Nasomaxillary Fractures - It's All in the Buttress

Abstract

Introduction: Complex midfacial trauma involves disruption to the structural stability of the facial skeleton. Primary anatomical reduction and fixation of key horizontal and vertical midfacial buttresses is paramount to facial function and normal cosmesis. While all buttresses are consequential to optimal surgical outcomes, the nasomaxillary buttress is often overlooked. Despite this, it is of key importance to facial and nasal morphology, midfacial stability, and re-establishing patency of nasal airflow. Method(s): Retrospective analysis of 100 complex midfacial fractures and 100 zygomatic fractures from a level one trauma center was carried out. Patient demographics, clinical and radiological features, and operative factors were analyzed for effect on surgical outcomes and requirement for corrective intervention. Result(s): Within two retrospective datasets looking at complex midfacial trauma and zygomatic trauma, traumatic fracture extension through the nasomaxillary buttress was present in 81% and 32% of cases, respectively. The nasomaxillary buttress was the joint most fractured buttress in complex midfacial trauma alongside the Zygomaticomaxillary buttress. Despite being geographically separate, energy transfer from the zygomatic region can extend to disrupt the nasomaxillary buttress. Conclusion(s): Fractures of the nasomaxillary buttress are common in both complex midfacial fractures and as an extension of trauma to the zygomatic region. Reconstructing the traumatized nasomaxillary buttress is essential to reconstructing the medial and vertical articulation of the midface and restoration of the nasofacial angle. Failure to anatomically reduce can result in facial asymmetries such as nasal deformation and facial hollowing.Copyright © 2025