ACRYLIC SPLINTS FOR DENTAL ALIGNMENT IN COMPLEX FACIAL INJURIES

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 w ith dental impressions, model surgery, and fabrication of dental splin ts to establish proper preinjury occlusion. The study population consi sted of 18 men and 6 women, whose ages ranged from 18 to 49 years (mea n, 30.7 yr) at the time of injury. High velocity motor vehicle acciden ts were responsible for facial injuries in 18 patients, gunshot wounds in 2, low velocity blunt trauma in 3, and falls in 1. All facial frac tures involved the occlusion, and unstable and/or comminuted palatal/m axillary and mandibular fractures, often with edentulous segments, wer e 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 li nes. These fragments were then repositioned according to dental wear f acets and preinjury occlusion. When possible, preinjury occlusal recor ds were obtained before splint fabrication. Models were mounted on a G aletti 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 direc tly to the splint with acrylic. Twenty-six splints were used in the 24 patients to establish proper occlusal relationships before internal f ixation of fractures. The types of splints were palatal (n = 8), palat al-occlusal (n = 6), lingual (n = 8), lingual-occlusal (n = 1), and oc clusal (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 occurre d 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 atti tude that internal rigid fixation has obviated the need for traditiona l management techniques, we believe that the fabrication of acrylic de ntal splints is essential to the management of complex facial injuries involving the dentition.