Injuries of the hard palate and the horizontal buttress of the midface.

Traumatic injuries to the hard palate occurred in 20% of all Le Fort midfacial fractures. The side of a palatal split was directly related to the side that received the highest Le Fort injury. In a symmetric midfacial injury, the palate had a true midline split. Repair of palatal injuries from blunt trauma involved either wire and splinting (eight patients) or miniplate fixation without a splint (11 patients). There were fewer complications in those treated by the miniplate fixation technique (two of 11), as compared to those treated with wire and splinting (four of eight). In miniplate fixation of midfacial fractures, attention is focused on the reconstruction of the supporting buttresses of the midface, both vertical and horizontal. In regard to the palate, this requires union of the inferior horizontal buttress. Gunshot wounds accounted for 21% of the patients and resulted in large bony disruption of the palate, which required free soft tissue and bone grafts for repair of the inferior horizontal buttress.