Xin Jin, Yu Zhuang, Ziqing He, Jianfei Zhang, Jun Shi, Wenbin Zhang
In these two cases of displaced segmental maxillary fractures, preservation of residual soft-tissue attachments appeared to contribute to segment survival when adequate reduction and stable fixation could be achieved. Mucosa-related fixation may be considered as an individualized option in carefully selected patients with potentially viable partially detached segments. These observations are preliminary and hypothesis-generating, and further studies with larger case series and longer follow-up are needed to clarify the indications, limitations, and long-term outcomes of this approach.
BACKGROUND: Displaced segmental maxillary fractures involving partially detached bone segments are difficult to manage because treatment requires both stable fixation and preservation of residual vascularity. Excessive mucoperiosteal elevation may further compromise the blood supply of a displaced segment and increase the risk of bone resorption, sequestration, or necrosis. This report presents two cases of displaced segmental maxillary fractures treated with soft-tissue-preserving fixation strategies.
CASE PRESENTATION: Two patients with displaced segmental maxillary fractures were managed using individualized mucosa-related fixation techniques. In the first case, a 35-year-old man presented with a large displaced anterior maxillary segment and loss of local buttress support. After restoration of the occlusal relationship, the segment was stabilized using intraoral epimucosal reconstruction plate fixation. In the second case, a 51-year-old woman sustained an open maxillofacial injury with a dentoalveolar segment involving teeth 23-25. The segment showed complete loss of bony continuity with the surrounding maxilla, with only limited labial mucosal attachment remaining. Palatal transmucosal screw fixation with long titanium screws was performed to stabilize the segment while preserving the residual labial soft-tissue attachment. Both patients achieved stable reduction and satisfactory healing. No obvious postoperative necrosis, sequestration, infection, or exposure of fixation materials was observed. In the second case, the preserved dentoalveolar segment achieved bony healing, and teeth 23-25 remained stable during follow-up.
CONCLUSION: In these two cases of displaced segmental maxillary fractures, preservation of residual soft-tissue attachments appeared to contribute to segment survival when adequate reduction and stable fixation could be achieved. Mucosa-related fixation may be considered as an individualized option in carefully selected patients with potentially viable partially detached segments. These observations are preliminary and hypothesis-generating, and further studies with larger case series and longer follow-up are needed to clarify the indications, limitations, and long-term outcomes of this approach.