Kumar Umesh, Jain Pradeep
Department Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Indian J Plast Surg. 2021 Aug 2;54(3):284-288. doi: 10.1055/s-0041-1729665. eCollection 2021 Sep.
The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures. This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization. Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications. Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault.
矢状位上颌骨骨折常与上颌骨其他骨折并存,因此需要与其他上颌骨骨折一起制定明确的治疗策略。本研究对60例矢状位上颌骨骨折患者进行了观察。腭部骨折被分为六个亚组。在治疗过程中,患者被分为三组。A组患者的I型、IV型、V型和VI型骨折采用颌间固定和上颌前部支撑稳定术进行治疗。B组患者包括II型、III型和IV型腭部骨折。这些骨折无移位,采用颌间固定、前牙槽骨钢板固定和上颌前部支撑稳定术进行治疗。C组包括腭部有明显间隙的II型和III型骨折,采用颌间固定、腭穹窿钢板固定、前牙槽骨钢板固定和上颌前部支撑稳定术进行治疗。矢状位上颌骨骨折在年轻男性中更为常见。Le Fort I型和II型骨折单独或合并出现时与之关联更为频繁。旁矢状位和矢状位骨折是最常见的类型。对A组的16例患者、B组的20例患者和C组的24例患者进行了治疗。咬合不正(2例)、钢板外露(2例)和口鼻瘘(2例)是最常见的并发症。矢状位上颌骨骨折可通过临床和影像学检查进行诊断。II型和III型移位腭部骨折需要进行腭穹窿钢板固定。固定于腭中后三分之一后半部的单块钢板可为腭穹窿提供足够的稳定性。