Repair Of Facial Fractures Research Articles

Abstract: Opioid Consumption Following Outpatient Plastic Surgery

BACKGROUND: A rise in opioid abuse has led to increases in dependency, overdose, and healthcare resource utilization. Currently, there are no data detailing the need for opioids in post-operative pain management following outpatient Plastic Surgery procedures. The goal of this study was to evaluate patient satisfaction, opioid consumption, and physician prescribing practices following these procedures to provide evidence-based strategies for post-operative pain control. METHODS: Patients who underwent outpatient Plastic Surgery procedures were identified at their first post-operative visit. Included were all English-speaking patients aged 18 to 90 who underwent elective, outpatient procedures. Those with pre-existing pain disorders were excluded. Patients were asked to complete an electronic survey in which they were queried on overall satisfaction with pain control, highest post-operative pain level, current pain level, number of days requiring opioid pain medication, reason for discontinuing medication, use of non-opioid medication for pain control, adverse effects, number of tablets consumed, and number of tablets remaining. Responses were also stratified by type of procedure performed. RESULTS: Sixty patients completed the survey. The majority (92%) reported overall satisfaction with pain control. On a scale of 1–10, the average worst post-operative pain score was 6.4. The average pain score at the first post-operative visit was 2.3, with only 25% still taking opioids at that time. Opioids were discontinued in 58.6% of patients because they no longer had pain, in 20.7% because they had mild pain controlled with other analgesics, in 13.8% because they ran out of medication, and in 6.9% because they experienced intolerable side effects. Patients who underwent first-stage tissue expander-based breast reconstruction were prescribed the most opioids, but patients who underwent facial fracture repair consumed the most opioids. Patients who underwent soft tissue excisional procedures were prescribed the least and consumed the least number of tablets. The average number of tablets prescribed was 30, while the average number of tablets consumed was 17. CONCLUSION: A balance between pain control and responsible prescribing of narcotic pain medications must be achieved. In most cases, pain was well-controlled with high rates of patient satisfaction. On average, patients received nearly twice the amount of pain medications that were used. This study can be used to guide prescribing practices of narcotic analgesics amongst Plastic Surgeons. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest to disclose.

Airway Management and Control of Severe Hemorrhage by Transarterial Embolization Through Interventional Radiology and 3-Staged Repair of Multiple Facial Fractures in a Maxillofacial Trauma Patient

Airway compromise and severe hemorrhage are the two most common life-threatening problems associated with maxillofacial trauma. The treatment of intractable hemorrhage to prevent airway obstruction and hypovolemic shock is imperative. Common methods for initially controlling hemorrhage include oronasal packing, placement of Foley catheters, and temporary reduction of facial fractures. When these measures are unsuccessful, carotid artery ligation has proven effective. However, the modern application of Interventional Radiology to achieve trans-arterial embolization (TAE) of the offending vessel is equally effective and offers improved morbidity and mortality. Here we present a case of a 39-year-old male who sustained life threatening hemorrhage of bilateral internal maxillary artery with multiple facial fractures. The purpose of this report is to discuss evidence based approach to control and treat intractable hemorrhage in complex maxillofacial trauma patients.

Teaching facial fracture repair: A novel method of surgical skills training using three-dimensional biomodels

Background The facial fracture biomodel is a three-dimensional physical prototype of an actual facial fracture. The biomodel can be used as a novel teaching tool to facilitate technical skills training in fracture reduction and fixation, but more importantly, can help develop diagnostic and management competence. Objective To introduce the ‘facial fracture biomodel’ as a teaching aid, and to provide preliminary evidence of its effectiveness in teaching residents the principles of panfacial fracture repair. Method Computer three-dimensional image processing and rapid prototyping were used to generate an accurate physical model of a panfacial fracture, mounted in a silicon ‘soft tissue’ base. Senior plastic surgery residents in their third, fourth and fifth years of training across Canada were invited to participate in a workshop using this biomodel to simulate panfacial fracture repair. A short didactic presentation outlining the ‘patient's’ clinical and radiological findings, and key principles of fracture repair, was given by a consultant plastic surgeon before the exercise. The residents completed a pre- and postbiomodel questionnaire soliciting information regarding background, diagnosis and management, and feedback. Result A total of 29 residents completed both pre- and postbiomodel questionnaires. Statistically significant results were found in the following areas: diagnosis of all fracture patterns (P=8.2×10−7 [t test]), choice of incisions for adequate exposure (P=0.04 [t test]) and identifying sequence of repair (P=0.019 [x2 test]). Subjective evaluation of workshop effectiveness revealed a statistically significant increase in ‘comfort level’ only among third year trainees. Overall, positive feedback was reported among all participants. Conclusions Biomodelling is a promising ancillary teaching aid that can assist in teaching residents technical skills, as well as how to assess and plan surgical repair.

