External fixation of facial fractures

Although external fixation is not indicated in every type of facial fracture, its use alone or with intermaxillary or internal fixation may be of benefit with problems resulting from avulsed segments, infection, inadequate previous reduction, delayed reduction, severe displacement and comminution, non-union, cerebrospinal fluid leak or where a combination of these factors exists. The judicious application of extraskeletal fixation can save valuable anesthetic time as well as assure accesibility of the pharynx and maintenance of an airway and routes for nutrition when these might otherwise be compromised. Although extraskeletal fixation is not withou problems or contraindications, it must be weighed in view of the patient's physical, mental and neurological status, and the existence of concomitant injuries.