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 categorized 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 prioritized 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.
The Le Fort (or LeFort) fractures are a pattern of midface fractures originally described by the French surgeon, René Le Fort, in the early 1900s. He described three distinct fracture patterns. Although not always applicable to modern-day facial fractures, the Le Fort type fracture classification is still utilized today by medical providers to aid in describing facial trauma for communication, documentation, and surgical planning. Several surgical techniques have been established for facial reconstruction following Le Fort fractures, including maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF). The main goal of any surgical intervention is to re-establish occlusion, or the alignment of upper and lower teeth, to ensure the patient is able to eat. Complications following Le Fort fractures rely on the anatomical structures affected by the inciding injury.
