Surgical Management of Maxillary Fractures: Principles of Reduction, Fixation, And Functional Restoration

Abstract

Maxillary fractures comprise a heterogeneous group of injuries involving the central and lateral midface, including Le Fort fractures, zygomaticomaxillary complex fractures, dentoalveolar injuries, maxillary sinus wall fractures, and pediatric maxillofacial trauma. Operative treatment is generally indicated when fractures produce displacement, malocclusion, instability, facial projection abnormalities, orbital dysfunction, or significant functional impairment. The primary objectives of surgery are restoration of preinjury occlusion, facial width and projection, orbital relationships, and continuity of the vertical and horizontal maxillary buttresses. Open reduction and internal fixation remains the dominant strategy for displaced and unstable injuries. However, the optimal surgical exposure, number of fixation points, and role of advanced imaging remain dependent on fracture pattern and patient characteristics. Two-point fixation may provide adequate stability in selected zygomaticomaxillary complex fractures, whereas three-point fixation may improve rotational control in unstable patterns, although the quality of comparative evidence remains limited. Minimally invasive, transconjunctival, and intraoral approaches may reduce visible scarring without compromising exposure in appropriately selected injuries. Pediatric fractures require special consideration because of facial growth, mixed dentition, and developing tooth germs. This review summarizes current indications, operative principles, surgical approaches, fixation strategies, complications, antibiotic considerations, and emerging technologies in maxillary fracture management.