Anatomy and Classification of Le Fort Fractures
- The face is divided into thirds: lower, middle, and upper.
- The middle third, or midface, includes various bones and structures.
- The maxillary bone contains important anatomical structures.
- The infraorbital nerve provides sensation to the central face.
- Facial biomechanics play a role in midface reconstruction.
- Le Fort fractures were originally described by René Le Fort.
- The low-speed fracture patterns originally described may not always apply today.
- The Le Fort classification is still used for communication and treatment planning.
- Modern midface fractures often occur in combination with other craniofacial trauma.
- Le Fort fractures are categorised into three types: I, II, and III.

History, Evaluation, and Diagnosis of Le Fort Fractures
- Le Fort conducted experiments on cadavers to study facial trauma.
- Advances in motor vehicle accidents and medical techniques have changed fracture patterns.
- The Le Fort classification is used as a starting point for describing midface fractures.
- It is used for communication, documentation, and treatment planning.
- Modern midface fractures may not fit neatly into one of the Le Fort types.
- Initial evaluation follows the ABCs (airway, breathing, circulation) protocol.
- Le Fort fractures can obstruct the airway and require emergency management.
- Other life-threatening injuries should be evaluated by the appropriate specialist.
- A surgeon specializing in facial trauma performs a thorough facial exam.
- Facial swelling and bruising can make evaluation challenging.
- History and physical exam can suggest a diagnosis, but imaging is necessary for accuracy.
- Computed tomography (CT) of the face and skull is the preferred imaging modality for diagnosing Le Fort fractures.
- CT imaging is more effective than plain x-ray in detecting fractures.
- Magnetic resonance imaging (MRI) is less useful for visualizing skeletal injuries in Le Fort fractures, but may be helpful for assessing soft tissue injuries.
- Extensive soft tissue injuries may require the use of MRI.

Signs and Further Evaluation for Le Fort Fractures
- If a tooth is lost during trauma, its location should be identified to prevent complications.
- Abnormalities in vision or pupillary response require evaluation by a neurosurgeon and ophthalmologist.
- Skull base injuries can result in a cerebrospinal fluid (CSF) leak.
- Clear liquid draining from the nose or ear may indicate a CSF leak.
- Suspicion of a CSF leak requires further evaluation.

Surgical Treatment and Goals of Intervention for Le Fort Fractures
- Surgical treatment is usually required for Le Fort fractures, especially if they are displaced or affect facial functions.
- Maxillomandibular fixation (MMF) and/or open reduction and internal fixation (ORIF) are commonly used surgical techniques.
- MMF involves fixing the upper and lower teeth in their correct position to re-establish occlusion.
- ORIF is an open surgical repair of broken bones, often used for unstable facial buttresses.
- Bone grafts may be necessary for stabilizing the facial bones.
- The primary goal of intervention is to restore the patient's ability to eat and speak.
- Occlusion (alignment of upper and lower teeth) and facial biomechanics must be re-established to support chewing.
- Restoring cosmetic deformities is a secondary goal, but should not be prioritised over occlusion.
- Other goals include improving facial symmetry and minimizing long-term complications.
- The specific goals of intervention may vary depending on the individual patient's needs and injuries.

Maxillomandibular Fixation (MMF) and Open Reduction and Internal Fixation (ORIF)
- MMF is a surgical procedure to re-establish occlusion by fixing the upper and lower teeth in their correct position.
- Various surgical techniques exist for establishing MMF, depending on the patient's injury and surgeon's preference.
- MMF restricts the patient's ability to speak, eat, breathe through their mouth, and maintain oral hygiene.
- Patients in MMF require a liquid-only diet and may experience weight changes.
- MMF may not be suitable for patients with a history of pulmonary disease, psychological disorders, or seizure disorders.
- ORIF is an open surgical repair of broken bones, commonly used for complex Le Fort fractures.
- It is especially important for repairing unstable facial buttresses to restore chewing function.
- Plates and screws are often used to stabilize the facial bones.
- Bone grafts may be required to further stabilize the buttresses.
- Recovery time after ORIF surgery may take up to six weeks before the patient can resume normal activities.