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 | *Type II and III injuries associated with cribriform plate disruption and CSF rhinorrhea | ||
==Classification== | ==Classification== | ||
| Line 25: | Line 26: | ||
*Le Fort III plus involvement of frontal bone | *Le Fort III plus involvement of frontal bone | ||
*Unstable fracture | *Unstable fracture | ||
==Clinical Features== | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Maxillofacial trauma DDX}} | {{Maxillofacial trauma DDX}} | ||
==Evaluation== | |||
*CT sinus/face | |||
==Management== | ==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== | ==See Also== | ||
Revision as of 07:53, 17 November 2017
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
Classification
Le Fort 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)
- Stable fracture
Le Fort II
- Pyramidal fracture through central maxilla and hard palate
- Movement of hard palate and nose occurs, but not the eyes
- Can be stable or unstable fracture
Le Fort 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
- Unstable fracture
Le Fort IV
- Le Fort III plus involvement of frontal bone
- Unstable fracture
Clinical Features
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- CT sinus/face
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
- ↑ Cite error: Invalid
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