Characteristics of maxillofacial injuries and safety of in-theater facial fracture repair in severe combat trauma.

The study objectives were to characterize maxillofacial injuries and assess the safety of in-theater facial fracture repair in U.S. military personnel with severe combat trauma from Iraq and Afghanistan. We performed a retrospective chart review of the Expeditionary Medical Encounter Database from 2004 to 2010. 1,345 military personnel with combat-related maxillofacial injuries were identified. Injury severity was quantified with the Abbreviated Injury Scale and Injury Severity Score. Service members with maxillofacial injury and severe combat trauma (Injury Severity Score ≥ 16) were included. The distribution of facial fractures, types, and outcomes of surgical repairs, incidence of traumatic brain injury, concomitant head and neck injuries, burn rate/severity, and rates of Acinetobacter baumannii colonization and surgical site infection were analyzed. The prevalence of maxillofacial injury in the Expeditionary Medical Encounter Database was 22.7%. The most common mechanism of injury was improvised explosive device (65.7%). Midface trauma and facial burns were common. Approximately 64% of the study sample sustained traumatic brain injury. Overall, 45.6% (109/239) had at least one facial bone fracture. Of those with facial fractures, 64.2% (n = 70) underwent surgical repair. None of the service members who underwent in-theater facial fracture repair developed A. baumannii facial wound infection or implant extrusion.

Teaching facial fracture repair: A novel method of surgical skills training using three-dimensional biomodels.

The facial fracture biomodel is a three-dimensional physical prototype of an actual facial fracture. The biomodel can be used as a novel teaching tool to facilitate technical skills training in fracture reduction and fixation, but more importantly, can help develop diagnostic and management competence. To introduce the 'facial fracture biomodel' as a teaching aid, and to provide preliminary evidence of its effectiveness in teaching residents the principles of panfacial fracture repair. Computer three-dimensional image processing and rapid prototyping were used to generate an accurate physical model of a panfacial fracture, mounted in a silicon 'soft tissue' base. Senior plastic surgery residents in their third, fourth and fifth years of training across Canada were invited to participate in a workshop using this biomodel to simulate panfacial fracture repair. A short didactic presentation outlining the 'patient's' clinical and radiological findings, and key principles of fracture repair, was given by a consultant plastic surgeon before the exercise. The residents completed a pre- and postbiomodel questionnaire soliciting information regarding background, diagnosis and management, and feedback. A total of 29 residents completed both pre- and postbiomodel questionnaires. Statistically significant results were found in the following areas: diagnosis of all fracture patterns (P=8.2×10(-7) [t test]), choice of incisions for adequate exposure (P=0.04 [t test]) and identifying sequence of repair (P=0.019 [χ(2) test]). Subjective evaluation of workshop effectiveness revealed a statistically significant increase in 'comfort level' only among third year trainees. Overall, positive feedback was reported among all participants. Biomodelling is a promising ancillary teaching aid that can assist in teaching residents technical skills, as well as how to assess and plan surgical repair.

Trends in Facial Fracture Treatment Using the American College of Surgeons National Surgical Quality Improvement Program Database

Facial fractures are commonly encountered scenarios for surgeons in the emergency room. The aim of this study was to assess epidemiology and complication rates of facial fractures and the impact of surgical specialty on facial fracture repair using the American College of Surgeons National Surgical Quality Improvement Program database. The authors performed a retrospective review of prospectively collected data from the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program databases using Current Procedural Terminology codes to identify patients undergoing facial fracture repair. Demographic data, postoperative complications, comparison between single and multiple facial fractures, and surgical specialty were accessed. Chi-square tests or Fisher's exact test were used for comparing categorical variables and t tests for continuous variables. A total of 1170 patients were analyzed. The mean age was 38.7 ± 17.0, and the male-to-female ratio was 3.72:1. The most prevalent facial fracture was mandibular fracture in the single-fracture group and zygomatic fracture in the multiple-fracture group. Mandibular fractures were more prevalent in males and orbital fractures in females. Wound complication, morbidity, and mortality rates were 1.8, 1.3, and 0.1 percent, respectively. Multiple facial fractures and orbital fractures were more frequently treated by plastic surgeons among all surgeons. Epidemiologic analysis of facial fractures identifies the most affected patient populations and the characteristics of their fractures. Comparison of complication rates and surgical specialty may permit broad insight into how patients are currently managed. Therapeutic, III.

