesis is generally believed to lead to better long-term results and faster recovery.

Absorbable plating systems composed of polylactic acids have recently become available and are gaining popularity for maxillofacial repair. These systems have the advantage of providing rigid osseous fixation without permanent foreign body implantation. This theoretically reduces the risk of infection and plate exposure. The other main advantage of these systems is the ability to contour plates with thermal manipulation (hot saline sponge or specialized heated instruments) even after the plates have been positioned in situ. This facilitates contouring plates to a precise and appropriate shape across fracture lines.

The use of endoscopically-assisted techniques allows for limited incisions for the reduction of facial fractures. These techniques have been pioneered for use in the reduction of condylar and orbital fractures but have recently been applied to more extensive procedures.3,4,5 The use of endoscopic techniques allows for limited incisions, faster recovery periods, and shorter hospital stays.4,5 Despite the advantages afforded with these techniques, the indications for open procedures have not been drastically altered. Facial trauma that involves severely dislocated or comminuted fractures of the facial skeleton and major reconstruction of the facial support structures still requires the use of open techniques and direct visualization.

Reconstruction of the facial skeleton involves the reestablishment of the original contours of the face with the precise alignment of fractures. The advancement of image guidance systems has assisted the surgeon in preoperative evaluation and surgical planning, but its recent introduction into the operative arena allows real-time localization of displaced facial skeletal segments during reduction and internal fixation. The use of this technology can help the surgeon obtain a postoperative result that most closely approximates the pre-trauma skeletal structure. This may be most useful in cases where the adjacent bony anatomic landmarks are also displaced or altered and the continuing incorporation of computer-aided guidance of reduction of facial fractures will help to optimize surgical results.6

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Kristin K Egan, MD, to the writing and development of this article.



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References
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References

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Further Reading

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Keywords

Le fort fracture, le fort fracture, facial trauma, facial fracture repair, facial fracture treatment, horizontal fracture, pyramidal fracture, transverse fracture, craniofacial dysjunction, maxilla repair, LeFort fracture, Le Fort fracture, maxilla fracture, maxillary fracture, facial fracture, facial trauma, Le Fort I fracture, Le Fort II fracture, Le Fort III fracture, maxillofacial repair, maxillo-facial repair, MMF, maxillomandibular fixation, maxillo-mandibular fixation

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Contributor Information and Disclosures

Author

Kris S Moe, MD, FACS, Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine; Clinical Associate Professor of Surgery, Division of Head and Neck Surgery, University of California, San Diego
Kris S Moe, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Society for Head and Neck Surgery, and North American Skull Base Society
Disclosure: Nothing to disclose.

Coauthor(s)

Patrick Byrne, MD, Assistant Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University
Patrick Byrne, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American College of Surgeons
Disclosure: Nothing to disclose.

David W Kim, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Director, Division of Facial Plastic and Reconstructive Surgery, University of California at San Francisco
David W Kim, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Adel R Tawfilis, DDS, Assistant Clinical Professor, Department of Surgery, Division of Plastic Surgery, University of California at San Diego Medical Center
Adel R Tawfilis, DDS is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, and American Society of Maxillofacial Surgeons
Disclosure: Nothing to disclose.

Medical Editor

James F Thornton, MD, Assistant Professor, Department of Plastic and Reconstructive Surgery, University of Texas Southwestern
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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