Repositioning, mosaic of the upper cleft

The upper jaw is the foundation of the midface: it carries the upper teeth and forms the orbital floor and the walls of the maxillary sinuses and nose. A maxillary fracture results from a strong blow — a road accident, a fall or a sports injury — and is often combined with injuries to the nose, cheekbones and orbit. At UKRMED Maxillofacial Surgery, treatment is planned by maxillofacial surgeon Anna Kravchenko: reduction and titanium plate fixation restore the bite and the shape of the face.

Le Fort classification

Surgeons classify upper jaw fractures by Le Fort type:

• Le Fort I (low) — the line runs above the tooth roots, detaching the alveolar process with the teeth.
• Le Fort II fracture (middle) — a pyramidal fracture through the nasal bones and the lower orbital rim.
• Le Fort III fracture (high) — complete separation of the midface bones from the skull base.

The higher the type, the more complex the injury and the greater the risk to the eyes. A 2026 systematic review of almost 8,000 patients with facial fractures found ophthalmic complications in nearly half of them. That is why an ophthalmologist's examination is mandatory with a midface fracture.

Signs of a fracture

• a changed bite and mobile upper teeth or jaw;
• facial swelling and bruising around the eyes;
• nosebleed and difficulty breathing through the nose;
• numbness of the cheek and upper lip;
• a lengthened or flattened midface;
• double vision.

Diagnosis

A facial CT scan is essential: it shows every fracture line, displacement, the orbits, sinuses and skull base. Ophthalmology, ENT or neurosurgical consultations are arranged as needed.

Maxillary fracture surgery

1. General anaesthesia.
2. Access mainly through incisions inside the mouth, with additional inconspicuous incisions if needed.
3. Restoring the bite: the upper teeth are aligned with the lower ones and the jaws are temporarily fixed together.
4. Maxillary osteosynthesis — fixing the fragments with miniplates along the facial buttresses.
5. Repair of orbital or sinus walls if needed.

A 2024 review of Le Fort I fractures stresses that the key to success is anatomical reduction guided by the bite, while the most common complications are bite problems, sensory disturbances and facial deformity. Associated fractures of the mandibular condyles increase the risk of bite problems, so they must always be taken into account.

Recovery

For the first weeks: swelling, soft or liquid food and careful oral hygiene. Do not blow your nose and avoid flying and exertion until the doctor allows. Bone union usually takes four to six weeks; full tissue recovery takes several months.

Possible complications

• Bite problems — with imprecise reduction; the bite is checked during and after surgery.
• Numbness of the upper lip, cheek and teeth — usually temporary.
• Nasal congestion or sinusitis — maxillary fractures run through the sinuses; an ENT specialist is involved if needed.
• Displacement of fragments — the risk is higher if the jaw is loaded too early, so following the diet is important.
• Infection — rare, with poor oral hygiene.

Tell the doctor straight away if clear fluid drips from the nose, especially when you lean forward: with Le Fort II and III fractures, this may signal injury to the base of the skull.

Prices at UKRMED

The surgeon gives the cost after the CT scan, depending on the fracture type and extent of repair.

If a midface deformity remains after the injury, it is corrected separately — see midface deformity treatment.

Sources

1. Cho J. Y., Ryu J. Management of Le Fort I Fractures. Craniomaxillofac Trauma Reconstr, 2024. https://doi.org/10.1177/19433875241278796
2. Alanazi R. A., Almutairi A., Almuwarraee S. et al. Ophthalmic complications following maxillofacial and midface fractures: a systematic review. Maxillofac Plast Reconstr Surg, 2026. https://doi.org/10.1186/s40902-025-00498-1
3. AO Foundation. AO Surgery Reference: CMF trauma. https://surgeryreference.aofoundation.org/cmf/trauma