During the past two decades new methods and techniques for the treatment of middle floor facial fractures have been developed. The orthopedic approach alone or associated with various procedures of internal suspension gradually became obsolete. Nowadays, a successful treatment implies the early surgical exploration and a careful restoration of bone skeletal structure. Osteosynthesis with mini-plates provides for the reduction and tridimensional stability of bone fragments. Moreover, in the communicative fractures and in those accompanied by substance loss, the titanium mini-plates are the best method for the immediate fixation of bone grafts.