Bilateral fixation of a nasotracheal tube by transfacial kirschner wires

Because of the high margin for error with transfacial internal wire fixation, even in the hands of an experienced practitioner, alternative modalities in the treatment of zygomaticomaxillary complex fractures should be considered. When the use of transfacial rigid wire fixation is indicated, emphasis should be placed on prevention and early recognition of nasotracheal transfixation to avoid unnecessary postoperative catastrophies.