Splint-Assisted Reduction of Comminuted or Complex Maxillofacial Fractures

Abstract

The aim of the study was to obtain anatomic bone healing and restoration of the patient's premorbid occlusion in complex facial fractures or comminuted facial fracture. Ten patients who applied to a tertiary health care clinic with complex or comminuted fractures, and mandibular fractures combined with condylar fractures which may impair the occlusal harmony were included in the study.After the preparation of premorbid occlusal splints and direct bonded orthodontic brackets, splint-assisted reduction and internal fixation have been performed. The treatment protocol was completed with 4 to 6 weeks of intermaxillary fixation over the splint. All fracture lines showed complete bone healing, without major complications requiring further treatment. Complications included a minor degree of malocclusion in one of the panfacial fracture patients and slight avascular resorption of the condyle in one of the avulsive open comminuted mandibular fracture patients.Using orthodontic splints and direct bonded brackets to obtain and maintain delicate reduction is an efficacious method for the prevention of occlusal disharmony and aesthetic impairments in comminuted lower facial unit and complicated facial fracture patients.

Utilization of Virtual Surgical Planning for Surgical Splint-Assisted Comminuted Maxillomandibular Fracture Reduction and/or Fixation

“…5,6,8 It can reinforce the arch bar stability and prevent fracture segments rotation and distraction before and during application of arch bars and/or plates and screws. 5,6 Because of its ability in anatomical reduction assistance of fractures, [5][6][7] it is a tool that changes complex jaw fractures to less complicated fractures. Consequently, the effort needed for reduction is decreased, wide surgical exposure needed for ORIF is also decreased, and accuracy of the treatment is increased.…”

“…This procedure occurred bedside, in the operating room, or dental unit. 5,7 Complications included more soft tissue injury or tooth loss from impression taking.…”

“…Then splints will be fabricated on the reduced models. [5][6][7][8] Recently, virtual or computer-aided surgery has evolved over time and gained popularity in craniomaxillofacial surgery: craniofacial reconstruction, orbital reconstruction, tumor resection, maxillomandibular reconstruction, orthognathic surgery, dental/craniofacial implant, traumatology, temporomandibular joint surgery, and others. [9][10][11][12][13][14][15][16] The main advantages of this computer technology are the possibilities for preoperative planning, improvement in precision with predicted outcome, reduction in surgical time, and better patient satisfaction than conventional methods.…”

“…These splints assist in the anatomical reduction of bony segments, immobilize and maintain the reduction before or during maxillomandibular fixation (MMF) or ORIF application, and act as stabilization during bone healing period. [5][6][7] Traditionally, when we consider splint for treatment of maxillomandibular fractures, an impression will be taken of the upper and lower jaws. After pouring the impression, the models will be sectioned at the fracture sites, reduced, and waxed together in the ideal position.…”

Salient Points to Observe in Panfacial Fracture Management

“…Consultation, coordination and cooperation with other relevant departments (such as neurosurgery, ophthalmology, otolaryngology, anesthesiology etc.) is prudent (3). …”