What are the Risk Factors for Mortality Among Patients Who Suffer Le Fort III Fractures?

PURPOSE: Le Fort III fractures are the most severe subtype of the Le Fort fractures and are associated with adverse clinical outcomes. The purpose of this study was to identify risk factors for mortality among patients who suffer Le Fort III fractures. MATERIALS AND METHODS: A retrospective cohort study was completed using the 2016-2018 National Inpatient Sample. Patients with isolated Le Fort III fractures were selected. Patients who incurred bone fractures or organ injuries outside the head and neck were excluded. There were multiple, heterogenous predictor variables. The primary outcome variable was mortality. Relative risk was used to determine independent risk factors of mortality. Statistical significance was deemed for P values less than .05. RESULTS: The final sample consisted of 559 patients (mean age, 45.9 years) who suffered a Le Fort III fracture, of whom 15 patients (2.68%) died. Most patients were male (82.7%) middle-aged adults (42.9%) of White race (66.5%) within the lowest income quartile (31.7%) that lived in large metro areas (54.9%). Relative to males, females were nearly 62 times more likely to die (P < .01). Relative to privately insured subjects, uninsured subjects were 23 times (P < .05) more likely to die. Relative to weekday admissions, weekend admissions increased the risk of mortality by 8 times (P < .05). Cranial vault fractures (odds ratio, 7.24; P < .05) and upper cervical fractures (odds ratio, 63.27; P < .05) were risk factors for mortality. Relative to males, females were at an increased risk for mortality (relative risk [RR] 7.14, 95% confidence interval [CI] 2.60, 19.61). Skull base fracture (RR 2.99, 95 CI 1.04, 8.63), cranial vault fracture (RR 3.04, 95 CI 1.07, 8.65), subdural hemorrhage (RR 2.98, 95 CI 1.10, 8.05), subarachnoid hemorrhage (RR 6.73, 95 CI 2.34, 19.35), and injury of blood vessels at neck level (RR 13.24, 95 CI 2.46, 71.16) were each risk factors for mortality. CONCLUSIONS: Intracranial injury was not a risk factor for mortality. Instead, cranial vault fractures and skull base fractures increased the risk for mortality. In addition, uninsured patients and female patients were each at an increased risk for mortality.

Association of frontal and maxillary bone fractures and concomitant craniocerebral injuries in patients presenting with head trauma.

Background: Maxillofacial fractures and craniocerebral injuries are common in patients with head trauma. These are injuries with high mortality and morbidity. Therefore, patients with head trauma should be evaluated early with a multidisciplinary approach. Aim: The association between frontal and maxillary bone fractures and concurrent craniocerebral injuries were investigated in patients presenting with head trauma in this study. The data of the patients were analyzed retrospectively. Methods and Material: Age and gender distributions were evaluated in frontal and maxillary fractures. Concomitant craniocerebral injuries were investigated. Craniocerebral injuries were grouped as pneumocephalus, extra-axial, intra-axial injuries and brain edema. Craniocerebral injuries in frontal and maxillary fractures were compared statistically. Results: Frontal bone and maxillary bone fractures were detected in 24% and 95% of the patients. Coexistence of pneumocephalus and intra-axial injuries in frontal bone fracture was statistically significant. The association of frontal posterior wall fractures with pneumocephalus and parenchymal contusion was found to be statistically significant. In addition, the association of craniocerebral injuries were evaluated and statistically significant ones were determined. Conclusion: The presence of maxillofacial fractures in patients presenting with head trauma increases mortality and morbidity. Craniocerebral injuries can be life-threatening and delay the treatment of facial fractures. Upper facial bone fractures are significantly more common in craniocerebral injuries.

How Do Le Fort-Type Fractures Present in a Pediatric Cohort?

