Secondary correction of malocclusion after treatment of maxillofacial trauma

Secondary correction of malocclusion after treatment of maxillofacial trauma
October 2004
Pekka Laine, DDS, PhD *
Risto Kontio, MD, DDS ÇƒÜ
Antero Salo, MD, DDS, PhD Çƒ?
Karri Mesim?ßki, MD, DDS ¨?
Christian Lindqvist, MD, DDS, PhD ?
Riitta Suuronen, MD, DDS, PhD ¨? *
Journal of Oral and Maxillofacial Surgery Online
Malocclusion after primary treatment of maxillofacial trauma is not frequently reported in the literature. Despite many developments in the treatment of facial fractures, the most common hard tissue complications after maxillofacial trauma are temporomandibular joint (TMJ) dysfunction, followed by infections and malocclusions.1,2 When rigid metallic plates and screws became available, the requirements for accuracy in surgery increased, as even a mild discrepancy in alignment of bony fragments and osteosynthesis can have a severe effect in occlusion. As with all surgery, the rate of complications decreases with the greater experience of the operating surgeon.3
Maxillofacial trauma patients frequently have other injuries, most often neurologic or orthopedic. If emergency surgery must be carried out, the facial fractures will usually be operated on at the same time. Emergency situations may lead to poor preoperative imaging and inadequate preoperative treatment planning of maxillofacial injuries. On the other hand, if the primary operation is delayed due to the instability of the patient, the possibility of malocclusion, infection, and nonunion is increased.4
In severe trauma, often associated with defects in soft and hard tissues, radiographic examination and cast analysis are often not possible in the initial surgical planning. Instead, the surgeon must rely on 3-dimensional surgical planning, with the aid of, for example, stereolithographic models.5,6
The most common reason for malocclusion after primary midfacial trauma treatment is maxillary widening or impaction, as anteroposterior (AP) and/or transversal dimensions have been altered at the operation. In impacted maxillas, the impaction of the nose is usually the most disturbing subjective symptom for the patient. After primary surgery of comminuted midfacial fractures, the occlusal plane might easily become oblique and tilted.
There are many proposed diagnostic and treatment protocols for mandibular condyle fractures published in the international literature. However, it still remains unclear whether the patient should be treated open or closed and, if operated, what approach and fixation method would be optimal.7ÇƒÏ9
There also are several reports on negative effect of growth after mandibular condyle and TMJ trauma in children.10 Condylar fracture, being rather asymptomatic, can be misdiagnosed and even undiagnosed, especially if the patient is seen by a general practitioner and not by a specialist. In bilateral condylar fractures, if undiagnosed or inadequately treated, an open bite and decreased mouth opening may eventually develop and the mandible may become retrognathic.11
When the decision on surgical treatment is considered, aesthetic or functional disturbances to the patient are the first considerations. The patientÇƒÙs general condition must be evaluated by other specialists, quite often neurologists, before operative treatment proceeds.
We describe 8 patients treated in our unit for a diagnosed malocclusion after primary trauma treatment.
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