The patient is prepped and draped to include both the oral cavity and the maxillofacial skeleton. The le fort classification system attempts to distinguish according to the plane of injury. Le fort i fracture violent force over a more extensive area above the level of the teeth will result in le fort i fracture horizontal fracture line seen above the apices of the maxillary teeth, detaching the tooth bearing portion of the maxilla from the rest of the facial skeleton. How to simplify the ct diagnosis of le fort fractures. Le fort fractures belong the central le fort i and ii and centrolateral le fort iii fractures of the midface. The nasal bone b is fractured along the nasofrontal suture in le fort types ii and iii. Anaesthesia and common oral and maxillofacial emergencies. Patients with facial fractures are commonly encountered in the speciality of maxillofacial surgery whereas patients with supernumerary teeth like mesiodens are a rare entity. There is no fracture of the zygomatic arch or lateral orbital walls, excluding a le fort iii fracture. Orthodontic management of a le fort ii and midline palatal. A le fort fracture is a fracture of the midface that result in the separation of all or a portion of the midface from the skull base. In all three levels of le fort fractures, a pterygoid plate fracture is seen.
It explains the features and options of the ao cmf classification system. Le fort fracture definition, fracture types, and symptoms. Le fort fractures constitute a pattern of complex facial injury that occurs secondary to blunt facial trauma. Technique for rigid fixation of le fort and palatai fractures. The numerous components seen in the le fort fractures make classification difficult. Department of oral and maxillofacial surgery, rutgers university school of dental medicine, camden, new jersey, usa. Imaging in rheumatology pdf download imaging in pediatric skeletal trauma pdf download. The management of facial fractures begins with the establishment of an. In patients with facial trauma, multidetector computed tomography is the firstchoice imaging test because it can detect and characterize even small fractures and their associated complications quickly and accurately. The standard oral route for tracheal intubation may not be possible because of the limiting mouth opening in cases with posteroinferior displacement of the fractured maxilla and bilateral fracture of the anterior mandible. A transverse fracture is a le fort i fracture that is above the level of the apices of the maxillary teeth section, including the entire alveolar process of the maxilla, vault of the palate and. This paper intends to report a case of le fort ii fracture in. Sports like football, baseball and hockey account for a high percentage of facial injuries among young adults. Facial trauma, maxillary and le fort fractures author.
The association of a mesiodens with a le fort fracture is a rare finding. Oblique fracture crossing zygomaticomaxillary suture, inferior orbital rim, nasal bridge. The fracture extends from the nasal septum to the lateral pyriform rims, travels horizontally above the teeth apices, crosses below the zygomaticomaxillary junction, and traverses the pterygomaxillary junction to interrupt the pterygoid plates. The fracture occurs at the level of the piriform aperture and involves the anterior and lateral walls of the maxillary sinus, lateral nasal walls and, by definition, pterygoid plates. Maxillary fractures are associated with a relatively high rate of complications, probably as a result of the highenergy nature of. Cmtr91003 body fracture traversing anterior transition zone. It is the panfacial fracture that occurs in the midfacial region and involves the maxillary bone and surrounding structures in the horizontal, pyramidal or transverse direction. The finding of a pterygoid plate fracture unilaterally or bilaterally should alert the clinician to the possibility of a le fort fracture fig. These fractures were named by rene le fort, a french surgeon in 1901 who took intact cadavers and caused forceful blunt trauma to the skulls. Le fort fractures american academy of ophthalmology. Initially a combined specialty of eye, ear, nose, and throat.
Murr, in complications in head and neck surgery second edition, 2009. An electronic fracture case collection complements the tutorial papers. Maxillofacial fractures 1 ct is both the stateoftheart and the. A le fort ii fracture also involves a fracture through the orbital rim and floor, as seen at the medial extent of most zmc fractures, whereas a le fort iii involves a fracture of the zygomaticfrontal and zygomaticsphenoid junctions, as seen at the lateral and posterior extent of most zmc fractures. Download le fort fracture of skull medical presentation. Le fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base. Our objective is to simplify the task of classifying le fort fractures. Our case is the first report of le fort ii fracture from bahrain. Treating fractures in the field introduction one of the more common injuries on a battlefield or in everyday life is a fracture. Bahrain, computed tomography, facial bones, le fort fracture.
The classical description of le fort fractures is based on a symmetric arrangement of the fracture lines on the right and left side. A dacryolith is a rare finding and can be considered as a complication of a le fort i fracture. Handbook of fractures pdf latest edition free download ebook. In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bone dorsally.