PURPOSE: Le Fort-type fractures are very rare in children, and there is a paucity of literature presenting their frequency and characteristics. The purpose of this study was to determine the etiology, frequency, and fracture patterns of children with severe facial trauma associated with pterygoid plate fractures in a pediatric cohort. PATIENTS AND METHODS: We performed a retrospective cohort study of all children aged younger than 16 years with pterygoid plate and facial fractures who presented to our institute between 1990 and 2010. Patient charts and radiologic records were reviewed for demographic and fracture characteristics. Patients were categorized into 2 groups as per facial fracture pattern: non-Le Fort-type fractures (group A) and Le Fort-type fractures (group B). Other variables including dentition age, frontal sinus development, mechanism of injury, injury severity, and concomitant injuries were recorded. Univariate methods were used to compare groups. RESULTS: We identified 24 children; 25% were girls, and 20.8% were of nonwhite race. Most presented with Le Fort-type fracture patterns (group B, 66.7%). Age was significantly different between group A and group B (mean, 5.9 years and 9.9 years, respectively; P = .009). No significant differences in Injury Severity Score, rate of operative repair, and length of stay were found between groups. CONCLUSIONS: Most children with severe facial fractures and pterygoid plate fractures presented with Le Fort-type fracture patterns in our cohort. The mean age of children with Le Fort-type fractures was greater than in those with non-Le Fort-type patterns. However, Le Fort-type fractures did occur in younger children with deciduous and mixed dentition.

Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya.

BACKGROUND: The purpose of the present study was to evaluate changing pattern in characteristics of maxillofacial fractures and concomitant injuries in Western Libya During revolution and to assess the association between mechanism of injury and fracture patterns. MATERIAL AND METHODS: A retrospective review of medical records and radiographs of 187 patients treated for maxillofacial fractures from January 2010 to December 2012 was performed, there were 326 fractures in 187 patients. RESULTS: The male: female ratio was 6:1. Most fractures occurred in patients aged 11 to 40 years, and few injuries occurred in patients aged > 50 years. Most fractures occurred from motor vehicle accidents, and other most frequent causes included assault, gunshot, and fall injuries. Most maxillofacial fractures involved the mandible, zygomatic complex, or maxilla. Most mandibular fractures occurred at the parasymphysis, angle, or condyle. Associated injuries most frequently involved the head, chest, and extremities. Most patients were treated with open reduction (132 patients [71%]), and 26 patients (14%) were treated nonoperatively. There were 21 complications (11%). CONCLUSIONS: In summary, motor vehicle accidents were the most frequent cause of maxillofacial fracture in western Libya, possibly because of the lack of seat belt legislation. Interpersonal violence was a less frequent cause of maxillofacial fracture, possibly because of the religious restriction on alcohol consumption.

Midfacial fractures: A retrospective etiological study over a 10-year period in Western Romanian population.

INTRODUCTION: Midfacial fractures are extremely important oral and maxillofacial problems because they take varied forms and are frequently accompanied by major long-term esthetic or functional complications. Their etiology and epidemiology vary significantly in the literature, and the main causes are varied by population. The aim of this study is to identify the main traumatic etiology of midfacial fractures, along with the main categories of affected patients in our geographical area, in order to establish the need for measures that can prevent fractures in the future. MATERIALS AND METHODS: We conducted a retrospective study over a 10-year period in 379 patients. Data were extracted from the patients' charts, and the following variables were taken into consideration: sex, age, environment of origin, education level, and traumatic etiology. RESULTS: Midfacial fractures most frequently affected the 20-29 years age group (31.93%), male sex (n = 333, 87.86%, M:F = 7.23:1), patients from urban areas (n = 206, 54.35%), and patients without education (46.70%). The most frequent etiology was interpersonal violence (44.85%), followed by fall trauma (16.62%) and road traffic accidents (15.30%). Statistical correlations evidenced that urban environment favors midfacial fractures caused by interpersonal violence and road traffic accidents or sports injuries, while in rural areas, domestic accidents and animal attacks are predominant (P = 0.000). CONCLUSIONS: The overwhelming incidence of interpersonal violence in our population is currently a major public health problem. Implementing laws and initiating national programs for the prevention of interpersonal violence would lead to a considerable reduction of midfacial fractures in the Western Romanian population.

Retrospective Clinical Study of Maxillary Sagittal Fractures: Predictors of Postoperative Outcome.

PURPOSE: Because of less attention to the sagittal component of maxillary fractures, these fractures are often misdiagnosed or the reduction is missed leading to maxillary transverse discrepancies. Therefore, the purpose of this study was to identify factors associated with good or adverse postoperative outcomes of maxillary sagittal fractures. MATERIALS AND METHODS: This study was a single-center retrospective cohort study. The sample was composed of cases of maxillary sagittal fractures treated at the Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Trauma Unit of Xi'an Jiaotong University (Xi'an, China) from January 2008 through December 2013. The predictor variables were age, gender, occupation, cause of injury, injury severity, treatment timing, treatment method, and quality of fracture reduction. The outcome variable was the postoperative treatment effect index. Descriptive, bivariate, and multivariate statistics were computed. The P value was set to .05. RESULTS: The sample was composed of 40 cases. The male-to-female ratio was 4:1; the most vulnerable age group was 20 to 30 years (30%); laborers (72.5%) were more prone to injury; and the main cause of injury was motor vehicle accident (62.5%). No cases of isolated sagittal fracture were found and most (35%) occurred with other maxillary fractures, including Le Fort fractures. A statistically significant association between treatment timing and quality of fracture reduction and the postoperative treatment effect index (P < .05) was found. CONCLUSION: The results of this study suggest that better results are achieved when fractured bone is treated sooner. Anatomic repositioning of the fractured bone is the important predictor for good postoperative outcomes.

