Accepted Manuscript Palate Fracture Repair with Light-Cured Resin Splint: Technical Note Jimmy Waldrop, MD, Elizabeth L. Dale, MD, Jordan Halsey, BS, Larry A. Sargent, MD PII:
S0278-2391(15)00341-9
DOI:
10.1016/j.joms.2015.03.049
Reference:
YJOMS 56737
To appear in:
Journal of Oral and Maxillofacial Surgery
Received Date: 7 January 2015 Revised Date:
19 March 2015
Accepted Date: 20 March 2015
Please cite this article as: Waldrop J, Dale EL, Halsey J, Sargent LA, Palate Fracture Repair with LightCured Resin Splint: Technical Note, Journal of Oral and Maxillofacial Surgery (2015), doi: 10.1016/ j.joms.2015.03.049. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title Page Palate Fracture Repair with Light-Cured Resin Splint: Technical Note
SC
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Corresponding author: Jimmy Waldrop, MD Assistant Professor Department of Plastic and Reconstructive Surgery University of Tennessee College of Medicine, Chattanooga Email: [email protected] 979 E Third St. Suite C-920 Chattanooga, TN 37403 Phone: 423-778-9047 Fax:423-763-4571
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Elizabeth L. Dale, MD Chief Resident Department of Plastic and Reconstructive Surgery University of Tennessee College of Medicine, Chattanooga Jordan Halsey, BS Student, MS-IV University of Tennessee College of Medicine, Memphis
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Larry A. Sargent, MD Chairman Department of Plastic and Reconstructive Surgery University of Tennessee College of Medicine, Chattanooga
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Abstract
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SC
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Palate fractures are rare, and their treatment is a matter of debate. While some authors favor rigid plate fixation, others report successful treatments without it. Sagittal split and comminuted fractures may require rigid fixation to reduce the maxillary width, but further stabilization is needed. Also, palate repair without a splint is complicated by prolonged intermaxillary fixation (IMF), causing stiffness to the temporomandibular joint. We introduce a technique utilizing a rapid light-cured resin (Triad TranSheet) frequently used by orthodontists for making dental retainers. Its use is similar to splints traditionally created pre-operatively, but obviates the need for making impressions, a model and a molded splint. A series of patients treated with this technique over a five year period is presented. Thirteen (13) patients are included. Average duration of IMF was 4.7 weeks (range 3-6 weeks). Average duration of palate splint was 8.4 weeks (range of 5 to 12 weeks). One patient had malocclusion, but none had malunion, infection or oronasal fistula. Our series demonstrates a simple, cost-effective and successful technique. It can be used alone or in combination with rigid fixation, and allows for shortened duration of maxillomandibular fixation.
Introduction
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Various methods of palatal fracture repair have been described over the past three decades. In 1983, Manson described a method involving a pre-operatively created mold and palatal splint.1 He demonstrated that the splint prevented lingual rotation of the palate which would occur with intermaxillary fixation (IMF).
EP
Later, he advocated bone grafts for use in stabilizing the midface buttresses in addition to stabilization of the palate.2 These early methods proved to be time-
AC C
consuming and outcomes were variable. When miniplates and screws became available, Mintz described an open reduction and rigid fixation technique.3 He argued that the new method allowed for decreased palate rotation and improved stability. The technique was found to be especially useful for sagittal palatal fracture repair, where the risk of palatal collapse is substantial.3 However, Manson reported that plate exposure occurred as a complication in 10% of the patients who underwent rigid fixation.4 In addition, for comminuted fractures, a splint was required to adequately stabilize the fracture in combination with internal fixation 15% of the time. Park and Ock described a transapalatal
ACCEPTED MANUSCRIPT
approach which requires temporomandibular joint (TMJ) immobilization for as long as 4-6 weeks.5 Despite the popularity of open reduction and internal fixation (ORIF), two recent studies describe techniques that rely exclusively on molar wiring. Chen utilized an “intermolar wire” which spans the palate between the
RI PT
maxillary molars, while Kumaravelu’s method involves figure-of-eight wiring
between the maxillary and mandibular first molars.6,7 In light of this, it is clear
that ORIF is not being universally adopted. A similarly non-invasive method of palate fracture repair was developed at our institution, essentially replacing
SC
Manson’s splint technique with a simpler approach. The material is typically
used for the creation of orthodontic retainers, and the method was developed as
M AN U
a means to stabilize the palate after open or closed reduction. This report describes the technique and outcomes of use over a five-year period.
