These injuries generally occur from a direct blow to the “middle” part of the face. The two most common maxillary fractures are segmental fractures and Le Forte I. Segmental fractures can be diagnosed both clinically and radiologically. In most cases, there would be instability and mobility in more than one tooth, unlike a single tooth luxation injury. Treatment in most cases requires rigid stabilisation of the fracture for a minimum of four to six weeks. This can usually be accomplished by means of a fixed wire attached to the adjacent teeth, although in some severe cases, intra-osseous fixation may be required.
A rare but serious maxillary fracture is the Le Forte I fracture. This can occur subsequent to a severe anterior blow to the maxilla from a head, elbow or goalpost. These fractures cause a separation of the maxilla from the nasal-septal structures and the pterygoid plates. This allows the maxilla to move as a separate structure. The greatest concern to the touchline doctor is the instability of the fracture and the potential for closing the airway, as the fractured maxilla can drop posteriorly. In this situation, the touchline doctor must reposition the maxilla anteriorly to open up the airway.