Once the occlusal relationship between the maxilla and the mandible are optimally established, the upper facial fractures are repaired. Establishment of an appropriate skeletal buttress allows maximal preservation of function and cosmesis of the patient. Early reconstruction provides optimal skeletal buttress and skin coverage preservation. The key relationships of the upper half of the face include the periorbital rims, zygomatic arches, and the zygomaticomaxillary struts. Bony loss is often bridged initially with metallic struts attempting prevention of soft tissue contracture or collapse with devascularized bone grafts or fragments from the initial injury.
Computerized tomography is often a helpful tool in assuring the three dimensional relationships.
Ideally the integrity of the mucosal lining can be obtained within 5-7 days of the initial injury. Repairing the face by functional and aesthetic units allows for optimal healing. Bony loss in the upper face is treated by skeletal splints and devascularized bone grafts. These devascularized bone grafts require obliteration of dead space, intact epithelial and mucosal coverage for viability. The lower facial structures will often require replacing whole functional units in order to restore mucosal bony and cutaneous functional elements.