Case 5 Le Fort Fractures
5.1 Description
Anterior open bite on physical examination
Transverse fracture across the maxilla involving the zygomaticomaxillary (ZM) and nasomaxillary (NM) buttresses on both sides, consistent with a Le Fort I fracture
Fracture of the pterygoid plates
5.2 Work-Up
5.2.1 History
Mechanism of injury: Helpful for determining severity of impact and trajectory of force
Changes in vision, occlusion, sensation, breathing, or hearing
Previous facial trauma
5.2.2 Physical Examination
Identify any potentially life-threatening conditions. Always take spinal precautions and rule out cervical injury.
Perform a detailed examination of the face including:
Inspection for swelling/edema
Palpation for tenderness, crepitus, or step-off
Examination for sensory and motor changes
Eye examination: Visual acuity, diplopia, entrapment
Intranasal and intraoral examination of ears and tympanic membrane
State of dentition: Fractured, missing, or decayed teeth and occlusal pattern
Assess for midface instability: Stabilize the face at the nasal root (left hand) and grasp the upper anterior alveolar arch (right hand) and pull forward/down.
If the midface is mobile with stability at nasal root, it is indicative of a Le Fort I fracture.
If there is also mobility at the nasofrontal (NF) suture, it is a Le Fort II fracture.
If there is also mobility at the zygomaticofrontal (ZF) suture, it is a Le Fort III fracture (see Fig. 5.1).
Fig. 5.1 Le Fort fracture patterns:(I) Transverse fracture through the zygomaticomaxillary (ZM) and nasomaxillary (NM) buttresses; (II) pyramidal fracture through ZM buttresses, infraorbital rims, medial orbit, and nasofrontal (NF) junction; (III) complete craniofacial disjunction with separation of the cranium from the face at zygomaticofrontal (ZF) sutures, orbital, and NF junction.
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