Le Fort fractures: Difference between revisions
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==Classification== | ==Classification== | ||
{| class="wikitable" style="float:right; margin-left: 10px;" | |||
| align="center" style="background:#f0f0f0;"|'''Le Fort Fracture''' | |||
| align="center" style="background:#f0f0f0;"|'''Front View''' | |||
| align="center" style="background:#f0f0f0;"|'''Side View''' | |||
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|Type I||[[File:LeFort1e.png|120px]]||[[File:LeFort1a.png|150px]] | |||
|- | |||
|Type II||[[File:LeFort2b.png|120px]]||[[File:LeFort2a.png|150px]] | |||
|- | |||
|Type III||[[File:LeFort3b.png|120px]]||[[File:LeFort3a.png|150px]] | |||
|} | |||
===Le Fort I=== | ===Le Fort I=== | ||
*Transverse fracture separating body of maxilla from pterygoid plate and nasal septum<ref name="tintinalli">Tintinalli 7th Edition, pgs 1730-1738</ref> | *Transverse fracture separating body of maxilla from pterygoid plate and nasal septum<ref name="tintinalli">Tintinalli 7th Edition, pgs 1730-1738</ref> | ||
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*Le Fort III plus involvement of frontal bone | *Le Fort III plus involvement of frontal bone | ||
*Unstable fracture | *Unstable fracture | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 05:43, 10 May 2019
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
| Le Fort Fracture | Front View | Side View |
| Type I |  |
|
| Type II |  |
|
| Type III |  |
|
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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
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
- ↑ Tintinalli 7th Edition, pgs 1730-1738