Complex Palate Fracture Management: Case Report and Literature Review

Correspondence: Nupur Aggarwal (E-mail: [e-mail])

Abstract

Background Complex palate fractures and their management are less discussed in literature and are usually challenging to manage due to their close association with simultaneous panfacial fractures. These injuries need precise and stable fixation to avoid malocclusion. Hence, this paper describes the management of a case of type III palate injury with a large fistula and reviews the literature regarding management options of the same.

Methodology The author describes a rare scenario of Type III palate injury, along with challenges faced, and reviews literature for palate fracture treatment options.

Results A rare case of type 3 injury of the palate with a large palatal fistula of 3.5 × 4 cm size due to bone loss post-trauma is described. Associated panfacial injuries were present (LeFort I + II + III). In the first stage, open reduction internal fixation of fractures with IMF was done. Transmolar wiring was done to maintain the width of the palate. The vertical maxillary buttress could not be fixed due to shattered bone. Hence, a prolonged IMF for 4 weeks was needed. Also, large fistula size, unstable fragments, and post-trauma mucosal edema led to delayed closure of the fistula after 8 weeks. Right-sided distally based tongue flap was used to close the defect in view of left-sided tongue laceration earlier. After final flap closure and inset after 3 weeks, the wound healed adequately, followed by adequate speech and oral intake.

Conclusion Palate fractures need timely diagnosis and management based on the fracture pattern. A large, randomized trial is needed to establish the efficacy of palatal plating over palatal wiring. Type III palate injuries, if associated with small segment loosening, may be covered primarily; however, with a large fistula, as in the case described staged approach is a better option.

Keywords: palate fracture Type III, panfacial trauma, IMF, staged closure, tongue flap

Publikationsverlauf

Artikel online veröffentlicht:
10. November 2025