Complex maxillofacial fractures: management and surgical procedures.

Complex maxillofacial fractures may be defined as combined, mixed, or unclassified. Adequate diagnostic technics must be used with the formulation of a plan for general management and sequential maxillofacial surgery. The basic principal of building from the stable mandible to the first superior stable bone must be adhered to. Exploration of all fracture sites with direct reduction and fixation is the most satisfactory technic for best cosmetic and functional results. The maxillary buccal vestibule incision in midfacial fractures provides exploration of the lateral walls of the maxilla, nasal aperture, zygomatic buttress, maxillary tuberosity and pterygoid area, maxillary antrum and roof (or orbital floor), and infraorbital rim. The extent of the injury can be determined and direct reduction and fixation obtained. Additional approaches for reduction and internal stabilization are used according to the findings. When direct wiring technics are inadequate, internal and external skeletal fixation must be used.