Base of Skull Blocks for Open Reduction and Internal Fixation of Faciomaxillary Fractures.

INTRODUCTION: Faciomaxillary fractures (FMF) occur in a significant proportion of trauma patients. Nearly all polytrauma patients and even those with isolated FMF are managed under general anesthesia for definitive management. We propose the use of regional nerve blocks as a safe and effective means for open reduction and fixation of isolated FMF. AIM AND OBJECTIVES: The aim is to evaluate the feasibility, effectiveness and safety of base of skull maxillomandibular and distal trigeminal nerve blocks in the management of FMF. MATERIALS AND METHODS: Ten young adults with fractures of the zygoma, mandible and Le Fort I/II injuries were included in the study. Patients with associated craniocervical and abdominothoracic injuries were excluded. RESULTS: The patients' ages ranged from 21 to 40 years, with a mean time of onset of anesthesia being 5 to 12 minutes and total duration of 105 to 220 minutes. Supplementary block for patchy anesthesia was needed in three. All underwent unhindered surgery without complication. CONCLUSION: Base of skull maxillary-mandibular and distal trigeminal blocks are an effective and efficient alternative to general anesthesia for the open reduction and internal fixation of FMF.

Facial Dog Bite Injuries of a 19-Month-Old Child: A Case Report.

It is estimated that 4.5 million Americans are bitten by dogs each year, and half of those are children. One in five dog bites results in injuries that require some form of medical attention. Children between 5 and 9 years of age are the most affected age group for this type of injury. A 19-month-old boy was admitted to the emergency department of Children's Hospital of Michigan for treatment of injuries due to a dog attack. Injuries were limited to the face of the child. Dental injuries included avulsion of upper lateral incisors, severe luxation of upper central incisors, and fracture of the facial alveolus bone. Surgical management of facial wounds was accomplished through irrigation, debridement and suturing. Dental treatment included extraction of central incisors and suturing soft tissues.

Loss of reflex tearing after maxillary orthognathic surgery: a report of two cases.

BACKGROUND: Few reports have described the ophthalmic complications that occur after maxillary orthognathic surgery. Since cases of decreased reflex tearing after maxillary orthognathic surgery are extremely rare, we describe 2 cases of loss of reflex tearing after maxillary orthognathic surgery. CASE PRESENTATION: Two Asian women, an 18-year-old and a 32-year-old, suffered from unilateral dryness and irritation caused by maxillary orthognathic surgery. In both patients, Schirmer test (II) showed reduced reflex tearing in 1 eye. Computed tomography showed that the pterygoid plate had been fractured in both patients. CONCLUSIONS: The pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa may be injured during Le Fort osteotomy.

Etiology, distribution, treatment modalities and complications of maxillofacial fractures.

PURPOSE: This study evaluated the trends and factors associated with maxillofacial fractures treated from 1997 to 2007 in the Oral and Maxillofacial Surgery Department of the Clermont-Ferrand University Hospital. METHODS: This study included 364 patients of which 82% were men and 45%, 20-29-years old. The etiology, anatomical distribution, treatment modality and complications of maxillofacial fractures were examined. RESULTS: Overall, interpersonal violence, traffic accidents and falls were the most common mechanisms of injury. There was a decreasing trend in traffic accidents and increasing one in falls as a cause of fracture over the 11-years period of this study. Young male patients were preferentially victim of interpersonal violence and traffic accidents, while middle-aged ones were of falls and work-related accidents. Middle-aged female patients were preferentially victim of traffic accidents and interpersonal violence, while older ones were of falls. And the number of fractures per patient varied according to the mechanism of injury: low after work-related accidents and high after traffic accidents. About two-third of fractures involved the mandible. Most of these mandibular fractures were treated by osteosynthesis with or without intermaxillary fixation, with the proportion of the latter increasing over time. There were very few postoperative infections and only in mandible. CONCLUSIONS: Maxillofacial fractures predominantly occur in young men, due to interpersonal violence. There is nevertheless an increasing trend in falls as a cause of fracture, especially in female patients, consistent with the increasing trend in presentation of older people. Most maxillofacial fractures involve the mandible and there is an increasing trend in treating these fractures by osteosynthesis without intermaxillary fixation. Antibiotic prophylaxis associated with dental hygiene care can be indicated to prevent postoperative infections.

