Maxillary fracture

Vittorio Carlino MGE VI

The maxilla represents the bridge between the cranial
base superiorly and the dental occlusal plane inferiorly.
Maxillary fractures account for approximately 6-25% of all
facial fractures. Maxillary fractures account for
approximately 6-25% of all facial fractures.
Pathophysiology:
Le Fort I fractures (horizontal) may result from a force
of injury directed low on the maxillary alveolar rim in a
downward direction. The fracture extends from the
nasal septum to the lateral pyriform rims, travels
horizontally above the teeth apices, crosses below the
zygomaticomaxillary junction, and traverses the
pterygomaxillary junction to interrupt the pterygoid
plates.
 Le Fort II fractures (pyramidal) may result from a blow
to the lower or mid maxilla. Such a fracture has a
pyramidal shape and extends from the nasal bridge at
or below the nasofrontal suture through the frontal
processes of the maxilla, inferolaterally through the
lacrimal bones and inferior orbital floor and rim through
or near the inferior orbital foramen, and inferiorly
through the anterior wall of the maxillary sinus; it then
travels under the zygoma, across the pterygomaxillary
fissure, and through the pterygoid plates.
 Le Fort III fractures (transverse), also termed
craniofacial dysjunctions, may follow impact to the
nasal bridge or upper maxilla. These fractures start at
the nasofrontal and frontomaxillary sutures and extend
posteriorly along the medial wall of the orbit through the
nasolacrimal groove and ethmoid bones.
Treatment
Treatment is surgical.
 Mandibular fracture
Mandibular fracture is a break through the mandibular bone. In about 60% of
cases the break occurs in two places. It may result in a decreased ability to
fully open the mouth. Mandibular fractures are typically the result of trauma.
The most common area of fracture is at the condyle (36%), body (21%),
angle (20%) and symphysis (14%). While a diagnosis can occasionally be
made with plain X-ray, modern CT scans are more accurate. The healing time
for a routine mandible fractures is 46 weeks. The most common long-term
complications are loss of sensation in the mandibular nerve, malocclusion
and loss of teeth in the line of fracture. The more complicated the fracture
(infection, comminution, displacement) the higher the risk of fracture.
Condylar fractures have higher rates of malocclusion which in turn are
dependent on the degree of displacement and/or dislocation.