Technique
TE D
Description of Technique
The technique utilizes a rapid light-cured resin (Triad TranSheet) frequently used by orthodontists for making dental retainers. First, the anterior midline of the maxilla beneath the piriform aperture is reduced and plated in an open fashion.
EP
Arch bars are then placed, and IMF wires are applied. The medial and lateral maxillary buttresses are then reduced and plated. Other facial fractures are also
AC C
addressed at this point, e.g., mandibular fractures. IMF wires are then cut, allowing access to the palate. The palate splint is then created intra-operatively, requiring about 10 minutes to shape, cure and fix into position. The resin is a monomer which is polymerized by the application of blue light.
First, the soft resin is molded to the reduced palate inside the oral cavity (Figure 1). The material is then brought out of the mouth, and excess is trimmed based on imprints of the alveolar-teeth junction (Figure 2). The splint is then cured with blue light until it hardens. The curing process begins with the splint placed back
ACCEPTED MANUSCRIPT
against the palate to ensure proper contour, and completed outside the mouth (Figure 3). The time to harden the splint is about 3 minutes. The splint is placed against the palate and marks are made to plan placement of drilled holes for circumdental wires. Three wires are typically sufficient (Figure 4). Finally, the
RI PT
wires are threaded around the teeth and twisted down, securing the splint into position (Figure 5).
Methods
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Cases were collected over a five-year period, from July of 2008 to June of 2013. Common procedural terminology (CPT) codes were used to identify patients who
M AN U
had a palatal fracture repair. Inclusion criteria included the presence of a palate fracture, use of a palate splint, and follow-up records to at least one follow-up visit after removal of splint. Computed tomography (CT) scans were reviewed to categorize the type of palate fracture and associated facial fractures. Outcomes were collected using procedure notes, discharge summaries, clinic follow-up notes and available photographs. Complications of interest were infection, non-
TE D
union, malocclusion and oronasal fistula. In addition, the duration of palate splint and interdental fixation was recorded.
The case series review was approved by the Institutional Review Board of the
AC C
Outcomes
EP
University of Tennessee College of Medicine, Chattanooga.
A total of 13 patients with palate fractures met inclusion criteria. The average age was 31 years, and 12 were male (92%). The type of palate fracture is represented in Table 1. Additional Lefort I, II or III fractures were present in 68.7% of patients, and 54% had associated mandible fractures. All patients were maintained in IMF in the immediate post-operative period for at least 4 weeks due to associated fractures, and the tendency of our patients to be poorly compliant with liquid diet instructions. While some surgeons would not maintain IMF wires after rigid fixation of mandible or midface fractures, our patient
ACCEPTED MANUSCRIPT
population is particularly unreliable with liquid diet limitations; therefore, most patients (and all in the included series) are maintained in IMF to prevent loss of reduction with chewing. After IMF wires were removed, the palate splint was maintained for an average of 4 more weeks to allow adequate healing of the
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palate (Table 2). The only complication was one case of malocclusion, and this patient also had a mandible fracture. He elected not to have a revision
SC
procedure.
Discussion
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Consistently, the studies describing palate fracture repair have been limited by small sample sizes due to the rarity of palatal injury. The one exception is a 162 patient case series reported in 2008.6 The paucity of cases has made direct comparison of techniques difficult. However, it is clear that there are shortcomings to many of the described techniques. Some of the complications of previously described palatal repair methods include prolonged IMF (up to 12
TE D
weeks), plate extrusion and inadequate palatal stabilization.1,4 Additionally, previous methods utilizing rigid fixation are not effective in repairing comminuted palatal fractures.8 Manson’s original description of the utility of a palate splint stands the test of time, but the cumbersome and time-consuming technique for
EP
creation of the splint has propelled the creation of other methods of stabilization. The original palate splints required a three-step process that included making
AC C
impressions, a model and a molded splint. The splint we describe functions identically, with several advantages, namely its simplicity, cost and effectiveness. The time required is only about 10 minutes; it does not require pre-operative impressions, model creation and manipulation; and it avoids opening the palate in cases of closed fractures. The cost of the splint material is $7.88 per sheet, which in comparison to a titanium plate and several screws is markedly less expensive ($600-750). In addition, the only complication encountered was malocclusion, and that in a patient who also had a mandible fracture, making it possible that the mandible reduction contributed to this occurrence. Infection,
ACCEPTED MANUSCRIPT
non-union and oronasal fistula did not occur, and in the absence of metal plates, there was no concern for delayed plate exposure or extrusion.
