The Usefulness of Intermolar Traction Wiring for Restoration of Maxillary & Mandibular Dental Arch in Facial Bone Fracture

ABSTRACT

PURPOSE: Palatal fracture and mandible fracture result in instability of dental arch. Because they divide the maxillary and mandibular alveolus sagittally and / or transversely and comminute the dentition, they permit rotation of dental alveolar segments and significantly increase the potential for fracture malalignment, complicating fracture treatment. Previous treatment of palatal fracture consisted of palatal splint application and rigid palatal vault stabilization. This procedure result in patient's oral discomfort and removal of palate and screw. Mandible fracture often results in malocclusion due to widening of posterior aspect of dental arch. So we introduce simpler method using intermolar traction wiring, which can protect the widening of dental arch and rotation of dental alveolar segment. METHODS: Arch bar and intermolar traction wiring with wire 1-0, or 2-0 was applied. After exposure of fracture line, neutroclusion was maintained with intermaxillary fixation. And then open reduction & internal fixation on maxillary fracture line, commonly maxillary buttress, alveolar ridge, pyriform aperture except palatal vault or mandibular fracture line. After 1 week, intermolar traction wiring was removed. We checked occlusion and postoperative radiologic finding. RESULTS: From June 2007 to October 2007, 10 patient, who have maxillary fracture with palatal fracture and mandible fracture, underwent open reduction & internal fixation with intermolar traction wiring. All have satisfactory occlusion and there were no complication, like gingiva disease, mouth opening impairment and nonunion. CONCLUSION: The intermolar traction wiring accompany open reduction and internal fixation can be an alternative method for restoration of dental arch in facial bone fracture.