A decision has to be made whether or not the reduction of the palatal fracture is to be performed using a palatal splint. A palatal splint is recommended if the segments of tooth–bone units are relatively intact.
If the tooth–bone units are severely damaged or comminuted then a palatal splint alone may be insufficient.
In complex (comminuted) palatal fractures where the tooth–bone units are relatively intact, most surgeons consider utilization of a palatal splint critical. In these cases, it is necessary to take dental impressions, make dental models, and from these models make a palatal splint. (If dental models are available from previous treatment, this may be helpful.)
In these complex cases, cuts need to be made in the maxillary portion of the dental model to determine the premorbid contour of the maxillary arch. This is achieved by using the mandibular model. Once the maxillary cast model has been adjusted to its premorbid shape, the palatal splint is made using that maxillary model.
The palatal splint is then fixed on the palate, also using arch bars and peridental wires. Depending on the stability of the palatal unit, and of the postoperative airway, as well as any complicating issues of other midface fractures, the surgeon may choose to leave the patient in postoperative MMF.
In this photograph, dental impressions have been taken, models have been made, …