In reality, the le fort classification is an oversimplification of maxillary fractures. Any information contained in this pdf file is automatically generated from digital. How to simplify the ct diagnosis of le fort fractures ajr. The le ffracturas classification system attempts to distinguish according to the plane of injury. Interrelationship of structure and function in maxillofacial fractures. Le fort 1 fractures are essentially a horizontal maxillary fracture, separating the teeth from the upper face. The approach can be simplified in this way and the injury can be thought of as bilateral zygomaticomaxillary complex fractures and a noe fracture. The le fort classification system attempts to distinguish according to the plane of injury. Pdf among the classification of maxillary fracture, the le fort classification is the bestknown categorization. Fractures of the maxillary facial bones, also described as lefort fractures, are potentially disfiguring and potentially lethal injuries that require careful examination and expectant management. A retrospective study was conducted on 12 patients with juvenile nasopharyngeal angiofibroma jna who underwent the le fort type i approach. The le fort fracture without maxillary mobility constitutes 9 percent of maxillary fractures observed over a 3year period.
Mandible fracture an overview sciencedirect topics. Resident manual of trauma to the face, head, and neck. Common to all le fort fractures is fracture of the pterygoid processes. Preoperatively, all cases were investigated with computed tomographic. A high le fort level ii or iii injury exists as a one or twopiece. Diagnosis and treatment of midface fractures pocket. Accuracy of the tongue blade test in patients with suspected mandibular fracture. Le fort fractures constitute a pattern of complex facial injury that occurs secondary to blunt facial trauma.
Le fort iii fractures transverse, also termed craniofacial dysjunctions, may follow impact to the nasal bridge or upper maxilla. A le fort iii fracture rarely exists in isolation and is instead usually a component of pan. The le fort i fracture represents separation of the roof of the mouth from the face, with the fracture extending through the alveolar ridge to the base of the nose. The le fort iii fracture is characterized by a complete dislocation of the midface from the skull.
Continuity of this structure is a keystone for stability of leforg midface, involvement of which impacts surgical management of trauma victims, as it. Anaesthesia and common oral and maxillofacial emergencies. Originally described by rene le fort in 1901, le fort fractures are specific facial bone fracture patterns that occur in the setting of blunt facial trauma most. These fractures start at the nasofrontal and frontomaxillary sutures and extend posteriorly along the medial wall of the orbit through the nasolacrimal groove and ethmoid bones.
The fracture line extends through the lateral orbital wall, the orbital floor, the medial orbital wall and the rhinobase to the contralateral side, as well as through the zygomatic arches. Associated head and neck injuries with higher grade le fort fractures. Role of le fort type i osteotomy approach in juvenile. For the purposes of the present study, a le fort 1 fracture was defined as any fracture that started at the pterygoid plate, traversed the lateral and medial buttress, and exited at the piriform aperture figure 1. Initially a combined specialty of eye, ear, nose, and throat. If more than one lefort fracture exists the fractures are named from the highest downward, i. Le fort ii and le fort iii common gross edema of soft tissue over the middle third of the face, bilateral circumorbital ecchymosis, bilateral subconjunctival hemorrhage, epistaxis, csf rhinorrhoea, dish face deformity, diplopia, enophthalmos, cracked pot sound. This fracture pattern involves the nasofrontal suture, nasal and lacrimal bones, infraorbital rim in the region of the zygomaticomaxillary suture, maxilla, and pterygoid plates. The classification of these fractures includes le fort i, ii, and iii types of fractures. Conservative nonsurgical treatment methods and classic open reductions produce aesthetic and functional results that lead to posterior and oblique positioning of the maxillary occlusal. A le fort fracture of the skull is a classic transfacial fracture of the midface, involving the maxillary bone and surrounding structures in either a horizontal, pyramidal or transverse direction. Resident manual of trauma to the face, head, and neck, 1st ed, american academy of otolyaryngology head and neck surgery, 2012. A transverse fracture is a le fort i fracture that is above the level of the apices of the maxillary teeth section, including the entire alveolar process of the maxilla, vault of the palate and. Facial fracture management handbook lefort fractures.