Assessment of Endoscopic Role in Management of Facial Fractures

This study evaluates the usefulness of endoscopic repair in certain types of facial fractures (orbital floor, isolated zygomatic arch and isolated anterior table frontal sinus fractures).Endoscopic application in otorhinolaryngology has expanded into many areas including facial plastic surgery and facial trauma (orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures), therefore limiting the use of incisions for exposure. Endoscopically assisted facial bone surgery can be performed with many advantages, including: magnified direct visualization, decreased scarring, avoidance of numbness beyond the incision line, greater acceptability to the patient, decreased complication rate and short hospitalization. For assessment of the value of endoscopy in repair of certain facial fractures, we selected 12 consented patients with either orbital floor fracture, isolated zygomatic arch fracture or isolated anterior table frontal sinus fracture to be involved in our study after stabilizing the general condition. The patients were evaluated preoperatively by an ophthalmologist and all had complete CT study including coronal, axial (both bony and soft-tissue windows), sagital and 3D images. The patients were analyzed for sex, age, time of surgery, pre/postoperative symptoms; including ophthalmic symptoms, facial paraesthesia and aesthetic problems. The results of our endoscopic approach were evaluated esthetically and functionally to be classified into good, fair and poor results. We also classified the level of the surgery according to its difficulty into difficult, average and easy surgical performance.Good results were achieved in 8fractures (42%); fair in 8fractures (42%) and finally 3fractures (16%) with poor endoscopic result. The performed surgery considered easy in 9 (41%) patients, average in 6 (31%) patients and difficult in 4 (21%) patients. All patients had no significant complications. Conclusion: Endoscopic repair appears to be a safe and effective technique for repairing certain types of facial fracture.

Management of Midfacial Fractures: An Overview

ABSTRACT Trauma to the midface involves fracture of the maxilla, the zygoma, orbit and the nasoorbital ethmoid complex. The facial skeleton is made up of thin segments of bone encased and supported by a more rigid framework of ‘buttresses’. The midface is anchored to the cranium through this framework. Midfacial fractures can occur in isolation or in combination with other serious injuries. The road traffic accidents are still the main etiology of the midface fractures followed by assault, fall, sports and warfare injuries. The management of the midface remains a challenge for the maxillofacial surgeons, demanding both skill and expertise. Midface fractures are most often seen in young adult males whereas there is very low incidence in children. There is little difference in the outcome of stable patients whose fractures are treated very early vs those treated in a more delayed fashion. Rigid and semirigid plating systems perform well with few complications when used to repair midfacial fractures provided proper reduction is obtained. The dental occlusion must be used as the lower frame of reference when treating fractures that result in instability of the maxillary alveolus relative to the skull base. The most common complication after rigid repair of facial fractures appears to be malunion secondary to inadequate reduction. How to cite this article Thapliyal GK, Ranga Rajan H. Management of Midfacial Fractures: An Overview. J Postgrad Med Edu Res 2014;48(2):68-74.

Screw-wire osteo-traction (SWOT) in the reduction and fixation of frontonasal dysjunction in Le Fort II/III upper mid-facial fractures

