Rigid internal fixation for fractures involving tooth-bearing maxillary segments

Fracture dislocations of the middle third of the face usually involve a complex combination of the three types of fractures initially described by LeFort. Treatment of these injuries requires a six- to eight-week period of intermaxillary fixation, unless rigid internal fixation devices (plates and screws) are used to stabilize the fractures. However, rigid fixation carries the risk of producing a malunion and serious malocclusion if not performed correctly. A review of 22 patients with complex LeFort fractures treated with rigid fixation revealed that the only absolute contraindication to its use is difficulty in interdigitating the maxillary and mandibular teeth in a passive fashion at the time of fracture reduction. Rigid internal fixation should therefore be considered as an alternative treatment for most fractures of the middle third of the face.