Le Fort fractures

Classification

1. Le Fort I
   1. Transverse fx separating body of maxilla from pterygoid plate and nasal septum
   2. Only hard palate and teeth move (when rock hard palate while stabilizing forehead)
   3. Stable fx
2. Le Fort II
   1. Pyramidal fx through central maxilla and hard palate
   2. Movement of hard palate and nose occurs, but not the eyes
   3. Can be stable or unstable fx
3. Le Fort III
   1. Craniofacial dysjunction (fx through frontozygomatic sutures, orbit, nose, ethmoids)
   2. Entire face shifts w/ globes held in place only by optic nerve)
   3. Dish face deformity on lateral view
   4. Unstable fx
4. Le Fort IV
   1. Le Fort III plus involvement of frontal bone
   2. 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