The use of computer-guided flapless dental implant surgery (NobelGuide) and immediate function to support a fixed full-arch prosthesis in fresh-frozen homologous patients with bone grafts.

The behavior of fresh-frozen homologous bone (FFB) when used in combination with computer-guided implant surgery has not been investigated yet, and there is a lack of clinical evidence in the literature. The purpose of this retrospective study is to evaluate the implant survival and related fixed full-arch prostheses at the 1- to 5-year follow-up when performed with immediate function using a flapless surgical procedure and computer-aided technology (NobelGuide; Nobel Biocare AB, Goteborg, Sweden) in patients previously treated with FFB grafts. Furthermore, the related values of torque and complications observed were analyzed and discussed. Clinical charts of patients with edentulous arches treated with FFB grafts and NobelGuide system with at least 1 year follow-up were reviewed retrospectively.A total of 65 patients met the criteria of inclusion, receiving a total of 342 implants and 77 full-arch prostheses, with a mean follow-up of 32.87 months (range, 1-5 years). Survival of implants and prostheses was high, reaching 96.5% and 95%, respectively. Factors significantly related to failure of the implants were smoking, position of the implant as last distal abutment, and fracture of basal maxillary bone. Prostheses survival was influenced by bruxism, failure of multiple implants, and torque level of implant equal to 0 at implant insertion. All implants and prostheses failures occurred in the first year. A higher torque level at implant insertion did not correspond to a lower risk of implant failure.Within the limitations of our retrospective study, this treatment modality was predictable with high survival rates and high insertion torque. However, a few implant and prosthetic failures were found, together with several complications.

E-scooters and maxillofacial fractures: a seven-year multi-centre retrospective review.

BACKGROUND: Standing electric scooters (e-scooters) are a cost-effective and environmentally-friendly transport alternative, but also elicit substantial concern regarding associated craniofacial injuries. This study aims to describe the patient factors, procedural factors and post-operative outcomes of maxillofacial fractures caused by e-scooter accidents. METHODS: Retrospective chart review of patients aged 18 years or older who were surgically treated for these injuries in 2014-2020 at two Australian tertiary hospitals. RESULTS: There were 18 cases included. Most cases were male (66%). The mean age was 35 years. Common risk factors were alcohol use (86%) and lack of helmet use (62%). The most common fracture pattern was zygomatico-maxillary complex (ZMC) fractures (50%). There were no associated systemic injuries. Mean operation timing was 12 days post-injury for ZMC fractures and 3 days post-injury for condyle fractures. For ZMC fractures, the most common method of fixation was 2-point fixation (66%). For condyle fractures, the most common surgical approach was arch bars only (83%). Post-operative complications were reported in six cases, with malocclusion being the most common (n = 3). Revision surgeries were performed in two cases. CONCLUSIONS: Maxillofacial fractures associated with e-scooter accidents appear to be increasing in incidence. Robust longitudinal evaluations with larger sample sizes are required to better understand associated presentations, surgical approaches and post-operative complications.

Characteristics of Orbital Injuries Associated with Maxillofacial Trauma.

INTRODUCTION: The incidence of ocular injury associated with maxillofacial trauma remains poorly defined, with reported rates ranging from 0.8% to 92%. Our study aims to more accurately characterize ocular injuries associated with midface fractures. METHODS: We performed a retrospective review of 1677 patients from 2015 to 2020 with midface fractures at a Level I trauma center. Isolated nasal bone and frontal process of the maxilla fractures were excluded. Demographic information, mechanism of injury, need for surgery, and ophthalmologic findings were documented. Statistical analysis was conducted using SPSS. RESULTS: 773 patients between the ages of 15 and 92 were identified. Trauma most commonly resulted from assault (63.8%). The association between the mechanism of injury and ocular injury was statistically significant (p = 0.003), with 78.6% of gunshot wounds and 44.3% of assault patients having an ocular injury. The Ophthalmology service evaluated 62.6% of cases preoperatively. Minor ocular injury occurred in 36% of patients, including 46.1% of isolated orbital floor, and 28.2% of zygomaticomaxillary complex fractures. Major ocular injury occurred in 10.5% of patients. CONCLUSIONS: Over 10% of patients with midface fractures were found to have major ocular injuries. Ophthalmologic exams should be performed for all patients with midface fractures to guide clinical decision making and prevent further intraoperative ocular insults. LEVEL OF EVIDENCE: Level 4. This study represents a retrospective cohort study analyzing ocular injuries detected in patients presenting to a Level I trauma center with maxillofacial fractures between 2015 and 2020 Laryngoscope, 133:1624-1629, 2023.

