Residual complications in patients with major middle third facial fractures

Residual complications associated with middle third facial fractures have been poorly documented in the literature. In the present study, 240 patients with fractures of the middle third of the facial skeleton, who were treated at the Royal Melbourne Hospital, Victoria, between 1969 and 1976, were reviewed to determine the residual complications of these fractures. Cranial complications were relatively uncommon, and 60 % of cases of cerebrospinal fluid rhinorrhoea ceased within 3 days of fracture reduction and fixation. Persistent infraorbital sensory defects occurred in 22 % of patients with Le Fort II or Le Fort III fractures. Orbital complications included diplopia, which remained in 8 % of cases, and was often corrected by secondary surgery. Residual complications involving the nose or maxillary sinus were uncommon (less than 5 %). Occlusal disharmony was present as a residual problem in 19.6 % of cases, although this could be managed by simple means in 89 % of these cases so that primary surgery and simple secondary dental procedures a satisfactory result in 98 % of all patients. The low incidence of dental complications is most likely a result of the rigid fixation employed in the fracture management, allowing accurate control of the bone fragments.