Facial trauma can assume complex patterns closely related to the mechanisms of injury, often associating soft tissue injuries with bone fractures, sometimes with important functional and esthetic impact. The approach of such complex injuries must be individualized and basic principles of diagnosis, preoperative planning, wound care and postoperative management must be applied. We present a case of unusual orofacial trauma involving a complex fracture of the maxilla with associated soft tissue lacerations, involving the alveolar process, hard palate, maxillary sinus and nasal floor with near-avulsion of the fragment which was pediculated only by the anterior vestibular mucosa. The approach and surgical treatment of this case is presented along with a discussion of the management of this type of injuries.