A 162-case review of palatal fracture: management strategy from a 10-year experience

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.

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.

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.

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.