For most fractures, our method eliminates the need for open reduction and rigid
RI PT
fixation. One of our authors maintains that for sagittal split fractures, a single transverse plate may be necessary to restore pre-injury maxillary width when
there is significant widening. He advocates the use of the splint in addition due
to inadequate stabilization of the palate with a single plate. None of the patients
SC
in the current series required ORIF, however. For comminuted fractures in which plate fixation does not provide adequate stabilization, this method provides an
M AN U
excellent and simple stabilization. Another distinct advantage is the reduced duration in mandibulomaxilary fixation. This method stabilizes the palate, while allowing mandibular excursion after a short course of IMF, thereby limiting potential TMJ stiffness. Each of our patients remained in MMF for 4 weeks, due to associated fractures, but the splint was maintained longer, as advocated by
TE D
Manson, allowing motion at the TMJ.
While this is a small series, as a novel method of palate stabilization, there were no unexpected negative outcomes. The patients tolerated the splint well, and
EP
overall outcomes were excellent.
Open reduction with rigid fixation of palate fractures is used exclusively in some
AC C
centers, and methods of wire fixation are used in others, but the drawbacks of each technique are the subject of continued controversy, including problems with plate extrusion and inadequate stabilization. The technique described above is simple, cost-effective and successful. It is anticipated that it can be used for any palate fracture, or it can be used selectively for comminuted fractures not amenable to rigid fixation, or those not adequately stabilized after rigid fixation.
REFERENCES
ACCEPTED MANUSCRIPT
1. Manson PN, Shack RB, Leonard L, Su C, Hoopes J. Saggital fractures of the maxilla and palate. Plast Reconstr Surg. 1983 Oct; 72(4):484-488. 2. Manson PN, Crawley WA, Yaremchuk MJ, Rochman GM, Hoopes JE, French
bone grafting. Plast Reconstr Surg. 1985 Jul;76(1):1-12.
RI PT
JH Jr. Midface fractures: advantages of immediate extended open reduction and
3. Mintz SM, Frey MS. Screw technique for fixation of palatal fractures. J Oral Maxillofac Surg. 1988 Aug;46(8):711-2.
4. Manson PN, Glassman D, Vanderkolk C, Petty P, Crawley WA. Rigid
SC
stabilization of sagittal fractures of the maxilla and palate . Plast Reconstr Surg. 1990 May;85(5):711-7.
M AN U
5. Park S, Ock JJ. A new classification of palatal fracture and an algorithm to establish a treatment plan. Plast Reconstr Surg. 2001 Jun;107(7):1669-76; discussion 1677-8.
6. Chen CH, Wang TY, Tsay PK, Lai JB, Chen CT, Liao HT, Lin CH, Chen YR. A 162 case review of palatal fracture: management strategy from a 10-year experience. Plast Reconstr Surg. 2008 Jun;121:2065-2073.
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7. Kumaravelu C, Thirukonda GJ, Kannabiran P. A novel adjuvant to treat palatal fractures. J Oral Maxillofac Surg. 2011 Jun;69(6):e152-4. doi: 10.1016/j.joms.2010.12.053. Epub 2011 Apr 15. 8. Pollock RA. The search for the ideal fixation of palatal fractures: innovative
EP
experience with a mini-locking plate. Craniomaxillofac Trauma Reconstr. 2008
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Nov;1(1):15-24.
