Modalities of treatment for open reduction internal fixation (ORIF) are controversial. With most options for treatment, the surgeon should plan on placing arch bars and using MMF. Depending on the nature of the fracture, the surgeon may or may not choose to leave the patient in MMF for a period of time postoperatively.
The first option is to perform an ORIF of the palatal fracture with fixation of one or more plates on the palate through a palatal approach. If there has been significant splaying, palatal laceration in this area is common. Alternative to placing the plate submucosally in the palatal region, it could be placed on the surface of the mucosa and removed at a later point. Locking screw/plate systems allow epimucusal application of bone plates. A second plate is placed on the anterior alveolar segment, taking care not to injure the tooth roots.
A second option is to reduce the fracture and use a palatal splint.
A third option is a combination of the first two options where ORIF is performed and a palatal splint added for further stability.
If there is significant splaying of the fracture and instability of the palate, most surgeons opt for the first or third option. Some surgeons feel that the first option alone would provide adequate stability. Others feel that if the first option is not combined with a palatal splint, there is a risk of having some lingual splaying of the teeth when the patients are placed into MMF.
In the following explanation we will demonstrate the third option.