Surgical management of complex maxillofacial fractures.

The surgical treatment of severe and complex maxillofacial injuries requires sophisticated modalities. Personal surgical principles of maxillofacial trauma management are delineated. Exploration of all fracture sites with direct reduction and fixation is the most satisfactory technique for best cosmetic and functional results. The maxillary buccal vestibule incision is stressed for routine use in midfacial fractures. A plea is made for utilization of this incision for exploration of the lateral wall of the maxilla, the nasal aperture, the zygomatic buttress, maxillary tuberosity and pterygoid area, the maxillary antrum and roof (or orbital floor), and the infraorbital rim. The extent of the injury can be ascertained and direct reduction and fixation obtained. Two case presentations illustrate the complex management of such injuries. Postoperative follow-up demonstrates the cosmetic results and rehabilitation of properly managed cases.