Le Fort fractures: Difference between revisions

Revision as of 06:47, 10 May 2019

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

Differential Diagnosis

Maxillofacial Trauma

Ears
- Auricular hematoma
Nose
- Nasal fracture
- Nasal septal hematoma
Oral
Other face
- Le Fort fractures
- Mandible fracture
Zygomatic arch fracture
Zygomaticomaxillary (tripod) fracture
Related

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)			Stable
Type 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
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			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

References

↑ Tintinalli 7th Edition, pgs 1730-1738

Authors:

[tintinalli-1] Tintinalli 7th Edition, pgs 1730-1738

[1]

@@ Line 1: / Line 1: @@
-==Classification==
+==Background==
-[[File:SchaedelSchraegLeFort123.png|thumb|LeFort I (red), II (blue), and III (green) fractures]]
+*Midface fracture involving the maxilla and surrounding facial structures
-===Le Fort I===
+*Most commonly occur due to motor vehicle accident
-*Transverse fx separating body of maxilla from pterygoid plate and nasal septum
+*LeFort I fractures are isolated to the lower face
-*Only hard palate and teeth move (when rock hard palate while stabilizing forehead)
+*Type II and III injuries associated with cribriform plate disruption and CSF rhinorrhea
-*Stable fx
-===Le Fort II===
-*Pyramidal fx through central maxilla and hard palate
-*Movement of hard palate and nose occurs, but not the eyes
-*Can be stable or unstable fx
-===Le Fort III===
+==Clinical Features==
-*Craniofacial dysjunction (fx through frontozygomatic sutures, orbit, nose, ethmoids)
-*Entire face shifts w/ globes held in place only by optic nerve)
-*Dish face deformity on lateral view
-*Unstable fx
-===Le Fort IV===
-*Le Fort III plus involvement of frontal bone
-*Unstable fx
 ==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)
+||[[File:LeFort1e.png|120px]]||[[File:LeFort1a.png|150px]]||Stable
+|-
+|Type II||
+*Pyramidal fracture through central maxilla and hard palate
+*Movement of hard palate and nose occurs, but not the eyes
+||[[File:LeFort2b.png|120px]]||[[File:LeFort2a.png|150px]]||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
+||[[File:LeFort3b.png|120px]]||[[File:LeFort3a.png|150px]]||Unstable
+|-
+|Type IV||
+*Le Fort III plus involvement of frontal bone
+||||||Unstable
+|}
 ==Management==
-*Airway protection
+*Ensure airway patency
-**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
+**If intubation required, consider awake intubation
-**Prepare for surgical airway
+*Control hemorrhage
-*CT Face
+**Nasal and oral packing may be required
-*Control hemorrhage w/ nasal and oral packing if needed
+*IV antibiotics
-*Admit for IV abx and sx
+==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==
-*[[Maxillofacial Trauma]]
+*[[Maxillofacial trauma]]
-==Source==
+==References==
-Tintinalli
+<references/>
 [[Category:ENT]]
-[[Category:Ortho]]
+[[Category:Orthopedics]]
 [[Category:Trauma]]