This study evaluates the importance of specific posttraumatic reconstruction of the fractured anterior sinus wall. Several methods of different complexity of reconstruction are being compared by means of radiologic, rhinoscopic, and clinical data. Four groups of a total of 207 patients (age, 18-73 years; follow-up average, 4.2 years) with midfacial fractures, divided by operation technique and year, were evaluated. Control groups 1 to 3 received standard procedures without special regard on the reconstruction of the anterior sinus wall; the study group received specific reconstruction. The study group 4 showed a lower complication rate in nearly all measured parameters in comparison to groups 1 and 2. Study group 4 had the smallest incidences of posttraumatic sequelae in radiologic examinations; the clinical outcome was even to group 3. During open reduction and fixation procedures of midfacial fractures, attention should be given to the reconstruction of the anterior sinus wall to avoid postoperative discomfort.