Fractures are typically reduced and fixated with a bottom. If you have a good le fort fracture of skull medical presentation, upload the same on for a worthy audience and credits to download le fort fracture of skull powerpoint templates along with other premium content. The maxilla represents the bridge between the cranial base superiorly and the dental occlusal plane inferiorly. Kris s moe, md, facs, chief, division of facial plastic and reconstructive surgery, department of otolaryngologyhead and neck surgery, university of washington school of medicine. The most common mechanisms of injury for these fractures, which are frequently associated with drug and alcohol use, include motor vehicle collisions, assault, and falls. Fracture above the zygomatic arch, through the lateral and medial orbital walls and. Histology a text and atlas pdf book download netters atlas of human anatomy pdf download. Pdf among the classification of maxillary fracture, the le fort classification is the bestknown categorization. Diagnosis and treatment of midface fractures pocket. Did you know that facial fractures are a common occurrence in car accidents a le fort fracture type ii is one of several types of facial fractures suffered in serious motor vehicle collisions and is considered a traumatic injury what is a le fort fracture ii. The hallmark of lefort fractures is traumatic pterygomaxillary separation, which signifies fractures between the pterygoid plates, horseshoe shaped bony protuberances which extend from the inferior. Lefort classification of facial fractures uw emergency. This is especially true in the case of le fort ii and iii fractures.
Technique for rigid fixation of le fort and palatai fractures joms. Clinical associate professor of surgery, division of head and neck surgery, university. Resident manual of trauma to the face, head, and neck. Its intimate association with the oral cavity, nasal cavity, and orbits and the multitude of structures contained within and adjacent to it make the maxilla a functionally and cosmetically important structure. There are bilateral le fort ii fractures as the inferior orbital walls are fractured. Transverse fracture through the maxillary sinuses, lower nasal septum, pterygoid plates. The diagnosis of le fort ii fracture was made, which was repaired surgically by. Le fort type i fractures are caused by a force delivered above the apices of the teeth.
Pdf le fort fractures constitute a pattern of complex facial injury that occurs secondary to blunt facial trauma. Le fort i fracture lcm and nasal bone involvement collection id. Isolated le fort i, ii, and iii fractures are very rare. Le fort fractures types, clinical features and various types of management. Mesiodens is seen as a supernumerary tooth between the maxillary central incisors. Originally described by rene le fort in 1901, le fort fractures are specific facial bone fracture patterns that occur in the setting of blunt facial trauma most. Knowing this information can help you on test questions and in the field when you hear someone refer to it. Throat packs should be removed at the end of the operation and the oropharynx suctioned for debris and clots. This video is a basic class on lefort fracture of the maxilla, its mangement and outcome. Although usually not immediately lifethreatening, serious fractures can be fatal if not properly treated.
This subcourse discusses the procedures for immobilizing fractures. The other causes of facial fractures including midface trauma indicated in the literature are assaults, falls, sport injuries. Tintinalli je, stapczynski j, ma o, yealy dm, meckler gd, cline dm. The ethmoid bone a is involved in le fort type iii fractures. Le fort fracture classification radiology reference. Le fort iii fractures involvingnasoethmoidal region lateral view. Lowvelocity mechanism fall from standing, blunt trauma resulted in the majority of le fort i fractures 56%. In this case, there are bilateral le fort i fractures as there are fractures bilaterally of the anterolateral margin of the nasal fossa. We found a susprisingly equal number of fracture incidents during the different periods of time, but a decreasing number of maxillary fractures of type le fort i. Alveolar and dental fractures were not included in our series, since they are usually managed in the outpatient setting 1,2. View and download powerpoint presentations on lefort fracture ppt.
Those kinds of fractures are very common in children. Le fort i fractures horizontal may result from a force of injury directed low on the maxillary alveolar rim in a downward direction. Airway management in a patient with le fort iii fracture. A le fort fracture of the skull is a classic transfacial fracture of the midface, involving the maxillary bone and surrounding structures in either a horizontal, pyramidal or transverse direction. Le fort fractures require admission and usually surgical repair. Each le fort fracture level has one unique fracture different from. It has helped clinical management and surgical planning, so radiologists must communicate their findings to surgeons effectively. The handbook of fractures pdf 3rd edition includes the following sections with. Extubation should be planned as prudently as intubation, bearing in mind that the degree of oedema can worsen in the first 48 h after the injury.
A case of dacryolith and nasolacrimal duct obstruction after surgery for a le fort i fracture is described, and the reasons for and prevention of this condition are discussed. Find powerpoint presentations and slides using the power of, find free presentations research about lefort fracture ppt. The diagnosis of this case was unusual since there was no le fort i fracture, the right le fort ii fracture was minimally displaced and the palatal fracture was not. Although le fort type i involves injury to the nasal septum, it does not involve the nasal bone.
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