Frontonasal dysjunction may occur as a component of Le Fort II or III fractures. Frontonasal reduction and fixation in upper midfacial fractures using a bicoronal flap for access is essential for effective management of the fracture, 1 Prein J. Manual of internal fixation in the cranio-facial skeleton. Springer, Berlin1998: 95-147 Crossref Google Scholar but conventional anatomical reduction and stability can be difficult to achieve before osteosynthesis. Screw-wire osteo-traction (SWOT) is a useful adjunctive method to secure precise anatomical reduction and maintain stability during osteosynthesis. A few published reports describe its use in the management of lower midfacial fractures, 2 Kim M.G. Yoo R.E. Chang H. et al. An intermaxillary fixation screw traction wire: an aid for facial bone fracture repair. Ann Plast Surg. 2009; 63: 71-73 Crossref PubMed Scopus (5) Google Scholar , 3 Moon S.H. Lee J.H. Oh D. et al. Reduction of zygomatic fracture segment with intermaxillary fixation screw. J Craniofac Surg. 2012; 23: 842-844 Crossref PubMed Scopus (6) Google Scholar , 4 O’Regan B, Devine M. Screw-wire traction technique. An aid to anatomical reduction of multi-segment mid-facial fractures. Br J Oral Maxillofac Surg, http://dx.doi.org/10.1016/j.bjoms.2012.10.016, in press. Google Scholar but we know of no reports of it being used in the management of frontonasal dysjunction in upper midfacial fractures.

Intraoperative Computed Tomography for Repair of Facial Fractures

Intraoperative Computed Tomography for Repair of Facial Fractures

Intraoperative Computed Tomography for Repair of Facial Fractures

Objective: To assess the practicality and potential benefitsofintraoperativecomputedtomographyusingamobile scanner in the operating room during repair of orbitozygomatic fractures. Setting: Level I trauma center. Design: Twenty-five patients undergoing open reductionofaunilateraldisplacedfractureofthezygomaand/or repairofablow-outfractureoftheorbitwithcranialbone grafts were placed into a radiolucent head holder and interfaced with the mobile scanner. Spatial vectors were drawn on scans displayed on a computer monitor to allow intraoperative side-to-side comparison of the position of the malar prominences and orbital walls. Corrections of fracture reduction or bone graft position were made as indicated by the comparisons. Results: All scans were accomplished without apparent contamination of the surgical field. Major revisions were performed, based on the scans, in 2 patients whose displaced, comminuted zygoma fractures had been initially reduced with wide exposure of all fracture sites. Minor revisions were performed in 3 patients with displaced but less severely comminuted fractures that had been reduced without exposure of all fracture sites. Bone grafts were repositioned within the orbit in 2 patients with large 2-wall blow-out fractures. Conclusions: Intraoperative computed tomographic evaluation of the adequacy of repair of orbitozygomatic fractures is feasible with the mobile computed tomographic scanner. The scanner allows correction of discrepancies in position of the malar prominences and orbital walls at the time of acute repair, rather than during costly, more difficult delayed revisions. It may eliminate the need for direct visualization of all fracture sites to ensure adequate reduction in selected cases with displaced, comminuted fractures, thus decreasing operating room time and expense. Further study is required to fully document the cost-effectiveness of this approach to facial fracture management.

Transient Total Facial Nerve Paralysis

Endoscopic-assisted repair of subcondylar fractures is an additional tool for management; however, there is a steep learning curve. Generally, this technique allows good visualization of the fracture site for reduction through an incision with an acceptable cosmetic result. Recently, the surgical techniques and technology as well as the indications for endoscopic facial fracture repair are in development; there are few available data in the literature regarding detail complications and recovery processes following endoscopic fracture treatment. The purpose of this article was to reveal unusual complication following endoscopic repair of subcondylar fracture in terms of radiographic, photographic, and recovering orders of the facial nerve and facial reanimations. In our case, no damage to the facial nerve was observed intraoperatively, but the patient had total facial paralysis, immediately postoperatively. At long-term follow-up, the facial nerve function was recovered well within 6 months. The authors consider that transoral endoscopic-assisted open reduction constitutes a valid alternative to a transcutaneous approach for the reduction and fixation of subcondylar fractures. It provides the benefits of open reduction and internal fixation without the permanent complications, such as facial nerve injury.

