Complications of Midface Fractures

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

Note

The author does not have any conflict of interest, financial, or otherwise. This article, or any part of it, has not been previously published, nor is it under consideration for publication elsewhere.

• References

• 1 Gassner R, Tuli T, Hächl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg 2003; 31 (01) 51-61
• 2 Bakardjiev A, Pechalova P. Maxillofacial fractures in Southern Bulgaria - a retrospective study of 1706 cases. J Craniomaxillofac Surg 2007; 35 (03) 147-150
• 3 Mast G, Ehrenfeld M, Cornelius CP, Litschel R, Tasman AJ. Maxillofacial fractures: midface and internal orbit-part I: classification and assessment. Facial Plast Surg 2015; 31 (04) 351-356
• 4 Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg 1990; 48 (09) 926-932
• 5 Meslemani D, Kellman RM. Zygomaticomaxillary complex fractures. Arch Facial Plast Surg 2012; 14 (01) 62-66
• 6 Kühnel TS, Reichert TE. Trauma of the midface. GMS Curr Top Otorhinolaryngol Head Neck Surg 2015; 14: Doc06
• 7 Atighechi S, Karimi G. Serial nasal bone reduction: a new approach to the management of nasal bone fracture. J Craniofac Surg 2009; 20 (01) 49-52
• 8 DeFatta RJ, Ducic Y, Adelson RT, Sabatini PR. Comparison of closed reduction alone versus primary open repair of acute nasoseptal fractures. J Otolaryngol Head Neck Surg 2008; 37 (04) 502-506
• 9 Yang RS, Salama AR, Caccamese JF. Reoperative midface trauma. Oral Maxillofac Surg Clin North Am 2011; 23 (01) 31-45 , v
• 10 Rohrich RJ, Adams Jr WP. Nasal fracture management: minimizing secondary nasal deformities. Plast Reconstr Surg 2000; 106 (02) 266-273
• 11 Chang EW, Manolidis S. Orbital floor fracture management. Facial Plast Surg 2005; 21 (03) 207-213
• 12 Boyette JR, Pemberton JD, Bonilla-Velez J. Management of orbital fractures: challenges and solutions. Clin Ophthalmol 2015; 9: 2127-2137
• 13 Souyris F, Klersy F, Jammet P, Payrot C. Malar bone fractures and their sequelae. A statistical study of 1.393 cases covering a period of 20 years. J Craniomaxillofac Surg 1989; 17 (02) 64-68
• 14 Bogusiak K, Arkuszewski P. Characteristics and epidemiology of zygomaticomaxillary complex fractures. J Craniofac Surg 2010; 21 (04) 1018-1023
• 15 Nastri AL, Gurney B. Current concepts in midface fracture management. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (04) 368-375
• 16 Janus SC, MacLeod SP, Odland R. Analysis of results in early versus late midface fracture repair. Otolaryngol Head Neck Surg 2008; 138 (04) 464-467
• 17 Newman F, Cillo Jr JE. Late vascular complication associated with panfacial fractures. J Oral Maxillofac Surg 2008; 66 (11) 2374-2377
• 18 Zingg M, Laedrach K, Chen J. , et al. Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofac Surg 1992; 50 (08) 778-790
• 19 Coello AF, Canals AG, Gonzalez JM, Martín JJ. Cranial nerve injury after minor head trauma. J Neurosurg 2010; 113 (03) 547-555
• 20 Haxel BR, Grant L, Mackay-Sim A. Olfactory dysfunction after head injury. J Head Trauma Rehabil 2008; 23 (06) 407-413
• 21 Doty RL, Yousem DM, Pham LT, Kreshak AA, Geckle R, Lee WW. Olfactory dysfunction in patients with head trauma. Arch Neurol 1997; 54 (09) 1131-1140