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


Differential Diagnosis

Maxillofacial Trauma

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

See Also

References
  1. Tintinalli 7th Edition, pgs 1730-1738
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