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.