Bilateral temporomandibular joint dislocation with locked mandibular impaction.

Bilateral anterior temporomandibular joint dislocation is very rare, with only 2 reported cases published. In the present report, we describe a healthy 25-year-old man from Haida Gwaii, in British Columbia, Canada, who was transferred to our tertiary trauma center with life-threatening complications of a bilateral anterior temporomandibular joint dislocation with locked mandibular impaction.

Prosthetic rehabilitation of an edentulous maxilla with microstomia, limited interarch space, and malaligned implants: a clinical report.

BACKGROUND: Although dental implant treatment is a very successful option today, a meticulous treatment planning and close collaboration between the oral surgeon and restorative doctor is crucial to eliminate undesired outcomes. PURPOSE: To present a challenging case restored with a maxillary screw-retained fixed prosthesis using malpositioned/malaligned implants. MATERIALS AND METHODS: A 47-year-old female had a Lefort I fracture and lost all maxillary teeth due to traumatic injury in a traffic accident. Seven maxillary implants were placed using a 1-stage surgical approach, 6 months after open reduction surgery in a private practice. Radiographic and clinical evaluation indicated marginal bone loss around 3 anterior implants. The malposition and malalignment of implants made impression and casting procedures very complicated. The other challenging factors with this patient were microstomia, limited mouth opening due to scar tissue from previous plastic surgery, and a very small maxilla. The 1-piece metal framework did not fit accurately so it was sectioned into 3 segments. The 3 separate segments were screwed on the abutments individually, then connected to each other using an acrylic resin. The 3 framework segments were laser welded. After the laser welding, a passive fit of the framework was achieved. CONCLUSION: It has been suggested that providing an implant treatment to a patient with implants placed in wrong positions with undesired angulations can be very difficult. Also, laser welding may be a viable option to eliminate misfit of full-arch metal frameworks.

Etiology, diagnosis, and characteristics of facial fracture at a midwestern level I trauma center.

Study purpose was to describe facial fracture frequency, demography, injury characteristics, and diagnostic modalities at a Midwestern level I trauma center. A retrospective review was conducted on a Midwestern trauma center registry for years 2008 and 2009. Patient and injury data were collected along with diagnostic modality for facial fracture patients. Comparative statistics were conducted on the basis of the number of facial fractures, route of admission, presence of traumatic brain injury, and gender. There were 154 patients diagnosed with 443 facial fractures, representing 5% of the trauma population. Median patient age was 45 years. Median number of fractures was 2. Fractures were frequently present in orbit (32%), malar bone and maxilla (26%), and the nasal bones (19%). Motor vehicle crash was the most common mechanism (47%). Most fractures were diagnosed with maxillofacial computed tomography (78%). Males had an odds ratio of 2.5 (95% confidence interval, 1.15-5.43) for multiple facial fractures and composed 67% of the sample. Traumatic brain injury was diagnosed in 71% of patients. This study of a medium-sized city and its surrounding rural areas revealed differences from studies in large urban centers. Differences included lower gender ratio, older average age, and mechanism of injury. While urban trauma centers report assault as a leading cause of facial fracture, this study noted higher frequencies of motor vehicle crash and falls and fewer assaults.

CT Diagnosis of the Fracture of Anterior Nasal Spine.

