The aim of this study was to evaluate the application and limitation of ultrasound in the diagnosis of midfacial fractures. Eighty-one patients with radiologically proved fractures of the facial skeleton were included in this study. Examinations were performed using a 7.5-MHz small-part applicator. Another ten patients without facial fractures served as controls with normal sonoanatomical findings. The most important deficiency of ultrasound in the diagnosis of midfacial fractures is the difficult detection of non-dislocated fractures. According to our own experiences, the application of ultrasound in midfacial fractures is most useful for visualization of the zygomatic arch and the anterior wall of the frontal sinus, with immediate imaging after closed reduction avoiding radiation exposure. Moreover, it is restricted to fractures of the orbital margin and nasal bone. If ultrasound is performed as the first imaging modality in cases of suspected facial fractures by an experienced investigator, the visualization of fracture lines can avoid conventional imaging, so that only an indicated CT scan can be added. In doubtful cases, an individual combination of conventional radiographs would be the next step. By this, an overall reduction of radiation exposure seems possible.