A Reduction Technique for a Depressed and Impacted Nasomaxillary Buttress Fracture

Abstract

The aim of this study is to introduce an easy method of reducing the depressed and impacted segment in a nasomaxillary buttress fracture.Through the gingiva-labial vestibular incision, the fracture segments were exposed. A blunt end of the Cottle elevator was inserted to the cleft of the fracture segments. An upward and lateral force was applied until the impacted segment was released and reduced to its anatomical position. Then, the segments were fixed with a miniplate.Fifteen patients (12 males, 3 females, mean age: 34.5 ± 11.7 years) were operated on. In 14 patients, the fragments were reduced in the anatomical position and secondary surgery was not required. In 1 patient, however, the infraorbital rim could not be reduced enough through a gingival incision and a secondary surgery was performed to reduce the orbital rim.A blunt end of the Cottle elevator is shallow and long enough to be inserted into the cleft and strong enough to transfer the force to reduce it into its anatomical position. This reduction technique using a Cottle elevator is easy and can be used for reducing the depressed and impacted segment in nasomaxillary buttress fractures.

Nasomaxillary fracture: Retrospective review of 11 consecutive patients and literature review

“…However, a 2012 study distinguished nasomaxillary fractures from NOE fractures based on the presence of medial canthal tendon avulsion with canthal dystopia only in the latter [9]. A new surgical technique for managing nasomaxillary fractures was described in 2016 [2]. In the AOCMF classification system for midface fracture, a left nasomaxillary fracture is coded: 92 U.I.L [10,11] but it must be specified there is no medial canthal tendon avulsion.…”

“…Non-operative treatment by endonasal reduction and nasal meshes has been reported [2,6] but may carry a high risk of residual cosmetic and functional impairments. More specifically, insufficient reduction by the endonasal manoeuvres may be followed by nasal obstruction.…”

“…In previous studies, most patients with nasomaxillary fractures were managed surgically. Table 5 lists the treatment used in five publications retrieved from PubMed using the indexing terms 'nasomaxillary fracture' OR 'medial maxillary fracture' [2,[5][6][7]9].…”

“…Between these two extreme forms of midface fracture are nasomaxillary fractures, which are often mistaken for nasal bone fractures as the clinical presentations are closely similar and imaging studies are not obtained routinely. In addition, physician awareness of nasomaxillary fractures is low, as these lesions are uncommon and have rarely been the focus of published studies [2]. The diagnosis is important, however, because applying the treatment strategy for nasal bone fractures to impacted nasomaxillary fractures results in poor cosmetic and functional outcomes.…”

Medial maxillary (nasomaxillary buttress) fracture: Two case reports

“…Surgical treatment of medial maxillary (nasolabial buttress) fractures requires an accurate diagnosis and careful planning in each case because the treatment of concomitant fractures is also necessary. Recently, Yoshioka et al [ 2 ] and Hwang et al [ 3 ] have only reported 8 and 15 cases of this fracture, respectively. Medial maxillary (nasomaxillary) fractures are not included in any current classification of the maxillary fracture patterns, which include Le Fort-type, sagittal, or fracture of the alveolar process.…”