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Maxillary Fractures


Fractures of the maxilla, or upper jaw are more rare than mandibular fractures. But they are often associated with fractures to the nose or other parts of the central face. This is because the maxilla acts as a central support bone in the face, and impact to it can affect bone around the nose and eyes along specific "planes of weakness" in the bone structure. Fractures to the maxilla can often cause teeth to fracture as well.

The three stereotyped ways in which fractures involving the maxilla can occur are named after the physician who classified them 100 years ago. The first, called a LeFort I fracture, is a horizontal crack across the maxilla, which separates off the maxilla and teeth from the bone above. A LeFort II fracture, also sometimes called a "pyramidal" fracture because of its shape, forms a line from the sides of the maxilla and over the nose. The third and most complex, the LeFort III fracture, involves a break in the eye socket and bridge of the nose.

Treatment

Fractures involving the maxilla often cause a lot of swelling, so surgeons might delay treating a maxillary fracture for a couple of days until the swelling has gone down. CT scans may be used to get a clear picture of the fracture.

The first step to treating a maxillary fracture involves realigning and setting the fragmented bone, a process called "reduction." If the fracture is fairly simple, this may be done by binding the jaws together in order to use the lower jaw for support.

More complex fractures to the maxilla and surrounding bone may need to be treated with a procedure called "open reduction." This means surgically exposing the bone and re-positioning the fractured pieces with the use of small screws and plates that are attached directly to the bone. These screws are left to hold the bone together while it heals over the following several weeks.

Facial swelling caused by the injury can take weeks to fully subside. Recovery will also likely involve maintaining a liquid or soft diet for some time after the injury - depending on the fracture, this might be from one to six weeks.

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