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Non-surgical management of a traumatic mid-palatal suture diastasis by novel use of an orthodontic appliance Fiona Jenkins Dental Update 2024 16:1, 707-709.
Authors
FionaJenkins
BDS MDentSci FDS(Orth) MFDS M.Orth RCS(Eng)
Consultant in Orthodontics, St Luke's Hospital, Bradford Teaching Hospitals
Sutures are formed during embryonic development at the sites of approximation of the membranous bones of the craniofacial skeleton. They afford major sites of bone expansion during postnatal craniofacial growth, and also influence facial fracture patterns through offering a path of least resistance to force. There are some studies that have shown that the mid-palatal suture (MPS) fuses at 11–13 years and 14–16 years in females and males, respectively. This means that during childhood, the suture is open; thus force applied to the palate at this time tends to split the bone in the midline between the two unfused palatal shelves. The understanding of this biological process allows orthodontists to correct transverse growth discrepancies of the maxilla. Various appliances, including the hyrax appliance, can be used to allow rapid maxillary expansion (RME) by expanding the suture. Paradoxically, the same appliance can be used to allow rapid maxillary contraction (RMC) by contracting the suture. This method of application using a hyrax appliance is rare. We present a case report where this method of application allowed closure of a traumatic mid-palatal suture diastasis, correction of a traumatic transverse discrepancy of the maxilla and avoided an invasive surgical intervention in a 15-year-old male.
CPD/Clinical Relevance: This article highlights the importance of considering a patient's age and anatomical development when exploring treatment options. It is prudent to take advantage of this to enhance the natural biological healing process.
Article
Traumatic midface injuries can occasionally result in fractures of the hard palate. These fractures may occur as isolated injuries, but are more commonly associated with comminuted midfacial fractures.1 Even so, they are usually found in fewer than 10% of patients with mid-face fractures, although some isolated studies report a much higher incidence.2 Owing to their low incidence, they are often overlooked, causing post-operative malocclusion in trauma patients, resulting in potentially avoidable extensive surgical, orthodontic and/or restorative treatment to manage residual malocclusion.3 Palatal fracture patterns can be classified as follows:
We present a case of a 15-year-old male who attended our emergency department following a motorized bike accident. He presented with a minimally displaced Le Fort 2 facial fracture and a Type III (sagittal) fracture of his palate. The traumatic mid-palatal suture diastasis resulted in an upper midline central incisor diastema and tendencies towards a posterior scissor bite on the right hand side, causing aesthetic and functional challenges for management.
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