Le Fort fractures

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

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

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 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

See Also

• Maxillofacial trauma