Le Fort Fractures



10.1055/b-0034-97694

Le Fort Fractures

Michael J. Franco & Albert S. Woo
An 18-year-old man presents with malocclusion and upper jaw pain following a motor vehicle collision.


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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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Le Fort Fractures
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