LE FORTS FRACTURES

LeFort I fractures are isolated to the lower face

Type II and III injuries[1]

Associated with cribriform plate disruption and CSF rhinorrhea

Classification:

Le Fort I

Transverse fx separating body of maxilla from pterygoid plate and nasal septum[2]

Only hard palate and teeth move (when rock hard palate while stabilizing forehead)

Stable fx

Le Fort II

Pyramidal fx through central maxilla and hard palate

Movement of hard palate and nose occurs, but not the eyes

Can be stable or unstable fx

Le Fort III

Craniofacial dysjunction (fx through frontozygomatic sutures, orbit, nose, ethmoids)

Entire face shifts w/ globes held in place only by optic nerve)

Dish face deformity on lateral view

Unstable fx

Le Fort IV

Le Fort III plus involvement of frontal bone

Unstable fx

Differentials:

Maxillofacial Trauma

Le Fort fractures

Skull fracture (peds)

Orbital trauma

Globe rupture

Orbital fracture

Frontal sinus fracture

Naso-ethmoid fracture

Inferior orbial wall fracture

Medial orbital wall fracture

Orbital hematoma

Traumatic Hyphema

Retinal detachment

Nasal fracture

Zygomatic arch fracture

Zygomaticomaxillary (tripod) fracture

Dental trauma

Mandible fracture

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 w/ nasal and oral packing if needed

Admit for IV abx and sx