Abstract
The midface relies on key vertical and horizontal buttresses for proper function and
appearance. Trauma to the midface can lead to untoward complications involving critical
structures of this area. Many reviews focus on operative management of midface fractures
with little focus on complications of the injury and operative repair. We review the
current literature on the most common initial and postoperative complications of midface
trauma with a specific focus on zygomaticomaxillary complex (ZMC) and Le Fort fracture
patterns. A thorough literature review was conducted using PubMed analyzing articles
relevant to the subject matter. Various search terms were used to identify articles
regarding midface fracture presentation, diagnosis, and management, as well as postoperative
complications. Articles were examined by all authors and pertinent information was
gleaned for the purpose of generating this review. Disruption of the midfacial buttress
system can lead to a significant compromise in form and function. A wide variety of
complications are seen in nasal bone fractures, orbital floor fractures, Le Fort,
and ZMC fractures. Some fracture patterns can be managed conservatively without operative
intervention; however, complications such as loss of facial width/projection, trismus,
malocclusion, ocular entrapment, and significant enophthalmos should be managed with
open repair. Timing and method of repair depend on patient-specific injury patterns
and surgeon preference. Proper management depends on a detailed understanding of the
anatomy and pathophysiology of each fracture pattern along with restoration of the
patient's premorbid state. Complications of midface fractures result from disruption
of the vertical and horizontal buttress support systems. Proper management and repair
of midface complications requires a strong understanding of its anatomic basis and
pathophysiology. Sequelae from these fractures can be serious and long lasting if
not addresses appropriately. Astute diagnosis and timely management can prevent patients
from suffering debilitating long-term sequelae.
Keywords
midface fractures - complications - zygomatic complex
