Le Fort fractures: Difference between revisions
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{| class="wikitable" style="float:right; margin-left: 10px;" | {| class="wikitable" style="float:right; margin-left: 10px;" | ||
| align="center" style="background:#f0f0f0;"|'''Le Fort Fracture''' | | 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;"|'''Front View''' | ||
| align="center" style="background:#f0f0f0;"|'''Side View''' | | align="center" style="background:#f0f0f0;"|'''Side View''' | ||
| align="center" style="background:#f0f0f0;"|'''Stability''' | |||
|- | |- | ||
|Type I|| | |Type I|| | ||
*Transverse fracture separating body of maxilla from pterygoid plate and nasal septum<ref name="tintinalli">Tintinalli 7th Edition, pgs 1730-1738</ref> | *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) | ||
||[[File:LeFort1e.png|120px]]||[[File:LeFort1a.png|150px]]||Stable | |||
|- | |||
|Type II|| | |||
*Pyramidal fracture 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 | ||
||[[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) | *Craniofacial dysjunction (fracture through frontozygomatic sutures, orbit, nose, ethmoids) | ||
*Entire face shifts with 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 | ||
||[[File:LeFort3b.png|120px]]||[[File:LeFort3a.png|150px]]||Unstable | |||
|- | |||
|Type IV|| | |||
*Le Fort III plus involvement of frontal bone | *Le Fort III plus involvement of frontal bone | ||
||||||Unstable | |||
|} | |||
==Clinical Features== | ==Clinical Features== |
Revision as of 06:44, 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
Classification
Le Fort Fracture | Description | Front View | Side View | Stability |
Type I |
|
Stable | ||
Type II |
|
Can be stable or unstable fracture | ||
Type III |
|
Unstable | ||
Type IV |
|
Unstable |
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
- ↑ Tintinalli 7th Edition, pgs 1730-1738