LE FORT FRACTURES
HEM - 2021
ANATOMY
• Upper Third
• Frontal bones
• Middle Third
• Zygomas, orbits, maxillae, nasal bones
• Lower Third
• Mandible
Kühnel, T. S., & Reichert, T. E. (2015). Trauma of the midface. GMS current topics in
otorhinolaryngology, head and neck surgery, 14, Doc06.
https://doi.org/10.3205/cto000121
LE FORT
• Le Fort I
• Horizontal maxillary fx
• Le Fort II
• Pyramidal fx
• Le Fort III
• Complete craniofacial separation
Kühnel, T. S., & Reichert, T. E. (2015). Trauma of the midface. GMS current topics in
otorhinolaryngology, head and neck surgery, 14, Doc06.
https://doi.org/10.3205/cto000121
Patterson R. (1991). The Le Fort fractures: René Le Fort and his work in anatomical
pathology. Canadian journal of surgery. Journal canadien de chirurgie, 34(2), 183–184.
LE FORT AP VIEW
LE FORT 1
• Le Fort I (low level or Guerian fracture)
• Unilateral/ bilateral
Horizontal fracture through the maxilla above the level of the
nasal floor and alveolar process
• Piriform rims
• Anterior maxilla
• Zygomatic buttresses
• Ptrygoid laminae
Kühnel, T. S., & Reichert, T. E. (2015). Trauma of the midface. GMS current topics in
otorhinolaryngology, head and neck surgery, 14, Doc06.
https://doi.org/10.3205/cto000121
Phillips, B. J., & Turco, L. M. (2017). Le Fort Fractures: A Collective Review. Bulletin of
emergency and trauma, 5(4), 221–230. https://doi.org/10.18869/acadpub.beat.5.4.499.
SIGNS AND SYMPTOMS
• Slight swelling of upper lip
• Ecchymosis in upper lip sulcus
• Hematoma intra-orally over zygoma and in palate
• Disturbed occlusion
• Mobility of teeth of the involved segment of maxilla
• Combination of soft tissue laceration
• Impacted type of fracture is oftenly not mobile and teeth cusps may be damaged
LE FORT 1
LE FORT II
• Le Fort II
(pyramidal or subzygomatic)
Separation of NF suture, medial orbital walls
(lacrimal bone), inferior orbital floor and rim
(adjacent to infrorbital canal and foramen), anterior
maxilla below zygomatic buttress and ptrygoid
laminae about halfway up.
Separation of the block from the base of skull
is completed via the nasal septum and may
involve the floor of the anterior cranial fossa
Kühnel, T. S., & Reichert, T. E. (2015). Trauma of the midface. GMS current topics in
otorhinolaryngology, head and neck surgery, 14, Doc06.
https://doi.org/10.3205/cto000121
Phillips, B. J., & Turco, L. M. (2017). Le Fort Fractures: A Collective Review. Bulletin of
emergency and trauma, 5(4), 221–230. https://doi.org/10.18869/acadpub.beat.5.4.499.
LE FORT II
LE FORT III
• LeFort III
(cranifacial dysjunction, high transverse, suprazygomatic)
Separation of NF suture, medial orbital walls
(involve the depth of the ethmoid bone and
cribriform plate, pass below optic foramen and cross
the inferior orbital fissur), inferior orbital floor,
lateral orbital wall, ZF suture, zygomatic arch,
suprazygomatic to the root of ptrygoid plate.
Kühnel, T. S., & Reichert, T. E. (2015). Trauma of the midface. GMS current topics in
otorhinolaryngology, head and neck surgery, 14, Doc06.
https://doi.org/10.3205/cto000121
Phillips, B. J., & Turco, L. M. (2017). Le Fort Fractures: A Collective Review. Bulletin of
emergency and trauma, 5(4), 221–230. https://doi.org/10.18869/acadpub.beat.5.4.499.
LE FORT III
SIGNS AND SYMPTOMS
ALTHOUGH IT IS POSSIBLE TO DISTINGUISH BETWEEN LE
FORT II AND III, THE SIGNS AND SYMPTOMS ARE ALMOST
•SIMILAR
Gross edema of soft tissue • Difficulty in mouth opening
• Bilateral circumorbital ecchymosis • Mobility of the upper jaw
• Bilateral subconjunctival hemorrahge • Occusional hematoma of the palate
• Obvious deformity of the nose • Cracked-pot sound on percussion
• Nasal bleeding and obstruction
• Step deformity at infra-orbital margin
• CSF leak rhinorrhea
• Anasthesia of midface
• Dish-face deformity
• Limitation of ocular movement
• Nasal bone moves with mid-face as a whole
• Possible diplopia and enophthalmous • Tenderness and sepration at FZ suture
• Retropostioning of the maxilla with anterior • Tenderness and deformity of zygomatic arch
open bite • Depression of occular level and pseudoptosis
• Lengthening of the face
Kim, H. S., Kim, S. E., & Lee, H. T. (2017). Management of Le Fort I fracture. Archives
of craniofacial surgery, 18(1), 5–8. https://doi.org/10.7181/acfs.2017.18.1.5
Patel BC, Wright T, Waseem M. Le Fort Fractures. [Updated 2021 Feb 25]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK526060/
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