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The midface is composed of the zygomas, nasoethmoid area, and internal portions of the orbits (upper midface), the paired maxillae, palatine bones, and sphenoid bone (lower midface). 1 Complex fractures of the midface present difficulty in achieving correct anatomical reduction due to the challenge of simultaneously reducing and stabilizing multiple bone fragments. Extraoral and intraoral methods to achieve fracture mobilization and reduction commonly used include Gillies elevation, malar hook, Dingman type elevators, and others (►Fig. 1). 2 No single method is used universally. The Gillies method has disadvantages in the management of multisegment fractures. 3 The surgical access is remote from the site of elevation, giving poor control of small fracture segments and an unpredictable direction of reduction force. This can lead to imprecise segment alignment and the frustration of repeated setup before the definitive miniplate fixation. Keywords► midfacial fracture ► fracture reduction ► screw-wire osteotraction ► multisegment fracture AbstractStable anatomical fracture reduction and segment control before miniplate fixation can be difficult to achieve in comminuted midfacial fractures. Fracture mobilization and reduction methods include Gillies elevation, malar hook, and Dingman elevators. No single method is used universally. Disadvantages include imprecise segment alignment and poor segment stability/control. We have employed screw-wire osteo-traction (SWOT) to address this problem. A literature review revealed two published reports. The aims were to evaluate the SWOT technique effectiveness as a fracture reduction method and to examine rates of revision fixation and plate removal. We recruited 40 consecutive patients requiring open reduction and internal fixation of multisegment midfacial fractures (2009)(2010)(2011)(2012) and employed miniplate osteosynthesis in all patients. SWOT was used as a default reduction method in all patients. The rates of successful fracture reduction achieved by SWOT alone or in combination and of revision fixation and plate removal, were used as outcome indices of the reduction method effectiveness. The SWOT technique achieved satisfactory anatomical reduction in 27/40 patients when used alone. Other reduction methods were also used in 13/40 patients. No patient required revision fixation and three patients required late plate removal. SWOT can be used across the midface fracture pattern in conjunction with other methods or as a sole reduction method before miniplate fixation.

The closure of large palatal fistulae may challenge oral and maxillofacial surgeons especially when considering subsequent prosthetic requirements. Surgical procedures used to reconstruct palatal defects include prostheses, local flaps, distant flaps, bone grafting and allografts. We present a case of successful closure of a large post‐resection palatal fistula using a combination of three established techniques. Closure of the superior naso‐antral layer was completed using Fickling's inkwell technique. The resultant large defect was closed using a ‘tadpole’ rotational palatal flap combined with a buccal fat pad advancement to secure the unsupported lateral aspect of the rotation flap and remaining denuded bone of the left hard palate. The fistula remains closed four years after surgery. This report demonstrates the effective combination of three local intra‐oral flaps as a single‐stage, low‐risk method of closing a large palatal fistula.

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