The lessons learnt from the management of 1500 consecutive patients with complex facial fractures have been analysed. This analysis and the major changes in treatment principles have resulted in dramatic improvement in results. The application of craniofacial surgical principles, extended exposure of the craniofacial skeleton, accurate fracture reduction with rigid internal bony fixation and primary bone graft reconstruction has revolutionised the care of these patients.The reattachment of the soft tissue to the reconstructed skeleton provides the final link in this comprehensive one stage reconstruction. Analysis of results has demonstrated the majority of complications and failures to be due to inadequate exposure and reduction of fractures with bone segments rigidly plated in their unreduced position. Inadequate bone grafting and failure to re-suspend the soft tissue and canthi results in post treatment deformity even if the bony reconstruction is adequate. Adherence to the principles of reconstruction will almost always result in a one-stage correction no matter how severe the initial injury.
With the advent of regional trauma centres and rapid air transport systems, a larger number of patients with extremely complex craniomaxillofacial trauma are now being seen. The problem of high-velocity facial injuries with multiple facial fractures concerns the severity of the bony injury.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.