A 162-case review of palatal fracture: management strategy from a 10-year experience.
BACKGROUND
Palatal fractures are frequently associated with Le Fort maxillary fractures in midfacial trauma. They may present diagnostic and therapeutic challenges and result in malunion and occlusion problems if not treated properly.


METHODS
In a retrospective study of 349 Le Fort maxillary fractures over 10 years, 162 patients were diagnosed with palatal fractures. The classification of fractures was based on the patterns observed on computed tomographic scans and treatment plan including type I, sagittal; type II, transverse; and type III, comminuted. Transverse palatal fractures were stabilized by standard Le Fort I buttresses and alveolar ridge fixation. Additional intermolar wiring fixation was applied for sagittal palatal fractures, and prolonged intermaxillary fixation with dental splinting was applied for comminuted palatal fractures.


RESULTS
Palatal fractures accounted for 46.4 percent of Le Fort maxillary fractures in this study. Motorcycle accident (69.5 percent) was the most common trauma mechanism. In the type I group, all patients achieved satisfactory results except one patient who needed orthognathic surgery because of malocclusion. Thirteen patients required orthodontic treatment without additional surgical intervention. There were three fistula formations in the type III group that required palatal flaps for closure.


CONCLUSIONS
The high incidence of concomitant palatal fractures in midfacial trauma suggests the importance of accurate diagnosis followed by appropriate management. Results of this study show that intermolar wiring fixation is a much less time-consuming and more cost-effective method for satisfactory treatment of sagittal fractures of the palate. Simultaneously, a palatal flap for closure of a palatal defect is the key to avoiding fistula formation.
Chen
Chih-Hao
CH
Taoyuan, Taiwan; and Philadelphia, Pa. From the Department of Plastic and Reconstructive Surgery, the Center for Biostatistics, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, and the Division of Plastic Surgery, University of Pennsylvania.
Wang
Theresa Y
TY
Tsay
Pei-Kwei
PK
Lai
Jui-Bin
JB
Chen
Chien-Tzung
CT
Liao
Han-Tsung
HT
Lin
Chih-Hung
CH
Chen
Yu-Ray
YR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001864:Bone Wires; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D018460:Fractures, Comminuted / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007572:Jaw Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D021362:Palate, Hard / Q000293:injuries*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome