Specialist Management of Midfacial Trauma
Maxillary fractures involve the upper jaw and midface, affecting both facial structure and dental occlusion.
These injuries are typically classified as Le Fort fractures, reflecting different patterns of separation between the upper jaw and the rest of the facial skeleton.
They require careful assessment and, in many cases, surgical treatment to restore function, facial form, and stability.
How Maxillary Fractures Present
Symptoms may include:
- Facial swelling and bruising
- Mobile upper teeth or jaw
- Change in bite (malocclusion)
- Difficulty chewing or speaking
- Nasal bleeding or obstruction
- Facial flattening or deformity
- Numbness of the upper lip or cheeks
- In more severe cases, visual disturbance
Because swelling can obscure findings, careful assessment is essential.
Assessment
Assessment includes:
- Clinical examination of facial stability and occlusion
- Evaluation of the airway and breathing
- Assessment of vision and eye movement
- CT imaging to define the fracture pattern and extent
This allows precise diagnosis and planning of treatment.
When Treatment Is Required
Le Fort fractures may require surgical management where there is:
- Instability of the upper jaw
- Malocclusion (changed bite)
- Facial deformity
- Involvement of the orbit or nasal structures
Minor, non-displaced fractures may be managed conservatively in selected cases, but this is less common.
Surgical Treatment
Treatment typically involves open reduction and internal fixation (ORIF).
- The fractured segments are repositioned into their correct anatomical alignment
- The bite is restored and stabilised
- Small titanium plates and screws are used to hold the bones in place
Access is usually through:
- Intraoral incisions (inside the mouth)
- Small, well-concealed facial incisions where necessary
In some cases, temporary intermaxillary fixation (jaw support) may be used during or after surgery.
Importance of Occlusion
Restoring the bite is a central part of treatment.
- The teeth provide a guide for correct positioning of the upper jaw
- Accurate alignment is essential for long-term function
This distinguishes maxillary fracture management from other facial injuries:
It is both a skeletal and dental reconstruction problem.
Timing of Surgery
Timing is important:
- Surgery is usually performed 1–2 weeks following injury
- This allows swelling to settle while avoiding healing in a displaced position
Delayed treatment can make correction more complex and may require reconstructive procedures.
Recovery
Recovery depends on injury severity.
- Swelling and bruising gradually settle over several weeks
- A soft diet is usually required during early healing
- Jaw function improves progressively
- Return to normal activity is gradual
Follow-up ensures:
- Stable healing
- Restoration of bite and function
Risks and Considerations
Potential risks include:
- Persistent changes in bite
- Facial asymmetry
- Numbness of the upper lip or cheek
- Infection or delayed healing (uncommon)
- Need for further surgery in complex cases
These risks are reduced through accurate planning and surgical technique.
Specialist Assessment and Treatment
Le Fort fractures represent complex midfacial injuries requiring coordinated management.
As a dual-qualified (medical and dental) Consultant Maxillofacial Surgeon, treatment is guided by:
- Detailed understanding of midfacial anatomy and biomechanics
- Expertise in restoring both skeletal structure and dental occlusion
- Experience in managing complex facial trauma
- Integration of function, stability, and facial symmetry
This ensures treatment is precise, structured, and outcome-focused.
When to Seek Assessment
Urgent assessment is required if you have:
- Facial trauma with suspected midfacial injury
- A change in your bite
- Mobility of the upper teeth or jaw
- Significant facial swelling or deformity
- Visual symptoms
These injuries require prompt specialist evaluation.
Consultation
Assessment includes clinical examination, imaging, and discussion of the appropriate treatment plan.
Book a Consultation
For assessment and management of maxillary (Le Fort) fractures in London, arrange a consultation to discuss your condition.