Fatal Hyponatremia Associated with Preoperative Desmopressin for Bleeding Disorder

Abstract We report a 21-year-old male who underwent surgical repair of facial fractures 5 days following trauma. The patient developed rapidly progressive hyponatremia (serum sodium nadir, 123 mmol/l) and acute cerebral edema that

Association between plate location and plate removal following facial fracture repair

Titanium-based plates used to repair facial fractures are sometimes removed despite their high biocompatibility. Local discomfort can lead to plate removal surgery. Local discomfort may differ according to patient characteristics, tissue properties and plate thickness; however, little is known about the relationship between these conditions and plate removal. We performed a hospital-based, retrospective cohort study of patients who underwent internal fixation for facial or frontal bone fracture. To identify factors associated with plate removal, we used multivariate logistic regression models. Data from 138 patients were analysed. All plates were made of commercially pure titanium, and all screws were made of titanium, 6% aluminium and 4% vanadium alloy. Plate thickness was 1.2 mm or 0.6 mm. Among plate locations, the frontozygomatic suture showed the highest percentage of complications (84%, 86 of 102 patients). The majority consisted of palpability and visibility. In patients who underwent plate removal (n = 96), all plates and screws were removed successfully. All plate-related complications were resolved after plate removal. No complications were introduced by plate removal. Plates 1.2 mm in thickness on the frontozygomatic suture had a relative risk of complications 2.48 times (95% confidence interval, 1.13-5.43) that of plates 0.6 mm in thickness. By multivariate analysis, the presence of plates on the frontozygomatic suture was a significant and independent risk factor for removal. Patients with plates on the frontozygomatic suture had a risk of plate removal 3.95 times (95% confidence interval, 1.55-10.07; P < 0.01) that of patients without plates on the frontozygomatic suture. Plates on the frontozygomatic suture have a high rate of complications. Thick plates increase these risks. Patients with plates on the frontozygomatic suture are more likely to undergo plate removal surgery than patients without plates on the frontozygomatic suture.

Usefulness of Intraoperative Computed Tomography in Facial Bone Fracture Repair and Sinus Surgery

Background and Objectives : The usefulness of intraoperative CT (iCT) in rhinologic surgery including reduction of facial bone fracture and sinus surgery was evaluated. Subjects and Method : Medical records and radiological findings of 17 patients who took iCT at the Medical Center between December 2008 and February 2010 were reviewed retrospectively. The mean follow-up period was 2.2 months. The 17 patients included 14 facial bone fractures and three sinus surgeries. Indications for iCT and the need for additional procedure after iCT were investigated. All operations were performed by the senior author. Results : Indications for iCT were comminuted nasal bone fracture with or without septal fracture, displaced zygoma fracture and orbital blowout fracture. The complex frontal sinus anatomy either by anatomic variation or tumor invasion was an indication for iCT in sinus surgery cases. Additional surgeries were necessary after iCT for five patients (29.4%) as follows: nasal bone reduction (2), zygomatic bone reduction (1), and the removal of meningioma (1) and inverted papilloma (1). Except for one patient, all patients showed satisfactory surgical outcomes in terms of completeness of fracture reduction or surgical removal of sinus pathology. Conclusion : In complex facial bone fracture or sinus diseases, an iCT helps to evaluate the completeness of fracture reduction or sinus dissection during the surgery and to decide the necessity for further surgery.

Does Perioperative Glucocorticosteroid Treatment Correlate With Disturbance in Surgical Wound Healing After Treatment of Facial Fractures? A Retrospective Study

To clarify whether perioperative glucocorticosteroid treatment used in association with repair of facial fractures predisposes to disturbance in surgical wound healing (DSWH). Retrospective review of records of patients who had undergone open reduction, with or without ostheosynthesis, or had received reconstruction of orbital wall fractures during the 2-year period from 2003 to 2004. Steroids were administered to 100 patients (35.7%) out of a total of 280. Dexamethasone was most often used, with the most common regimen being dexamethasone 10 mg every 8 hours over 16 hours, with a total dose of 30 mg. The overall DSWH rate was 3.9%. The DSWH rate for patients who had received perioperative steroids was 6.0%, and the corresponding rate for patients who did not receive steroids was 2.8%. The difference was not statistically significant. An intraoral surgical approach remained the only significant predictor to DSWH. With regard to DSWH, patients undergoing operative treatment of facial fractures can safely be administered doses of 30 mg or less of perioperative glucocorticosteroids equivalent to dexamethasone.

