Buttress fixation with plates

Abstract

The skeletal unit of the middle third of the face is formed by a system of horizontal and vertical buttresses. Fracture dislocations involving these buttresses can alter facial height, width, and posteroanterior projection, as well as lead to malocclusion. Treatment must restore the exact three-dimensional relationship of each component of the buttress system to the skeletal unit as a whole. This is best achieved through extended access approaches that allow for direct visualization of the fracture lines. Stability of the buttress reconstruction is improved if rigid internal fixation devices (plates and screws) are used to hold the reduced fracture fragments in alignment, and the need for prolonged maxillomandibular fixation may be eliminated. However, rigid fixation is much more technique-sensitive and non-forgiving than interosseous wire fixation. If used inappropriately, rigid fixation will produce an unacceptably high rate of iatrogenic complications, including malocclusion, that will require revision surgery.