During an accident or trauma, a maxillary fracture can occur. What are the consequences of such a divide? What is its support? Explanations from Dr Cédric Hardy, maxillofacial surgeon and stomatologist in Bordeaux.
The maxillae correspond to the two bones of the face on which the upper teeth are placed. Relatively rare, maxillary fractures can involve the upper jaw, that is to say the upper jaw which is fixed or the mobile jaw, the mandible. “Since the advent of the seat belt and the airbag, fractures and facial trauma have been reduced 20 times,” underlines Dr Cédric Hardy, maxillofacial surgeon and stomatologist at the Aquitaine maxillofacial surgery center (Bordeaux)
The different types of maxillary fractures
If they are not frequent, these fractures are most often correlated with sports practice (rugby, horse riding, combat sports, etc.), following a fall on an electric scooter or, more marginally, linked to fights. The Lefort classification distinguishes several types of facial fractures:
- Fractures I (or Guérin fracture) are located above the teeth;
- Fractures II (or pyramidal fracture) characterize those which pass through the lower part of the orbit;
- Les fractures IIImore serious, result in a separation of the face and the skull.
Fracture of the lower jaw (mandible) or upper jaw
Severe pain following the fracture can be accompanied by tooth loss, bleeding, swelling, or even asymmetries in the face. This type of fracture requires urgent consultation with a maxillofacial surgeon.
Fractures of the maxilla have the particularity of being linked to dental occlusion. As such, the surgery is more complex. “The intervention therefore consists of putting the bone back in place so that the teeth realign correctly and chewing is possible again., continues the surgeon. Given that it involves teeth, fracture of the maxilla most often involves, in addition to the maxillofacial surgeon, a dentist, particularly to restore the chewing function. “These are multi-disciplinary and potentially long treatments, sometimes over several years in multiple facial trauma.”adds Dr. Cédric Hardy.
To diagnose this type of fracture, professionals use a Code Beam scanner or CBCT (Cone Beam Computed Tomography), a 3D imaging technique. “It is an examination which allows the trauma to be observed and surgical intervention to be considered immediately. specifies the doctor.
How to operate on a maxillofacial fracture?
A maxillary fracture requires one or even two short surgical procedures, depending on whether the jaw is fractured in one place or in several places. This can be particularly the case in combat sports, such as boxing, after a hook aimed at the chin.
Under general anesthesia, the surgeon makes incisions through the inside of the mouth. To stabilize the jaw fracture, he then uses osteosynthesis by placing titanium plates and screws. If it is a fracture located at the level of the temporomandibular joint, the surgeon can make an incision at the level of the folds of the neck. “Once the bone is back in place, patients no longer have pain. They have significant bruising, but they can go home quickly.”, notes the specialist. For one to two months following surgery, the diet will be mainly liquid or soft. Sports activities can be resumed after 3 to 4 months.
Furthermore, as the facial bones have a very effective natural defense capacity, it is very rare that surgery for a maxillary fracture leads to a post-operative infection.
After-effects: Pain and tenderness after treatment
The face being very innervated, a fracture of the maxilla can cause after-effects in terms of sensitivity, particularly in the lower jaw, or even the chin. “These are not necessarily pains strictly speaking but rather erroneous sensations (hyperesthesias) to hot or cold, which can persist over time, or even a loss of sensitivity”adds the maxillofacial surgeon.
Maxillofacial rehabilitation after surgery
After the surgical procedure, physiotherapy sessions should be considered. The objective is twofold: it is a functional rehabilitation to recover the functions of chewing and swallowing, but also to treat scars.. “Treatment of one or more scars by a specialized physiotherapist can considerably improve their aesthetic appearance”adds Dr. Cédric Hardy.
Prevention of maxillary fractures in athletes
If maxillary fractures mainly concern athletes, a few preventive measures can be really effective.
- Among rugby players, for example, wearing a mouthguard is specially recommended. “Contrary to popular belief, the denture is not there to protect the teeth but to create a junction between the mandible and the facial bone and thus avoid fractures.explains the maxillofacial surgeon;
- For riders and electric scooter enthusiasts, wearing a full-face helmet equipped with a chin guard also provides protective measures.
