RTA 5 months old Fracture Malunion of Upper jaw Resurgery with Rhinoplasty

Emergency surgery after RTA results in open bite and flattened bridge of nose

This young lady is from Salem, Tamil Nadu. A road traffic accident five months ago resulted in fractures to her maxilla and a comminuted nasal bone fracture. Emergency surgery elsewhere left her with a flattened bridge of the nose and an open bite. Feeling very dissatisfied, she approached a local surgeon who referred her to us.

Le Fort I osteotomy surgery planned to correct open bite

Dr SM Balaji, nose correction and facial deformity correction specialist, examined the patient. He ordered imaging studies for the patient. He decided on a LeFort I maxillary osteotomy for the open bite correction. Treatment plan was then explained to the patient in detail. The patient was in agreement and consented to surgery.

Open bite surgery and rib graft for correction of flattened nose

Under general anesthesia, a rib graft was first harvested. A Valsalva maneuver demonstrated a patent thoracic cavity. The incision was then closed with sutures. Attention was next turned to the maxilla. A vestibular incision was then made exposing the maxillary bone. Plates used in the previous surgery were then removed. A LeFort I maxillary osteotomy was next performed. Arch bars were next wired to both jaws for stabilization. Following this, the vestibular incision was then closed with sutures.

The flattened bridge of nose was then addressed. The rib graft was first crafted to the right size. It was then tunneled to the bridge of the nose through a transcartilaginous incision. This resulted in a straight profile to the patient’s nose. The incision was then closed with sutures.

The patient expressed complete satisfaction before discharge from the hospital.