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Maxillary Fractures
Premaxillary or anterior maxillary alveolar bone (commonly referred to as
alveolar ridge) fractures are a common finding associated with the displacement
or avulsion of maxillary anterior teeth. Acute management can be performed by
the emergency physician. Gentle digital manipulation of the labial plate of bone
can be guided back into position under local anesthesia. Infiltration with 2%
lidocaine with 1:100,000 epinephrine is commonly used. The bone fragment can
be held in place temporarily by aluminum foil (three thicknesses) molded over the
teeth and alveolar ridge. This emergency splint should be held in place by having
the child gently bite down. A dental consultant should be contacted as soon as
possible for fabrication of a more permanent dental splint. Splinting the loose
teeth and suturing the gingival tissue hold the bone fragments in place.
Commonly associated mandibular and other facial fractures are covered in greater
detail in Chapter 107 Facial Trauma .

FIGURE 105.6 Position for the reduction of a dislocated mandible.