Patient has a freak accident at home while relaxing on a weekend
The patient is a 22-year-old male from Chennai in Tamil Nadu, India. He was relaxing at home on a weekend after completing his examinations. Walking into the balcony of his house in the dark, he had tripped on his dog. The fall had resulted in a direct impact to his midfacial region from a cushioned wooden swing.
He had felt an excruciating pain immediately upon impact and had cried out loudly. Hearing his cry, his parents had rushed to him. There was bleeding from inside his mouth and he appeared dazed from the impact.
They rushed him immediately to a nearby dental clinic. An intraoral examination had revealed a mobile maxillary bone along with a laceration near the maxillary labial frenum.
He had been diagnosed with a maxillary fracture and the laceration had been sutured. Once bleeding had been stopped, he had been referred to our hospital for management of his fracture. Our hospital is a leading center for facial fracture surgery in India. Jaw fracture surgery for complicated maxillary and mandibular fractures are routinely performed in our hospital
Patient brought to our hospital for management of his maxillary fracture
Dr SM Balaji, jaw fracture specialist, examined the patient and ordered imaging studies including a 3D CT scan. Examination revealed that the entire maxillary segment was mobile. There was complete horizontal separation of the maxilla from the skull. Horizontal maxillary fractures are also known as a floating palate.
There was no involvement of the orbital wall or the inferior orbital rim. The Zygomatic arches were also intact. There was no other facial injury other than the broken jaw and labial laceration. Oral surgeons in India are the primary surgeons for this injury.
All relevant testing was performed on the patient. There was no loss of sensation or abnormal sensations present in the region of the fracture. There was no ecchymosis to the skin overlying the fracture. The patient and his parents were informed that he had a maxillary Le Fort I fracture.
Treatment planning was explained to the patient and his parents in detail. All their fears and doubts were allayed. They were reassured that the patient would make a complete recovery from the fracture. The patient and his parents then consented to surgery.
Successful surgical reduction of the horizontally fractured maxillary segment
Under general anesthesia, the maxilla was examined and demonstrated crepitus with movement. A right maxillary lateral vestibular incision was made. Dissection was made down to the region of the fracture.
The fracture segments were stabilized and occlusion was checked. This was then fixed with two four-holed L-shaped titanium plates and screws.
Attention was next turned to the left side where two four-holed straight titanium plates were used to stabilize the fracture. Occlusion was checked again and found to be intact. All incisions were then closed with sutures. The patient was then extubated and taken to recovery in stable condition.
Complete restoration of esthetics and function following maxillary fracture reduction surgery
The patient made a full recovery and returned to normal life. He said that there was no change in his facial appearance and no pain. His parents were extremely relieved that he had made a complete recovery from his jaw fracture. They expressed their thankfulness to the surgical team for their son’s recovery.