Le Fort fractures

Background

• LeFort I fractures are isolated to the lower face
• Type II and III injuries
  • Associated with cribriform plate disruption and CSF rhinorrhea

Classification

LeFort I (red), II (blue), and III (green) fractures

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

• Le Fort fractures
• Skull fracture (peds)
• Auricular hematoma
• Nasal fracture
  • Nasal septal hematoma
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Dental trauma
• Mandible fracture

Orbital trauma

Acute

• Ruptured Globe^
• Corneal Abrasion
• Ocular foreign body
• Conjunctival laceration
• Caustic Keratoconjunctivitis^^
• Subconjunctival hemorrhage
• Traumatic iritis
• Traumatic hyphema
• Retinal detachment
• Retrobulbar hemorrhage/hematoma
• Traumatic mydriasis
• Orbital fracture
  • Frontal sinus fracture
  • Naso-ethmoid fracture
  • Inferior orbial wall fracture
  • Medial orbital wall fracture

Subacute/Delayed

• Endophthalmitis^
• Corneal Ulcer^

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 with nasal and oral packing if needed
• Admit for IV antibiotics and surgery

See Also

• Maxillofacial Trauma

References

Authors

Ross Donaldson, Aaron Snyder, Matthew Hankerson, Silas Chiu, Daniel Ostermayer, Neil Young, Claire