Figure Legend
Figure 1: Resin molded to the reduced palate Figure 2: Excess trimmed Figure 3: Splint cured with blue light Figure 4: Circumdental wires placed through drilled holes Figure 5: Splint secured into position
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N (13)
Sagittal/Parasagittal
7
Transverse/Oblique
4
Comminuted
2
IMF
32.6 (26-41)
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Palate Splint
Duration N days(range)
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Treatment
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Table 2: Duration of Stabilization
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Fracture Type
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Table 1: Palate Fracture Type
58.9 (33-85)
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S0278-2391(15)00341-9
DOI:
10.1016/j.joms.2015.03.049
Reference:
YJOMS 56737
To appear in:
Journal of Oral and Maxillofacial Surgery
Received Date: 7 January 2015 Revised Date:
19 March 2015
Accepted Date: 20 March 2015
Please cite this article as: Waldrop J, Dale EL, Halsey J, Sargent LA, Palate Fracture Repair with LightCured Resin Splint: Technical Note, Journal of Oral and Maxillofacial Surgery (2015), doi: 10.1016/ j.joms.2015.03.049. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title Page Palate Fracture Repair with Light-Cured Resin Splint: Technical Note
SC
RI PT
Corresponding author: Jimmy Waldrop, MD Assistant Professor Department of Plastic and Reconstructive Surgery University of Tennessee College of Medicine, Chattanooga Email: [email protected] 979 E Third St. Suite C-920 Chattanooga, TN 37403 Phone: 423-778-9047 Fax:423-763-4571
M AN U
Elizabeth L. Dale, MD Chief Resident Department of Plastic and Reconstructive Surgery University of Tennessee College of Medicine, Chattanooga Jordan Halsey, BS Student, MS-IV University of Tennessee College of Medicine, Memphis
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EP
TE D
Larry A. Sargent, MD Chairman Department of Plastic and Reconstructive Surgery University of Tennessee College of Medicine, Chattanooga
ACCEPTED MANUSCRIPT
Abstract
M AN U
SC
RI PT
Palate fractures are rare, and their treatment is a matter of debate. While some authors favor rigid plate fixation, others report successful treatments without it. Sagittal split and comminuted fractures may require rigid fixation to reduce the maxillary width, but further stabilization is needed. Also, palate repair without a splint is complicated by prolonged intermaxillary fixation (IMF), causing stiffness to the temporomandibular joint. We introduce a technique utilizing a rapid light-cured resin (Triad TranSheet) frequently used by orthodontists for making dental retainers. Its use is similar to splints traditionally created pre-operatively, but obviates the need for making impressions, a model and a molded splint. A series of patients treated with this technique over a five year period is presented. Thirteen (13) patients are included. Average duration of IMF was 4.7 weeks (range 3-6 weeks). Average duration of palate splint was 8.4 weeks (range of 5 to 12 weeks). One patient had malocclusion, but none had malunion, infection or oronasal fistula. Our series demonstrates a simple, cost-effective and successful technique. It can be used alone or in combination with rigid fixation, and allows for shortened duration of maxillomandibular fixation.
Introduction
TE D
Various methods of palatal fracture repair have been described over the past three decades. In 1983, Manson described a method involving a pre-operatively created mold and palatal splint.1 He demonstrated that the splint prevented lingual rotation of the palate which would occur with intermaxillary fixation (IMF).
EP
Later, he advocated bone grafts for use in stabilizing the midface buttresses in addition to stabilization of the palate.2 These early methods proved to be time-
AC C
consuming and outcomes were variable. When miniplates and screws became available, Mintz described an open reduction and rigid fixation technique.3 He argued that the new method allowed for decreased palate rotation and improved stability. The technique was found to be especially useful for sagittal palatal fracture repair, where the risk of palatal collapse is substantial.3 However, Manson reported that plate exposure occurred as a complication in 10% of the patients who underwent rigid fixation.4 In addition, for comminuted fractures, a splint was required to adequately stabilize the fracture in combination with internal fixation 15% of the time. Park and Ock described a transapalatal
ACCEPTED MANUSCRIPT
approach which requires temporomandibular joint (TMJ) immobilization for as long as 4-6 weeks.5 Despite the popularity of open reduction and internal fixation (ORIF), two recent studies describe techniques that rely exclusively on molar wiring. Chen utilized an “intermolar wire” which spans the palate between the
RI PT
maxillary molars, while Kumaravelu’s method involves figure-of-eight wiring
between the maxillary and mandibular first molars.6,7 In light of this, it is clear
that ORIF is not being universally adopted. A similarly non-invasive method of palate fracture repair was developed at our institution, essentially replacing
SC
Manson’s splint technique with a simpler approach. The material is typically
used for the creation of orthodontic retainers, and the method was developed as
M AN U
a means to stabilize the palate after open or closed reduction. This report describes the technique and outcomes of use over a five-year period.
