Malunion is the healing of bone in a faulty position following disruption from surgery or trauma that forms an imperfect union. Nonunion is the failure of similarly disrupted bone to heal completely despite treatment. The maxilla consists of several sections that form the skeletal base of most of the upper face, roof of the mouth, sides of the nasal cavity, and the floor of the bony portion of skull that holds and protects the eyeball (orbit). Malunion or nonunion in any areas of the maxilla may result in disruptions in function to any of the areas that it supports.

Many factors may adversely influence the healing (union) process of the maxilla including: age, blood supply to the area, improper bone position and stabilization, and arrested ossification process caused by infection and poor nutrition. This results in malunion or complete nonunion.

Characteristic findings with nonunion are pain and abnormal mobility of the maxilla after a normal healing period (6 to 12 weeks). Patients with malunion may have severe facial deformities, restriction or loss of masticatory function, malocclusion, loss of weight, and nutritional deficiencies.

Evaluation for malunion and nonunion require clinical examination for pain, abnormal mobility at the site of fracture, proper bite alignment, and x-rays including plain films and computed tomography (CT) scan.

Treatment is directed at removing the cause of the poor healing. When infection is present, antibiotics and surgical debridement or drainage may be required. Loose fixation appliances must be secured for adequate bone stabilization. Surgery to reposition the bones as well as bone grafting may be needed. Counseling for proper oral hygiene and nutrition may be needed.

Deformity or dysfunction of the maxilla and the surrounding structures (jaw, nose, eyes, upper face, and roof of mouth) may occur. Inadequate or improper eating processes, inadequate nutritional status, and facial deformities may be long-term effects of the displacement. In addition, depending on the extent of displacement, body image disturbances, which may require counseling, are possible after facial changes or surgery.

• None.

• For VA compensation purposes, the severity of maxillary nonunion is dependent upon the degree of abnormal mobility of maxilla fragments following treatment (i.e., presence or absence of false motion), and maxillary nonunion must be confirmed by diagnostic imaging studies

• For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography

• Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunction, and other impairments under the appropriate diagnostic code and combine under 38 CFR 4.25 for each separately rated condition.