Management of Midfacial Fractures: An Overview

Trauma to the midface involves fracture of the maxilla, the zygoma, orbit and the nasoorbital ethmoid complex. The facial skeleton is made up of thin segments of bone encased and supported by a more rigid framework of ‘buttresses’. The midface is anchored to the cranium through this framework. Midfacial fractures can occur in isolation or in combination with other serious injuries. The road traffi c accidents are still the main etiology of the midface fractures followed by assault, fall, sports and warfare injuries. The management of the midface remains a challenge for the maxillofacial surgeons, demanding both skill and expertise. Midface fractures are most often seen in young adult males whereas there is very low incidence in children. There is little difference in the outcome of stable patients whose fractures are treated very early vs those treated in a more delayed fashion. Rigid and semirigid plating systems perform well with few complications when used to repair midfacial fractures provided proper reduction is obtained. The dental occlusion must be used as the lower frame of reference when treating fractures that result in instability of the maxillary alveolus relative to the skull base. The most common complication after rigid repair of facial fractures appears to be malunion secondary to inadequate reduction.