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

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
• 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

Differential Diagnosis

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Evaluation

A 3-D CT reconstruction showing a Le Fort type 1 fracture (marked by arrow).

• 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

• Maxillofacial trauma