Superior Orbital Fissure Syndrome After Repair of Maxillary and Naso-orbito-ethmoid Fractures: A Case Study

The superior orbital fissure syndrome results from damage to the nerves passing through the superior orbital fissure. In the present case, the superior orbital fissure syndrome developed after repair of facial bone fractures, although the symptoms were not observed before surgery and no obvious cause was found. To investigate the aetiology of this syndrome, we examined the superior orbital fissure anatomically. We measured the width of superior orbital fissure on the horizontal plane including the optic canal using the computed tomography (CT) scans of other patients and cadavers. The results indicated that the width was 3.73+/-1.64 mm in the CT scans of patients and 3.21+/-1.09 mm in the cadavers. There was no significant difference between the width in the CT scans and cadavers. The width in the present patient on the affected side was 1.6mm, that is relatively narrow. After operation, narrow superior orbital fissure may reduce the tolerance to compression of the nerves by oedema. We consider the narrow superior orbital fissure as a risk factor for superior orbital fissure syndrome. When the superior orbital fissure is congenitally narrow, the surgeons should try to avoid excessive pulling of the bone fragment and compression of the orbital tissue during repair of the facial bone fractures.

3D CT for Diagnosis of Facial/Mandibular Fractures

Objective To describe how the use of 3-D reformatted computer tomographic (CT) images increases the accuracy of diagnosis of facial and mandibular fractures and influences surgical planning. Methods Retrospective review of 20 patients with facial and/or mandibular fractures between 2005 and 2006, diagnosed with CT facial bones (axial and coronal images and 3-D renderings). The study was conducted at a university- affiliated institution. Standard CT facial bones protocol consisting of 1.5mm contiguous axial and coronal sections were performed on a 40-slice scanner (Philips Medical Systems, Cleveland, OH). 3-D reconstructions were then obtained. Scans were reviewed by the consulting surgeon. Pre-operative diagnoses were confirmed intraoperatively. Results Patient mean age was 31 years (17–46). Pre-operative diagnoses included: 18 mandible fractures, 8 zygomatico-maxillary/orbital floor, and 4 midface fractures. Mechanisms of injury included assault, motor-vehicle accidents, sports- and work-related injuries, and falls. Diagnosis and surgical planning was influenced in 1/3 of fractures after reviewing 3-D reformatted images. 3-D reformatting did not add any cost to the CT scans performed, did not expose patients to additional radiation, nor did it significantly increase the time to obtain the study. Conclusions 3-D CT reformatting is an inexpensive, easy-to-obtain diagnostic imaging modality that increases the accuracy of diagnosis and helps improve planning of surgical repair of facial and mandibular fractures.

Medial Canthal Open Nasal Fracture Repair

Open repair of facial fractures may offer better outcomes than closed approaches. Advantages are inherent with direct visualization and the use of fixation devices. Yet, closed approaches are commonly favored for nasal fractures for simplicity, the avoidance of a facial scar, and because exposure to the nasal bones through traditional approaches is limited. Inadequate nasal repair, however, may result in collapsed or crooked noses caused by failure to adequately reduce and fixate fractures. We describe a medial canthal approach that provides optimal bony nasal exposure, minimizes facial incisions, and provides excellent open reduction and direct fixation of nasal fractures. We retrospectively reviewed 21 consecutive patients with nasal bony fractures surgically treated with open reduction and internal fixation, using a small, medial canthus incision. The surgical technique is described in detail. In all 21 patients, the entire fractured nasal bridge was visualized. The fractures were reduced and then fixated to the normal anatomic position using a microfixation system (1.0 mm module). The scars were well hidden and tolerated by all patients. At follow-up of 6 to 18 months, 1 patient underwent scar revision for a depressed scar. Another patient required hardware removal secondary to tenderness associated with the microplate. Otherwise, there were no complications such as saddle nose, canthal dystopia, canthal webbing, or nasolacrimal outflow obstruction. No patient needed or desired revision rhinoplasty. The medial canthal approach was effective in permitting wide exposure and microplate fixation of nasal fractures.

Analysis of results in early versus late midface fracture repair

To evaluate the complication rate in relation to the timing of surgical repair of midface fractures. Retrospective chart review at a level 1 trauma center. Thirty-four patients were evaluated. Overall complication rate was 23.5% with no significant difference between the early repair (21.1%) and late repair (26.7%) groups. The scope of facial fracture repair was similar between the two groups as measured by the number of screws used and through an injury quantifying system. The only variable that tended toward significance was intraoperative blood loss, which was greater in the early repair group (P = 0.06). There is no clear consensus with respect to timing of midface trauma repair. Early repair may result in greater blood loss. Further study is needed to help establish a more precise recommendation for the timing of midface trauma repair.