Management of upper midfacial injuries.

Midfacial fractures may extend into orbital roofs, frontal sinus walls, and ethmoidal and sphenoidal bones if the traumatic impact is of sufficient force. The cranium and facial skull are affected and there is the risk of intracranial complications. Management thus requires a teamwork approach. Isolated compound fractures of the anterior frontal sinus may be reconstructed by direct access through the wound. We prefer a coronal hairline incision in most cases. In isolated (compound) fractures of the orbital roof, combined frontomaxillary fractures without dural involvement, and frontobasal fractures that necessitate an intracranial approach for dural closure, primary upper midfacial reconstruction is attempted. In frontal comminution, preservation of the frontal bone or orbital roof is impossible. Secondary management is indicated after an interval of at least six months for fronto-orbital reconstruction with autologous or alloplastic material.