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. 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. It is usually identified by the fraction between the pterygoid plates known as pterygomaxillary separation. Pterygoid plates are the horseshoe-shaped bony protuberances that are located at the inferior margin of the maxilla and maxillary sinuses.
Types of Le Fort Fractures
On the basis of the affected area, there are three forms of a Le Fort fracture. Le Fort type I fracture is associated with the lower face while the Le Fort type II and Le Fort type III fractures are related to cribriform plate disruption and CSF rhinorrhea.
Le Fort I Fracture (Floating Palate)
A stable transverse fracture that separates the body of maxilla from the pterygoid plate and nasal septum is referred as Le Fort I fracture. It might occur due to a force of injury directed on the lower part of the maxillary alveolar rim or upper dental row, downwards.
The Le Fort type I fracture is associated with the pterygoid plate and lateral bony margin of the nasal opening. Also, the medial and lateral buttresses of the maxillary sinus are involved in this type of fracture. This is also known as Guerin fracture which involves the movement of hard palate and teeth.
Le Fort Type II Fracture
The Le Fort type II fractures are the stable or unstable pyramidal fractures that arise on the central maxilla and hard palate. In this type of fracture, only the nose, and the hard palate move but eyes do not.
A blow to the mid or lower maxilla can result in a fracture of pyramid shape that involves the pterygoid plate and the inferior orbital rim that is referred as Le Fort type II fracture. The fracture extends from or below the nasofrontal suture at the nasal bridge through the superior medial wall of the maxilla.
Le Fort Type III Fracture
Le Fort type III fractures are the unstable fractures that illustrate face deformity on the lateral view. It occurs through frontozygomatic sutures, orbit nose, and ethmoids. In such type of fracture, the entire face shifts except the optic nerve holding the globes in place.
Exposure to a considerable amount of force can result in Le Fort fracture. Usually, the motor vehicle accidents, assaults and falls are the predominant cause for this type of fracture.
Le Fort I Fracture Symptoms
- Slight swelling of the upper lip and mobility of teeth
- Floating Maxilla
- Impacted or Telescopic fracture
- Anterior open bite Disturbed occlusion
- Midpalatal split
- Damaged or subluxed teeth
Le Fort II Fracture Symptoms
- Ballooning or moon face
- Deformity at the infraorbital margin
- Mobile midface
- Black eye
- Anesthesia or paresthesia of cheek
- Subconjunctival ecchymosis Oedema of the conjunctiva
Le Fort II Fracture Symptoms
- Tenderness and distinction at frontozygomatic suture
- Face lengthening
- Depression of ocular levels
- Gagging on the sides of injury due to the tilting of the occlusal plane between the edges of the incisions and tips of the posterior teeth
- Hooding of eyes
Diagnosis and Treatment
For the diagnosis of such fracture, a physical exam is conducted to check the mobility of hard and soft palate of the midface with respect to the remainder of facial structures. Usually, a radiograph or CT scan is suggested for detecting the fracture. Surgical treatment is recommended for this fracture which requires extraordinary care to avoid drastic, permanent dis-figuration in and around the jaw area.