Twenty-four patients with complex facial injuries were managed by wide subperiosteal exposure, precise anatomical reduction, rigid internal fixation, and immediate bone grafting when indicated, in conjunction with dental impressions, model surgery, and fabrication of dental splints to establish proper preinjury occlusion. The study population consisted of 18 men and 6 women, whose ages ranged from 18 to 49 years (mean, 30.7 yr) at the time of injury. High velocity motor vehicle accidents were responsible for facial injuries in 18 patients, gunshot wounds in 2, low velocity blunt trauma in 3, and falls in 1. All facial fractures involved the occlusion, and unstable and/or comminuted palatal/maxillary and mandibular fractures, often with edentulous segments, were the major indications for fabrication of acrylic splints. Depending on the nature of the fracture pattern, model surgery was performed on the maxillary and/or mandibular models and segmented along fracture lines. These fragments were then repositioned according to dental wear facets and preinjury occlusion. When possible, preinjury occlusal records were obtained before splint fabrication. Models were mounted on a Galetti articulator and palatal, lingual, and/or occlusal splints were fabricated. Edentulous segments were compensated for by local buildup of the splints to produce an occlusal stop. Arch bars were fixed directly to the splint with acrylic. Twenty-six splints were used in the 24 patients to establish proper occlusal relationships before internal fixation of fractures. The types of splints were palatal (n = 8), palatal-occlusal (n = 6), lingual (n = 8), lingual-occlusal (n = 1), and occlusal (n = 3). Satisfactory to excellent restoration of occlusion was obtained in 21 of the 24 patients (88%). No complications occurred as a direct result of the dental splints. Follow-up time has ranged from 2 months to 5 years (mean, 2.1 yr). Nonocclusal complications occurred in 10 of the 24 patients (42%) and included infection (n = 5), mild enophthalmos (n = 2), ptosis from superior orbital fissure syndrome (n = 2), and nasolacrimal duct obstruction (n = 1). Contrary to the attitude that internal rigid fixation has obviated the need for traditional management techniques, we believe that the fabrication of acrylic dental splints is essential to the management of complex facial injuries involving the dentition.
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