Palatal Fracture Fixation on Severe Panfacial Fracture: Is There Any Clinical Significance?

Abstract

Background: Fractures of the hard palate are infrequent. They are found in less then 10% of patients with midfacial fractures. They practically never occur in isolation and are usually part of alveolar process fractures or more complex midfacial fractures of the Le Fort type. Treatment of palatal fractures is planned and performed with the goal of restoring the transverse width of the palate, the anteroposterior projection of the maxillary arch, and the patient’s pretraumatic occlusal plane, as well as maintaining horizontal stability of the midface.Case Presentation: Reporting patient female 17 years old with panfacial fracture due to traffic accident. There was slight epidural haemorrhage on frontal area. The fractures are on upper face, midface, and lower face including the hard palate. We performed open reduction internal fixation on palate to correct the arch of the upper jaw. The other fracture site can be corrected easier. The approaches that we done are bicoronal, subsilier, and intraoral. The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and aesthetic outcomes.Conclusion: Palate fractures are relatively uncommon and are associated with significant rates of malocclusion and wound complications. These injuries are typically managed with plate fixation of the alveolar ridge with variable approaches to the palatal vault

<p><strong>Karakteristik fraktur palatum yang disertai fraktur dentoalveolar pada pasien trauma maksilofasial</p></strong><p><em><strong>Characteristics of palate fracture accompanied with dentoalveolar fracture in patients with maxillofacial trauma</p></em><strong>

“…Indikasi lain dari reduksi tertutup yaitu comminuted fracture. 27,28,29 Fraktur palatum yang disertai fraktur dentoalveolar yang parah akan menimbulkan kesulitan dalam perawatannya dan kemungkinan komplikasi cukup besar. 30 Penelitian mengenai fraktur palatum masih jarang dilakukan di Indonesia.…”

“…Urutan terbanyak ketiga fraktur dentoalveolar tipe III yaitu fraktur alveolar disertai fraktur mahkota gigi dimana pasien biasanya mengeluhkan sakit dengan manipulasi udara, dan suhu, ada tanda merah muda atau kemerahan disekitar dentin dan sekitarnya atau darah di tengah-tengah gigi. 27,28,29 Perawatan fraktur palatal disertai fraktur dentoalveolar pada penelitian ini umumnya closed reduction yaitu dengan interdental wiring, intermolar wiring, intercanine wiring, dan sebagian kecil sampel dilakukan open reduction yaitu ORIF semicito atau orif elektif (tabel 1 kolom perawatan). Hal ini sesuai dengan penelitian-penelitian sebelumnya metode perbaikan fraktur palatum bervariasi dan mencakup pendekatan secara reduksi terbuka dan reduksi tertutup dengan wiring, plating, splinting, kawat gigi ortodontik, arch bar acylated, dan arch bar untuk fiksasi maksilomandibular ke fiksasi internal, dengan pelat dan sekrup ditempatkan di bawah mukosa palatum dan periosteum.…”