What Are Le Fort II Fractures?
Le Fort Type II fractures are basically midface fractures occurring due to orofacial or maxillofacial trauma because of high-impact forces or hits to this part of the face and jaw. These are pyramidal fractures that occur due to trauma in the midface region. The fracture lines in this kind of fracture are quite challenging to treat by the oral surgeon as it begins in the region of the bridge of the nose (nasion) and may extend up to the inferior orbital rims (below the eye socket) and extend upto the midface buttresses. The facial and dental management of patients suffering from maxillary Le Fort II fractures can be quite challenging in the field of facial or oral reconstruction surgery. Maxillary Le Fort II fractures pose clinical complications in the field of maxillofacial trauma.
There are mainly two major facial buttresses of the midface that are fractured, possibly in Le Fort II fractures. These are the vertical and horizontal buttresses of the mid-face. The oral surgeon needs to understand the affected fracture line or part of the affected patient.
What Are the Facial Factors Considered During Reconstruction Surgery?
The factors that should be considered by the oral and maxillofacial surgeon for restoring the mid-face contour include facial integrity restoration, projection, height, and width of the patient's face. Usually, oral and maxillofacial surgeons adopt the treatment plan of one-stage repair, precise open reduction followed by the wide exposure of fractured segments of the face and jaw. The last step would be the rigid fixation followed simultaneously alongside soft tissue repair. These are the steps in ORIF as mentioned above.
What Materials Are Used in Facial Reconstruction?
The reconstruction of the face is usually the placement of arch bars and the exposure of all fracture sites, reduction, and repositioning, followed by the placement of the patient's jaw into proper occlusion. Fixation of bars can be done using a miniplate or the new-age method called rhinoplasty. It uses diced cartilage fascia grafts followed by soft tissue repair.
What Is ORIF (Open Reduction and Internal Fixation)?
The main goal of maxillary Le Fort II fracture surgery is to establish occlusion in the patients. Also, because affected individuals in this fracture greatly worry about their mid-face structure and appearance (esthetics), the oral surgeon preliminarily first aims to restore the vertical and horizontal buttresses of the midface structure and restore esthetics.
The goal of treatment in this surgery is accomplished by following these steps by the maxillofacial surgeon sequentially :
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Reduction.
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Reposition.
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Fixation of the fracture site.
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Restoration of patient's correct bite (occlusion).
This is called ORIF or open reduction and internal fixation (ORIF). This surgery utilizes the pieces of broken bone due to maxillofacial trauma by use of screws, plates, sutures, or rods that can be manipulated into holding and healing the broken bone segments.
What Are Internal Fixation and Bone Grafts?
During the process of internal fixation, it is essential to select the plates that are adequately sized and suited to the patient's facial structure and esthetics. The internal fixation plates and screws of the buttresses should be primarily able to withstand any kind of vertical bite stress placed upon them. Bone grafts are used to treat these fractures by maxillofacial surgeons when deemed necessary. Bone grafts are usually indicated when patients tend to have bone defects in the form of gaps or defects that can be bridged using bone grafts.
Why Rhinoplasty Is Challenging and Does It Give Esthetic Results?
Rhinoplasty is one of the most challenging forms of facial surgery or plastic surgery procedures. In spite of performing this surgery correctly by the surgeon, post-operative complications can be encountered that can interfere with the patient's esthetics. In the case of Le Fort II fracture for example, because the midface buttresses and the nasal part of the face are affected, the main purpose of oral and maxillofacial surgeons is first to restore the integrity of the nose in the patient. However, often due to postoperative complications, patients may not experience satisfaction when esthetics are compromised or when their face does not resemble nearly the same or close to the look they had before the fracture. This brings us to the modern-day concept of using ORIF with rhinoplasty using diced fascia grafts. This technique has been researched by oral surgeons as a remarkable way to improve the patient's mid-face structure or esthetics. This procedure aims to recreate or possibly restore the closest look of the patient's face (how it used to be before rather).
Conclusion:
The management of maxillofacial trauma in Le Fort II fractures is complex and requires proper restoration of patient mid-face structure integrity by the oral and maxillofacial surgeon. A combination of ORIF and rhinoplasty using diced cartilage fascia graft can help in restoring the integrity of the nose, also further addressing the post-op complaints of affected patients (such as orofacial discomfort, pain, and swelling post-surgery). This combined procedure also is preferred by modern-day oral and maxillofacial surgeons because the need for secondary rhinoplasty can be prevented as well in unsuccessful cases.
