The management of complex maxillofacial injuries sustained in modern warfare or terrorist attack has presented military surgeons with a new form of injury pattern previously not discussed in the medical literature. The unique wounding characteristics of the IED, the portability of the weapon platform, and the relative low cost of development make it an ideal weapon for potential terrorist attacks. If potential future terrorist attacks in the United States follow the same pattern as the incidents currently unfolding in the Middle East, civilian practitioners will be required to manage these wounds early for primary surgical intervention and late for secondary and tertiary reconstructive efforts.