Technique
TE D
Description of Technique
The technique utilizes a rapid light-cured resin (Triad TranSheet) frequently used by orthodontists for making dental retainers. First, the anterior midline of the maxilla beneath the piriform aperture is reduced and plated in an open fashion.
EP
Arch bars are then placed, and IMF wires are applied. The medial and lateral maxillary buttresses are then reduced and plated. Other facial fractures are also
AC C
addressed at this point, e.g., mandibular fractures. IMF wires are then cut, allowing access to the palate. The palate splint is then created intra-operatively, requiring about 10 minutes to shape, cure and fix into position. The resin is a monomer which is polymerized by the application of blue light.
First, the soft resin is molded to the reduced palate inside the oral cavity (Figure 1). The material is then brought out of the mouth, and excess is trimmed based on imprints of the alveolar-teeth junction (Figure 2). The splint is then cured with blue light until it hardens. The curing process begins with the splint placed back
ACCEPTED MANUSCRIPT
against the palate to ensure proper contour, and completed outside the mouth (Figure 3). The time to harden the splint is about 3 minutes. The splint is placed against the palate and marks are made to plan placement of drilled holes for circumdental wires. Three wires are typically sufficient (Figure 4). Finally, the
RI PT
wires are threaded around the teeth and twisted down, securing the splint into position (Figure 5).
Methods
SC
Cases were collected over a five-year period, from July of 2008 to June of 2013. Common procedural terminology (CPT) codes were used to identify patients who
M AN U
had a palatal fracture repair. Inclusion criteria included the presence of a palate fracture, use of a palate splint, and follow-up records to at least one follow-up visit after removal of splint. Computed tomography (CT) scans were reviewed to categorize the type of palate fracture and associated facial fractures. Outcomes were collected using procedure notes, discharge summaries, clinic follow-up notes and available photographs. Complications of interest were infection, non-
TE D
union, malocclusion and oronasal fistula. In addition, the duration of palate splint and interdental fixation was recorded.
The case series review was approved by the Institutional Review Board of the
AC C
Outcomes
EP
University of Tennessee College of Medicine, Chattanooga.
A total of 13 patients with palate fractures met inclusion criteria. The average age was 31 years, and 12 were male (92%). The type of palate fracture is represented in Table 1. Additional Lefort I, II or III fractures were present in 68.7% of patients, and 54% had associated mandible fractures. All patients were maintained in IMF in the immediate post-operative period for at least 4 weeks due to associated fractures, and the tendency of our patients to be poorly compliant with liquid diet instructions. While some surgeons would not maintain IMF wires after rigid fixation of mandible or midface fractures, our patient
ACCEPTED MANUSCRIPT
population is particularly unreliable with liquid diet limitations; therefore, most patients (and all in the included series) are maintained in IMF to prevent loss of reduction with chewing. After IMF wires were removed, the palate splint was maintained for an average of 4 more weeks to allow adequate healing of the
RI PT
palate (Table 2). The only complication was one case of malocclusion, and this patient also had a mandible fracture. He elected not to have a revision
SC
procedure.
Discussion
M AN U
Consistently, the studies describing palate fracture repair have been limited by small sample sizes due to the rarity of palatal injury. The one exception is a 162 patient case series reported in 2008.6 The paucity of cases has made direct comparison of techniques difficult. However, it is clear that there are shortcomings to many of the described techniques. Some of the complications of previously described palatal repair methods include prolonged IMF (up to 12
TE D
weeks), plate extrusion and inadequate palatal stabilization.1,4 Additionally, previous methods utilizing rigid fixation are not effective in repairing comminuted palatal fractures.8 Manson’s original description of the utility of a palate splint stands the test of time, but the cumbersome and time-consuming technique for
EP
creation of the splint has propelled the creation of other methods of stabilization. The original palate splints required a three-step process that included making
AC C
impressions, a model and a molded splint. The splint we describe functions identically, with several advantages, namely its simplicity, cost and effectiveness. The time required is only about 10 minutes; it does not require pre-operative impressions, model creation and manipulation; and it avoids opening the palate in cases of closed fractures. The cost of the splint material is $7.88 per sheet, which in comparison to a titanium plate and several screws is markedly less expensive ($600-750). In addition, the only complication encountered was malocclusion, and that in a patient who also had a mandible fracture, making it possible that the mandible reduction contributed to this occurrence. Infection,
ACCEPTED MANUSCRIPT
non-union and oronasal fistula did not occur, and in the absence of metal plates, there was no concern for delayed plate exposure or extrusion.
