Le Fort fractures

Classification

LeFort I (red), II (blue), and III (green) fractures

Le Fort I

• Transverse fx separating body of maxilla from pterygoid plate and nasal septum
• Only hard palate and teeth move (when rock hard palate while stabilizing forehead)
• 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

• 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

Management

• Airway protection
  • 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
  • Prepare for surgical airway
• CT Face
• Control hemorrhage w/ nasal and oral packing if needed
• Admit for IV abx and sx

See Also

• Maxillofacial Trauma

Source

Tintinalli