Case 5 Le Fort Fractures



Sara A. Neimanis and Clinton S. Morrison

Case 5 Le Fort Fractures

Case 5 (a, b) A 38-year-old male presents complaining of malocclusion and upper jaw pain following a motor vehicle collision.



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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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 5 Le Fort Fractures

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