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In midfacial fractures the crucial area is the upper portion of the midfacial skeleton which lodges the orbits, the interorbital space with its anatomic relationship with the anterior cranial fossa, the lacrimal apparatus, the levator muscle, and the skeletal structures of the nose. Because of the severity of the injuries in a multisystem injured patient, these fractures may be neglected or receive inadequate primary treatment. In some cases the damage is so extensive that primary treatment can only accomplish part of the task. Late reconstruction is necessary, therefore, and is the subject of this paper.

The evaluation and treatment of the more common and severe complications of facial fractures are reviewed. This analysis includes such conditions as nonunion and malunion of the maxilla, mandible, and zygoma, temporomandibular ankylosis, diplopia, enophthalmos, hypertelorism, dacrocystitis, and cerebrospinal otorhinorrhea. The discussion attempts to stress the importance of diagnosis regarding cosmesis and functional abnormalities. When possible, the pathophysiology is elucidated and evaluated to decide about methods of prevention. Preferred traditional and improved techniques of management are noted and compared to some of the less satisfactory procedures.