LeFort fracture
Encyclopedia
Le Fort fractures are types of facial fractures
involving the maxillary bone and surrounding structures in a usually bilateral and either horizontal, pyramidal or transverse way. LeFort fractures are classic in facial trauma
. The Le Fort fracture was named after French surgeon
René Le Fort
(1869-1951), who described them in the early 20th century.
of the head and neck then after obvious fracture signs the patient is taken to CT scan for more specific anatomic information. To qualify for LeFort Fractures the pterygoid
plates must be involved. These are seen posterior to the maxillary sinuses on axial CT and inferior to the orbital rim on coronal slices. Also, the palate
is usually mobile on physical exam.
Le Fort I fractures (horizontal) may result from a force of injury directed low on the maxillary alveolar rim in a downward direction. It is also known as a Guerin fracture or 'floating palate', and usually involves the inferior nasal aperture. The fracture extends from the nasal septum to the lateral pyriform rims, travels horizontally above the teeth apices, crosses below the zygomaticomaxillary junction, and traverses the pterygomaxillary junction to interrupt the pterygoid plates.
Le Fort II fractures (pyramidal) may result from a blow to the lower or mid maxilla and usually involve the inferior orbital rim. Such a fracture has a pyramidal shape and extends from the nasal bridge at or below the nasofrontal suture through the frontal processes of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor and rim through or near the inferior orbital foramen, and inferiorly through the anterior wall of the maxillary sinus; it then travels under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.
Le Fort III fractures (transverse) are otherwise known as craniofacial dissociation and involve the zygomatic arch. These may follow impact to the nasal bridge or upper maxilla. These fractures start at the nasofrontal and frontomaxillary sutures and extend posteriorly along the medial wall of the orbit through the nasolacrimal groove and ethmoid bones. The thicker sphenoid bone posteriorly usually prevents continuation of the fracture into the optic canal. Instead, the fracture continues along the floor of the orbit along the inferior orbital fissure and continues superolaterally through the lateral orbital wall, through the zygomaticofrontal junction and the zygomatic arch. Intranasally, a branch of the fracture extends through the base of the perpendicular plate of the ethmoid, through the vomer, and through the interface of the pterygoid plates to the base of the sphenoid. This type of fracture predisposes the patient to CSF rhinorrhea more commonly than the other types.
Lefort II and Lefort III(common)- gross edema of soft tissue over the middle third of the face,bilateral circumorbital ecchymosis,bilateral subconjunctival haemorrhage,epistaxis,CSFrhinorrhoea,dish face deformity,diplopia,enophthalmos,cracked pot sound.
Lefort II- step deformity at infraorbital margin,mobile mid face,anesthesia or paresthesia of cheek.
Lefort III
- tenderness and separation at frontozygomatic suture,lengthening of face,depression of occular levels, enophthalmos, hooding of eyes, tilting of occlusal plane with gagging on one side.
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
involving the maxillary bone and surrounding structures in a usually bilateral and either horizontal, pyramidal or transverse way. LeFort fractures are classic in facial trauma
Facial trauma
Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries...
. The Le Fort fracture was named after French surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
René Le Fort
René Le Fort
René Le Fort was a French surgeon from Lille remembered for creating a classification for fractures of the face...
(1869-1951), who described them in the early 20th century.
Diagnosis
Diagnosis is made based on physical exam findings with confirmation by axial CT. The patient is taken for radiographyRadiography
Radiography is the use of X-rays to view a non-uniformly composed material such as the human body. By using the physical properties of the ray an image can be developed which displays areas of different density and composition....
of the head and neck then after obvious fracture signs the patient is taken to CT scan for more specific anatomic information. To qualify for LeFort Fractures the pterygoid
Pterygoid
Pterygoid can refer to:* Pterygoid processes of the sphenoid bone** The Lateral pterygoid plate by it* a muscle such as Lateral pterygoid muscle or Medial pterygoid muscle* a branch of the Mandibular nerve...
plates must be involved. These are seen posterior to the maxillary sinuses on axial CT and inferior to the orbital rim on coronal slices. Also, the palate
Palate
The palate is the roof of the mouth in humans and other mammals. It separates the oral cavity from the nasal cavity. A similar structure is found in crocodilians, but, in most other tetrapods, the oral and nasal cavities are not truly separate. The palate is divided into two parts, the anterior...
is usually mobile on physical exam.
Classification
There are three types of LeFort fractures:Le Fort I fractures (horizontal) may result from a force of injury directed low on the maxillary alveolar rim in a downward direction. It is also known as a Guerin fracture or 'floating palate', and usually involves the inferior nasal aperture. The fracture extends from the nasal septum to the lateral pyriform rims, travels horizontally above the teeth apices, crosses below the zygomaticomaxillary junction, and traverses the pterygomaxillary junction to interrupt the pterygoid plates.
Le Fort II fractures (pyramidal) may result from a blow to the lower or mid maxilla and usually involve the inferior orbital rim. Such a fracture has a pyramidal shape and extends from the nasal bridge at or below the nasofrontal suture through the frontal processes of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor and rim through or near the inferior orbital foramen, and inferiorly through the anterior wall of the maxillary sinus; it then travels under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.
Le Fort III fractures (transverse) are otherwise known as craniofacial dissociation and involve the zygomatic arch. These may follow impact to the nasal bridge or upper maxilla. These fractures start at the nasofrontal and frontomaxillary sutures and extend posteriorly along the medial wall of the orbit through the nasolacrimal groove and ethmoid bones. The thicker sphenoid bone posteriorly usually prevents continuation of the fracture into the optic canal. Instead, the fracture continues along the floor of the orbit along the inferior orbital fissure and continues superolaterally through the lateral orbital wall, through the zygomaticofrontal junction and the zygomatic arch. Intranasally, a branch of the fracture extends through the base of the perpendicular plate of the ethmoid, through the vomer, and through the interface of the pterygoid plates to the base of the sphenoid. This type of fracture predisposes the patient to CSF rhinorrhea more commonly than the other types.
Signs and Symptoms
Lefort I - Slight swelling of the upper lip, ecchymosis is present in the buccal sulcus beneath each zygomatic arch, malocclusion, mobility of teeth. Impacted type of fractures may be almost immobile and it is only by grasping the maxillary teeth and applying little firm pressure that a characteristic grate can be felt which is diagnostic of the fracture. Percussion of upper teeth results in cracked pot sound. Guerin's sign is present characterised by ecchymosis in the region of greater palatine vessels.Lefort II and Lefort III(common)- gross edema of soft tissue over the middle third of the face,bilateral circumorbital ecchymosis,bilateral subconjunctival haemorrhage,epistaxis,CSFrhinorrhoea,dish face deformity,diplopia,enophthalmos,cracked pot sound.
Lefort II- step deformity at infraorbital margin,mobile mid face,anesthesia or paresthesia of cheek.
Lefort III
Lefort III
The Le Fort III Osteotomy is used to correct generalised growth failure of the midface involving the upper jaw nose and cheek bones . The surgical approach and post operative management is similar as for the Le Fort II procedure....
- tenderness and separation at frontozygomatic suture,lengthening of face,depression of occular levels, enophthalmos, hooding of eyes, tilting of occlusal plane with gagging on one side.