Le Fort fractures

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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

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

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

Orbital trauma

Acute

Subacute/Delayed

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

  1. Tintinalli 7th Edition, pgs 1730-1738