Dental occlusion is the most important parameter in reestablishing facial contour, reduction of fracture, and obtaining postoperative chewing function. The most common means of placing the patient into maxillomandibular fixation (MMF) is the application of arch bars. Click here for further details on applying MMF/IMF. In many cases of Le Fort fracture the maxillary fracture may require reduction by disimpaction. Various instrumentations may be necessary in order to properly achieve the position of the maxilla. The instrumentation that may be used include the following: Rowe’s disimpaction forceps, “Stromeyer” hook, Tessier retromaxillary mobilizers.
A second surgical principle is to achieve anatomical correct repositioning of all midfacial bones. The height, width, and projection must be reestablished. Successful reconstruction of midfacial fractures is obtained by reestablishing the midfacial buttresses. If available, dental casts, stereolithographic models, and/or premorbid photographs may be useful guides for treatment.
As a general principle, all fractures should be exposed and reduced before plating.
The midfacial region is possibly the most demanding region in terms of surgical reconstruction and also one of the most controversial regions in terms of how to provide appropriate reconstruction.
It is up to the individual surgeon to determine the appropriate treatment protocol for each patient, including the selection of appropriate hardware for fracture fixation.
Complexity of fracture fixation is not only determined by fracture morphology, including the number of fracture lines, but also depends on the necessary approach, accessibility, visibility of the area of interest and the stability of the fracture reduction.
The number, size, and position of plates and screws might vary according to the biomechanical needs and individual fracture situation.
The placement of a skull in a sterile plastic bag, or the use of sterile artificial skulls for contouring plates, and technologies such as intraoperative radiologic imaging or navigation can be beneficial in restoring the proper anatomical form.
Pre- and postoperative 3-D imaging allows an objective assessment of the surgical result.