OBJECTIVE: To study anterior nasal spine fractures, including the incidence, missed diagnosis rates, and relationship with shapes using computed tomography (CT). METHODS: Two hundred cases of axial CT images performed for maxillofacial trauma were reviewed. The incidence, correct, and missed diagnosis rates of anterior nasal spine fractures were studied. The relationship between the fracture and the shape of the anterior nasal spine was also analyzed. RESULTS: The rate of anterior nasal spine fractures was 22.00% (44 of 200). The diagnostic accuracy was 4.55% (2 of 44) and the missed diagnosis rate was 95.45% (42 of 44). The fracture rates of the double rod, single rod, triangle, and irregular anterior nasal spine were 33.85% (22 of 65), 32.26% (10 of 31), 12.24% (12 of 98), and 0.00% (0 of 6), respectively. The double and single rod types of anterior nasal spine were most likely to be fractured than the type of triangle (χ2 = 11.05, 6.67, P < .0167). No fracture was found in the irregular type of anterior nasal spine. CONCLUSION: Anterior nasal spine fractures are not rare and the high missed diagnostic rate results from unfamiliarity with the structure. Double and single rod types of anterior nasal spines are easy to fracture. Bony reconstruction and thin thickness of CT images are necessary for diagnosis.

[Epidemiological and tomodensitometric aspects of post-traumatic maxillofacial fractures in Mopti, Mali]. / Profil épidémiologique et tomodensitométrique des fractures maxillo-faciales post-traumatiques à Mopti au Mali.

Introduction: facial injuries are a public health problem, both physically and psychologically, characterized by a variety of injuries and sometimes by severe esthetic or functional sequelae. The purpose of this study was to describe the epidemiological and tomodensitometric aspects of maxillofacial fractures in Mopti. Methods: we conducted a cross-sectional and descriptive study in the Department of Radiology of the Mopti Hospital from January 2019 to December 2019. All patients who had undergone maxillofacial CT scan for a trauma with fracture confirmed by CT scan during this period were included. The variables analyzed were age, sex, etiology and the types of fractures observed on CT scan. Data recording and analysis were carried out using SPSS version 20 and Excel 2013. Results: of a total of 120 patients, the mean age was 26.43 years with a standard deviation of 14.547. Men predominated (75%; n= 90). Road accidents were the leading cause of fractures (50%; n = 60). Occlusofacial fractures accounted for 38.33% (n= 46). Lefort II was the most common fracture (22.50%; n= 27). Conclusion: this study allowed us to identify the population groups most affected by maxillofacial fractures in the Mopti region: adolescents and young adults. Tomodensitometric results were dominated by occlusofacial fractures, in particular Lefort type II fractures.

The tolerance of the maxilla to blunt impact.

This study reports the results of 38 infraorbital maxilla impacts performed on male cadavers. Impacts were performed using an unpadded, cylindrical impactor (3.2 kg) at velocities between 1 and 5 m/s. The peak force and acoustic emission data were used to develop a statistical relationship of fracture risk as a function of impact force. Acoustic emission sensors were used to provide a noncensored measure of the maxilla tolerance and were essential due to the increase in impactor force after fracture onset. Parametric and nonparametric techniques were used to estimate the risk of fracture tolerance. The nonparametric technique produced an estimated 50% risk of fracture between 970 and 1223 N. The results obtained from the parametric and nonparametric techniques were in good agreement. Peak force values achieved in this study were similar to those of previous work and were unaffected by impactor velocity. The results of this study suggest that an impact to the infraorbital maxilla is a load-limited event due to compromise of structural integrity.

Considerations of maxillary tuberosity fractures during extraction of upper molars: a literature review.

BACKGROUND: Maxillary tuberosity fractures during molar teeth extraction commonly occur in dental practice; however, very few cases have been reported and discussed in the literature. A correct preoperative radiographic interpretation, coupled with the anatomical knowledge of the structures involved, is essential to prevent such complications. AIM: The purpose of this paper is to enumerate the predisposing and etiological factors of maxillary tuberosity fractures during the extraction of upper molars, discuss the procedures that need to be taken when small or large fractured fragments of the tuberosity are evident during surgery, and suggest appropriate recommendations. This study is based on a thorough literature review. CONCLUSIONS: Upon discovering that a maxillary tuberosity has fractured, the dentist must first halt the procedure before inadvertent laceration of the adjoining soft tissue occurs and then determine the extent of the fracture by palpating the mobile fragment. After performing the dissection of the soft tissues, immediate removal of the small fractures, including the tooth with small bony fragments, may be the best option, because of the difficulty incurred when attempting to retain the bone. When a large bony fragment is present, it is recommended (i) that the extraction be abandoned and surgical removal of the tooth be performed using root sectioning, (ii) that the dentist tries to detach the fractured tuberosity from the roots, or (iii) that the dentist stabilizes the mobile part(s) of the bone by means of a rigid fixation technique for 4-6 weeks and, at a future moment, attempts a surgical removal without the use of a forceps.