For most fractures, our method eliminates the need for open reduction and rigid
RI PT
fixation. One of our authors maintains that for sagittal split fractures, a single transverse plate may be necessary to restore pre-injury maxillary width when
there is significant widening. He advocates the use of the splint in addition due
to inadequate stabilization of the palate with a single plate. None of the patients
SC
in the current series required ORIF, however. For comminuted fractures in which plate fixation does not provide adequate stabilization, this method provides an
M AN U
excellent and simple stabilization. Another distinct advantage is the reduced duration in mandibulomaxilary fixation. This method stabilizes the palate, while allowing mandibular excursion after a short course of IMF, thereby limiting potential TMJ stiffness. Each of our patients remained in MMF for 4 weeks, due to associated fractures, but the splint was maintained longer, as advocated by
TE D
Manson, allowing motion at the TMJ.
While this is a small series, as a novel method of palate stabilization, there were no unexpected negative outcomes. The patients tolerated the splint well, and
EP
overall outcomes were excellent.
Open reduction with rigid fixation of palate fractures is used exclusively in some
AC C
centers, and methods of wire fixation are used in others, but the drawbacks of each technique are the subject of continued controversy, including problems with plate extrusion and inadequate stabilization. The technique described above is simple, cost-effective and successful. It is anticipated that it can be used for any palate fracture, or it can be used selectively for comminuted fractures not amenable to rigid fixation, or those not adequately stabilized after rigid fixation.
REFERENCES
ACCEPTED MANUSCRIPT
1. Manson PN, Shack RB, Leonard L, Su C, Hoopes J. Saggital fractures of the maxilla and palate. Plast Reconstr Surg. 1983 Oct; 72(4):484-488. 2. Manson PN, Crawley WA, Yaremchuk MJ, Rochman GM, Hoopes JE, French
bone grafting. Plast Reconstr Surg. 1985 Jul;76(1):1-12.
RI PT
JH Jr. Midface fractures: advantages of immediate extended open reduction and
3. Mintz SM, Frey MS. Screw technique for fixation of palatal fractures. J Oral Maxillofac Surg. 1988 Aug;46(8):711-2.
4. Manson PN, Glassman D, Vanderkolk C, Petty P, Crawley WA. Rigid
SC
stabilization of sagittal fractures of the maxilla and palate . Plast Reconstr Surg. 1990 May;85(5):711-7.
M AN U
5. Park S, Ock JJ. A new classification of palatal fracture and an algorithm to establish a treatment plan. Plast Reconstr Surg. 2001 Jun;107(7):1669-76; discussion 1677-8.
6. Chen CH, Wang TY, Tsay PK, Lai JB, Chen CT, Liao HT, Lin CH, Chen YR. A 162 case review of palatal fracture: management strategy from a 10-year experience. Plast Reconstr Surg. 2008 Jun;121:2065-2073.
TE D
7. Kumaravelu C, Thirukonda GJ, Kannabiran P. A novel adjuvant to treat palatal fractures. J Oral Maxillofac Surg. 2011 Jun;69(6):e152-4. doi: 10.1016/j.joms.2010.12.053. Epub 2011 Apr 15. 8. Pollock RA. The search for the ideal fixation of palatal fractures: innovative
EP
experience with a mini-locking plate. Craniomaxillofac Trauma Reconstr. 2008
AC C
Nov;1(1):15-24.
Figure Legend
Figure 1: Resin molded to the reduced palate Figure 2: Excess trimmed Figure 3: Splint cured with blue light Figure 4: Circumdental wires placed through drilled holes Figure 5: Splint secured into position
RI PT
ACCEPTED MANUSCRIPT
N (13)
Sagittal/Parasagittal
7
Transverse/Oblique
4
Comminuted
2
IMF
32.6 (26-41)
AC C
Palate Splint
Duration N days(range)
EP
Treatment
TE D
Table 2: Duration of Stabilization
M AN U
Fracture Type
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Table 1: Palate Fracture Type
58.9 (33-85)
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EP
TE D
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