Subunit principles in midface fractures: The importance of sagittal buttresses, soft-tissue reductions, and sequencing treatment of segmental fractures

The patterns of midface fractures were related to postoperative computed to mography scans and clinical results to assess the value of ordering fractur e assembly in success of treatment methods. A total of 550 midface fracture s were studied for their midface components and the presence of fractures i n the adjacent frontal bone or mandible. Preoperative and postoperative com puted tomography scans were analyzed to generate recommendations regarding exposure and postoperative stability related to fracture pattern and treatm ent sequence, both within the midface alone and when combined with frontal bone and mandibular fractures. Large segment (Le Fort I, II, and III) fract ures were seen in 68 patients (12 percent); more comminuted midface fractur e combinations were seen in 93 patients (17 percent). Midface and mandibula r fractures were seen in 166 patients (30 percent). Midface, mandible, and nasoethmoid fractures were seen in 38 patients (7 percent). Frontal bone an d midface fractures were seen in 131 patients (24 percent). Split-palate fr actures accompanied 8 percent of midface fractures. Frontal bone, midface, and mandibular fractures were seen in 54 patients (10 percent). The midface, because of weak bone structure and comminuted fracture pattern , must therefore be considered a dependent, less stable structure. Its inju ries more commonly occur with fractures of the frontal bone or mandible (tw o-thirds of cases) and, more often than not (>60 percent), are comminuted. Comminuted and pan-facial (multiple area) fractures deserve individualized consideration regarding the length of intermaxillary immobilization. Exampl es of common errors are described from this patient experience.