Le Fort Fractures
Description
Anterior open bite. Evidence of repaired right brow laceration.
Transverse fracture across the maxilla involving the zygomaticomaxillary (ZM) and nasomaxillary (NM) buttresses on both sides, consistent with a Le Fort I fracture. (Coronal images are needed to evaluate the pterygoid plates to confirm the diagnosis.)
Fracture extending from the right NM buttress to the infraorbital rim without displacement at the nasofrontal (NF) junction, consistent with a type IA naso-orbito-ethmoid (NOE) fracture.
Work-up
History
Mechanism of injury: Helpful for determining severity of impact and trajectory of force.
Changes in vision, occlusion, breathing, or hearing.
Previous facial trauma.
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 and depression; palpation for tenderness, crepitus, or step-off; sensory and motor examinations; eye, nasal, and intraoral examinations; and examination of ears and tympanic membrane.
State of dentition: Fractured, missing, or rotten (carious) teeth and occlusal pattern.
Assessment 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 the nasal root, it is indicative of a Le Fort I fracture. If there is also mobility at the NF suture, it is a Le Fort II fracture. If there is also mobility at the zygomaticofrontal suture, it is a Le Fort III fracture (Fig. 4.2).
Le Fort fractures patterns. Le Fort I: transverse fracture through the zygomaticomaxillary (ZM) and nasomaxillary buttresses. Le Fort II: pyramidal fracture through the ZM buttresses, infraorbital rims, medial orbit, and nasofrontal (NF) junction. Le Fort III: complete craniofacial dysjunction with separation of the cranium from the face at the zygomaticofrontal sutures and the orbital and NF junction.
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