Trends in le fort fractures at a south american trauma. For each unilateral le fort i fracture, computed tomography images were used to map each fractures point of entry on the. The hallmark of lefort fractures is traumatic pterygomaxillary separation, which signifies fractures between the pterygoid plates, horseshoe shaped bony protuberances which extend from the inferior. Fractures of the maxillary facial bones, also described as lefort fractures, are. Although visualization of injury to the struts and buttresses of the face is. Treatment of the le fort iii fracture involves breaking the injury into facial subunits. Le fort i fracture violent force over a more extensive area above the level of the teeth will result in le fort i fracture horizontal fracture line seen above the apices of the maxillary teeth, detaching the tooth bearing portion of the maxilla from the rest of the facial skeleton. A thorough search of the worlds literature following prisma guidelines was conducted through pubmed and ebsco. Drawings show unique components of each type of le fort fracture.
It is rare for the pterygoid processes to be fractured in the ab sence of a le. In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bone dorsally. Rene le fort described the planes of injury that result from significant force to the midface. Lefort fracture orthopedics a bilateral fracture of the maxilla, which is divided into 3 types, defined by r lefort in 1901 lefort fractures i dentoalveolar dysjunction fracture lines are transverse through the pyriform aperature above the alveolar ridge and pass posteriorly to the pterygoid region. Lefort ii fractures transect the nasal bones, medialanterior orbital walls, orbital floor, inferior orbital rims and finally transversely fracture the. This structure is intact in both le fort ii and iii fractures. In le fort ii fractures, the pyramidal midface is separated from the rest of the facial skeleton and skull base. The fracture begins inferior to the nasofrontal suture. Oblique fracture crossing zygomaticomaxillary suture, inferior orbital rim, nasal bridge. B, in le fort ii fracture, inferior orbital rim arrow is broken. This fracture line travels horizontally through the midface at the level of the bridge of the nose.
Reprinted with permission from 2 a, in le fort i fracture, anterolateral margin of nasal fossa arrow is broken. The amount of force impacted during a motor vehicle accident is much greater than le fort took into consideration during his work in the late 19th century. Transverse fracture through the maxillary sinuses, lower nasal septum, pterygoid plates. Le fort s fracture of the ankle is a vertical fracture of the anteromedial part of the distal fibula with avulsion of the anterior tibiofibular ligament, opposite to a tillauxchaput avulsion fracture. Le fort fracture classification radiology reference. Le fort iii fractures are referred to as centrolateral fractures.
If a nasal fracture is suspected, then a lateral view of the nasal bone with special nasal. Portable document format pdf, suitable for downloading to a smart. The most common mechanisms of injury for these fractures, which are frequently associated with drug and alcohol use, include motor vehicle collisions, assault, and falls. Lefort fracture definition of lefort fracture by medical. Only hard palate and teeth move when rock hard palate while stabilizing forehead. Lefort medical definition merriamwebster medical dictionary. Floating palate involves a transverse fracture through the maxilla. Lefort fractures transversely disrupt the important nasomaxillary and zygomaticomaxillary bony facial buttresses in essentially all cases. Lefort classification of facial fractures uw emergency.
Facial fracture management handbook lefort fractures iowa. Le fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base. Transverse fracture separating body of maxilla from pterygoid plate and nasal septum. Le fort type i osteotomy is a fracture that extends from the pyriform aperture to each of the pterygoid plates, resulting in the detachment of the upper jaw from the cranial base. The le fort type ii fracture pattern is also referred to as a pyramidal fracture. How to simplify the ct diagnosis of le fort fractures. Resident manual of trauma to the face, head, and neck aaohns. Management of lefort fractures biomedical and pharmacology. The le fort i classification describes a fracture that extends across both. Le fort fractures types, clinical features and various types of management. Although the precise location of the le fort fracture pattern is sometimes difficult to remember, the le fort i, ii, and iii fractures can be thought of as follows see fig.
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