A Reduction Technique for Depressed Medial Maxillary Fractures

The authors developed a technique for reducing the fractured segment by introducing an elevator through the accessory maxillary ostium (AMO).Through an upper gingivolabial vestibular incision, the fractured segments were exposed. In cases where no cleft was available for inserting the elevator, the blunt end of a Cottle elevator was inserted into the AMO via a nasal approach. The curved blunt end of a Cottle elevator was inserted into the middle meatus and the AMO was felt at the medial wall of the maxillary sinus. With gentle pressure, the tip was pushed into the maxillary sinus, and then pushed forward about 2 cm. An upward force was applied until the depressed segment was reduced to its original position. Through a gingivolabial vestibular incision, alignment of the reduced segments could be seen. Miniplate fixation can be applied. If the reduced segments are stable or too many segments are present, the fracture can be stabilized using tissue glue.The authors propose that in medial maxillary fractures where no cleft for the elevator is available, the fractured segment can be mobilized by introducing an elevator through the AMO.