Reconstruction of the midfacial vertical dimension following Le Fort fractures.

Fracture dislocations of the middle third of the face usually involve a complex combination of Le Fort's three great weak lines of the facial skeleton. The fracture lines transverse the vertical buttresses of the middle third of the face at near right angles and strong impact forces can cause displacement and malalignment of the buttresses. The vertical dimension of the midfacial skeleton may be shortened or lengthened and the maxilla may be rotated. Direct realignment and stabilization of the zygomaticomaxillary buttresses with rigid fragment-to-fragment fixation gives precise reconstruction of the vertical dimension and excellent mechanical stability without craniofacial suspension or external fixation. The principles were first demonstrated in a cadaver study and then applied to a prospective group of 20 patients with Le Fort midfacial fractures. These findings fully justify the increased operative time required to place the transosseous wires.