Le Fort fractures: Difference between revisions
Ostermayer (talk | contribs) (→Source) |
Ostermayer (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*LeFort I fractures are isolated to the lower face | *LeFort I fractures are isolated to the lower face | ||
*Type II and III injuries<ref>Tintinalli 7th Edition, pgs 1730-1738</ref> | *Type II and III injuries<ref name="tintinalli">Tintinalli 7th Edition, pgs 1730-1738</ref> | ||
**Associated with cribriform plate disruption and CSF rhinorrhea | **Associated with cribriform plate disruption and CSF rhinorrhea | ||
| Line 7: | Line 7: | ||
[[File:SchaedelSchraegLeFort123.png|thumb|LeFort I (red), II (blue), and III (green) fractures]] | [[File:SchaedelSchraegLeFort123.png|thumb|LeFort I (red), II (blue), and III (green) fractures]] | ||
===Le Fort I=== | ===Le Fort I=== | ||
*Transverse fx separating body of maxilla from pterygoid plate and nasal septum<ref> | *Transverse fx separating body of maxilla from pterygoid plate and nasal septum<ref name="tintinalli"></ref> | ||
*Only hard palate and teeth move (when rock hard palate while stabilizing forehead) | *Only hard palate and teeth move (when rock hard palate while stabilizing forehead) | ||
*Stable fx | *Stable fx | ||
Revision as of 11:36, 29 April 2015
Background
- LeFort I fractures are isolated to the lower face
- Type II and III injuries[1]
- Associated with cribriform plate disruption and CSF rhinorrhea
Classification
Le Fort I
- Transverse fx 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 fx
Le Fort II
- Pyramidal fx through central maxilla and hard palate
- Movement of hard palate and nose occurs, but not the eyes
- Can be stable or unstable fx
Le Fort III
- Craniofacial dysjunction (fx through frontozygomatic sutures, orbit, nose, ethmoids)
- Entire face shifts w/ globes held in place only by optic nerve)
- Dish face deformity on lateral view
- Unstable fx
Le Fort IV
- Le Fort III plus involvement of frontal bone
- Unstable fx
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
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