Transpalatal wiring for the management of sagittal fracture of the maxilla/palate

Sagittal fractures of the maxilla or palate, either in the midline or paramedian region, are usually associated with Le Fort fractures , resulting in oronasal communication. Early stabilization of these fractures prevents the functional impairments and life-threatening situations, such as continuous haemorrhage from the traumatized nasal mucosa and nasal regurgitation of food leading to the risk of aspiration.

The options available for the management of such fractures include a palatal occlusal splint, the use of an arch bar as tension band, intermaxillary fixation, transpalatal screw traction, and horizontal fixation at the palatal vault and/or across the basal bone of the pyriform aperture or alveolar ridge . A very simple, effective, quick, and non-invasive technique for the management of sagittal fractures of the maxilla or palate is presented herein. This technique can be performed in the emergency room or in the outpatient setting.

The technique is illustrated in Fig. 1 . One end of a 25- to 30-cm long 26-gauge stainless steel wire (end A, Fig. 1 ) is passed buccally through the embrasure between the maxillary first and second molar teeth on one side. This end is then pulled palatally and reinserted from the palatal aspect through the embrasure between the first and second molars on the opposite side and is pulled buccally. Similarly the other end of the wire (end B, Fig. 1 ) is passed transpalatally into the embrasure between the second premolar and first molar teeth on both sides. Choosing molars and premolars for wiring helps to maintain the palatal width posteriorly, as the tendency of splaying of the segments is greater in this region. Digital pressure is applied bilaterally on the buccal cortex in the zygomaticomaxillary buttress regions and the two ends of the transpalatal wire are twisted together to stabilize the fractured fragments.

Dec 14, 2017 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Transpalatal wiring for the management of sagittal fracture of the maxilla/palate
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