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A young man developed severe epistaxis following trauma that resulted in a Le Fort III fracture of the maxilla. Anterior and posterior packs were placed but bleeding recurred, selective catheterization showed the false aneurysm, and autologous clot was used to embolize successfully the bleeding site.

Of 93 patients with fractures of the mid-face who appeared for postoperative check-up, 25 were selected by chance for sinuscopy of the maxillary sinus. Chronic inflammatory mucosal changes occurred in 35 per cent; other pathological sequelae included solitary polyps, mucocele, scarry synechia, and prolapse of orbital fat and osteoma. In spite of these findings, all patients were free of complaints. The primary surgical revision was therefore declined in favour of a waiting attitude. For the diagnostic clarification of late complications, sinuscopy with Hopkin's optics offers a simple and efficient procedure, which should be routinely utilised.

Untreated craniofacial fractures may result in a deformity similar to that which results from underdevelopment of the maxilla. Such a deformity can be corrected by osteotomy simulating Le Fort type III fracture lines. This operation necessitates careful pre-operative planning which incorporates a feasibility study with the combined use of dental study casts, cephalometric radiography and life-size photographic reproductions. A case history which describes the management of late complications of a malunited class III fracture is given.

Condylar fractures with or without disruption of the temporo-mandibular joint occur commonly with other facial injuries. The subsequent development of ankylosis presents surgical and anaesthetic problems in management and results in severe physical disability to the patient. Oro-nasal fistula is a rare complication of fractures involving the middle third of the facial skeleton, and two cases are reported.

Ocular muscle imbalance is a common complication in fractures of the zygomaticomaxillary complex. Involvement can be direct; caused by entrapment of either the muscle or tendon in the fracture; or indirect, produced by central or peripheral damage to the cranial nerves supplying the muscles, massive orbital edema or hemorrhage. A case of complete paralysis of the extraocular muscles caused by a critical reduction of the size of the orbit as a result of fracture of the zygomaticomaxillary complex is described.