Le Fort fractures: Difference between revisions
 
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==Background==
==Background==
*Midface fracture involving the maxilla and surrounding facial structures
*Most commonly occur due to motor vehicle accident
*LeFort I fractures are isolated to the lower face
*LeFort I fractures are isolated to the lower face
*Type II and III injuries<ref>Tintinalli 7th Edition, pgs 1730-1738</ref>
*Type II and III injuries associated with cribriform plate disruption and CSF rhinorrhea
**Associated with cribriform plate disruption and CSF rhinorrhea


==Classification==
==Clinical Features==
[[File:SchaedelSchraegLeFort123.png|thumb|LeFort I (red), II (blue), and III (green) fractures]]
*Facial pain and signs of trauma
===Le Fort I===
*Facial instability
*Transverse fx separating body of maxilla from pterygoid plate and nasal septum<ref>Tintinalli 7th Edition, pgs 1730-1738</ref>
 
==Differential Diagnosis==
{{Maxillofacial trauma DDX}}
 
==Evaluation==
===Workup===
[[File:LeFort109M.jpg|thumb|A 3-D CT reconstruction showing a Le Fort type 1 fracture (marked by arrow).]]
*CT sinus/face
 
===Diagnosis===
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Le Fort Fracture'''
| align="center" style="background:#f0f0f0;"|'''Description'''
| align="center" style="background:#f0f0f0;"|'''Front View'''
| align="center" style="background:#f0f0f0;"|'''Side View'''
| align="center" style="background:#f0f0f0;"|'''Stability'''
|-
|Type I||
*Transverse fracture separating body of maxilla from pterygoid plate and nasal septum<ref name="tintinalli">Tintinalli 7th Edition, pgs 1730-1738</ref>
*Only hard palate and teeth move (when rock hard palate while stabilizing forehead)
*Only hard palate and teeth move (when rock hard palate while stabilizing forehead)
*Stable fx
||[[File:LeFort1e.png|120px]]||[[File:LeFort1a.png|150px]]||Stable
 
|-
===Le Fort II===
|Type II||
*Pyramidal fx through central maxilla and hard palate
*Pyramidal fracture through central maxilla and hard palate
*Movement of hard palate and nose occurs, but not the eyes
*Movement of hard palate and nose occurs, but not the eyes
*Can be stable or unstable fx
||[[File:LeFort2b.png|120px]]||[[File:LeFort2a.png|150px]]||Can be stable or unstable fracture
 
|-
===Le Fort III===
|Type III||
*Craniofacial dysjunction (fx through frontozygomatic sutures, orbit, nose, ethmoids)
*Craniofacial dysjunction (fracture through frontozygomatic sutures, orbit, nose, ethmoids)
*Entire face shifts w/ globes held in place only by optic nerve)
*Entire face shifts with globes held in place only by optic nerve)
*Dish face deformity on lateral view
*Dish face deformity on lateral view
*Unstable fx
||[[File:LeFort3b.png|120px]]||[[File:LeFort3a.png|150px]]||Unstable
 
|-
===Le Fort IV===
|Type IV||
*Le Fort III plus involvement of frontal bone
*Le Fort III plus involvement of frontal bone
*Unstable fx
||||||Unstable
|}


==Differential Diagnosis==
==Management==
{{Maxillofacial trauma DDX}}
*Ensure airway patency
**If intubation required, consider awake intubation
*Control hemorrhage
**Nasal and oral packing may be required
*IV antibiotics


==Management==
==Disposition==
*Airway protection
*Consider discharge in isolated LeFort I or stable LeFort II fractures without concerning features (in coordination with appropriate specialist consult - OMFS, ENT, or PRS)
**Consider awake intubation (eg, ketamine) if need airway; if possible do not paralyze a Le Fort for intubation or you may be forced into a crash surgical airway
*All others should be admitted
**Prepare for surgical airway
*CT Face
*Control hemorrhage w/ nasal and oral packing if needed
*Admit for IV abx and sx


==See Also==
==See Also==
*[[Maxillofacial Trauma]]
*[[Maxillofacial trauma]]


==Source==
==References==
<references/>
<references/>


[[Category:ENT]]
[[Category:ENT]]
[[Category:Ortho]]
[[Category:Orthopedics]]
[[Category:Trauma]]
[[Category:Trauma]]

Latest revision as of 06:32, 6 January 2022

Background

  • Midface fracture involving the maxilla and surrounding facial structures
  • Most commonly occur due to motor vehicle accident
  • LeFort I fractures are isolated to the lower face
  • Type II and III injuries associated with cribriform plate disruption and CSF rhinorrhea

Clinical Features

  • Facial pain and signs of trauma
  • Facial instability

Differential Diagnosis

Maxillofacial Trauma

Evaluation

Workup

A 3-D CT reconstruction showing a Le Fort type 1 fracture (marked by arrow).
  • CT sinus/face

Diagnosis

Le Fort Fracture Description Front View Side View Stability
Type I
  • Transverse fracture separating body of maxilla from pterygoid plate and nasal septum[1]
  • Only hard palate and teeth move (when rock hard palate while stabilizing forehead)
 LeFort1e.png LeFort1a.png Stable
Type II
  • Pyramidal fracture through central maxilla and hard palate
  • Movement of hard palate and nose occurs, but not the eyes
 LeFort2b.png LeFort2a.png Can be stable or unstable fracture
Type III
  • Craniofacial dysjunction (fracture through frontozygomatic sutures, orbit, nose, ethmoids)
  • Entire face shifts with globes held in place only by optic nerve)
  • Dish face deformity on lateral view
 LeFort3b.png LeFort3a.png Unstable
Type IV
  • Le Fort III plus involvement of frontal bone
 Unstable

Management

  • Ensure airway patency
    • If intubation required, consider awake intubation
  • Control hemorrhage
    • Nasal and oral packing may be required
  • IV antibiotics

Disposition

  • Consider discharge in isolated LeFort I or stable LeFort II fractures without concerning features (in coordination with appropriate specialist consult - OMFS, ENT, or PRS)
  • All others should be admitted

See Also

References

  1. ↑ Tintinalli 7th Edition, pgs 1730-1738
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