Maxillofacial and mandibular fractures.

Any traumatic event that produces maxillofacial and/or mandibular fractures generally results in gross and usually severe patient disfigurement and often results in the patient's inability to eat and drink. These fractures are exceptionally rewarding cases as simple techniques may be performed resulting in a successful functional outcome (ability to eat and drink) within a very short period of time (24 hours) after fracture stabilization. A markedly improved cosmetic appearance follows shortly thereafter once inflammation and edema resolve. The primary principle of fracture treatment, ie, providing stable fixation to the bone fragments, may be successfully used with wiring techniques only through an appreciation and proper application of biomechanical principles. Knowledge that bending forces (divided into their tensile and compressive components) are the primary forces to be neutralized dictates the use of the wiring techniques outlined as the "standard" to which all other methods of fixation for maxillofacial and mandibular fractures are compared. The location of the tension-band surface of the bone, the alveolar (oral) surface, dictates the most appropriate position for wire placement. Successful treatment is predicted on obtaining a cosmetically acceptable and functional result (Fig 29). Anatomic reduction and rigid fixation of fractures that can be reconstructed piece-by-piece creates optimal conditions for uncomplicated healing. Fractures in which bone loss or severe comminution exists, and which cannot be anatomically reconstructed, must be reduced using dental occlusion as the template for fracture fixation, thereby avoiding malocclusion. Excessive leverage on the bone fragments may occur secondary to malocclusion, resulting in an increased risk of complications (fragment motion, loosening of implants, infection). Some fractures with comminution or bone loss may not be suitable for wire fixation and must be treated by alternate methods (eg, external skeletal fixators, plates).