We performed a prospective study of 100 consecutive patients presenting to our unit with complex maxillary fractures. Fracture severity was assessed according to the alpha-numeric scoring system of Cooter and David and correlated with outcome. Regional maxillary and total fracture scores demonstrated a positive correlation with complication rates, with correlation coefficients of 0.89 and 0.98 respectively. Ocular and orbital complications were most commonly seen with these complex injuries, but occlusal problems were much less common. Despite close consultant-led supervision in a specialised centre, these injuries frequently result in long term problems.