LE FORT FRACTURES
LE FORT FRACTURES
FRACTURES
MODERATOR : DR RAJANIKANTH BR
PRESENTER : AMRUTA T ACHAR
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CONTENTS
• INTRODUCTION.
• ETIOLOGY.
• ANATOMY OF MIDFACE.
• CLASSIFICATION.
• LEFORT-I FRACTURES.
• LEFORT-II FRACTURES.
• LEFORT-III FRACTURES.
• COMPLICATIONS AFTER TREATMENT OF MIDFACE FRACTURES.
• EMERGING TECHNIQUES FOR MANAGEMENT.
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INTRODUCTION
frontal bone to level of upper teeth (in edentulous arches, upto alveolar
ridge)
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ETIOLOGY
• Any severe trauma can cause a fracture of the middle third of the facial
skeleton.
Assault
Sports Injuries
Workplace Hazards
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ANATOMY
• Midfacial complex is constructed of a series of vertical pillars that
primarily provide protection from vertically directed forces.
• Behind this buttress system, sits the medial and lateral pterygoid plates
inferiorly and skull base superiorly.
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ANATOMY
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ANATOMY
• The middle third of facial skeleton is made up of the following bones:
Two maxillae
Two Zygomatic bones
Two Zygomatic process of Temporal bones
Two Palatine bones
Two Nasal bones
Two Lacrimal bones
Vomer
Ethmoid with attached Conchae
Two Inferior Conchae
Pterygoid plates of Sphenoid
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ANATOMY
area of the nose and paranasal sinuses to the base of the skull.
direction.
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ANATOMY
PHYSICAL CHARACTERISTICS OF MIDFACE SKELETON
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CLASSIFICATION
ERICHS (1942) CLASSIFICATION OF LEFORT FRACTURES
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CLASSIFICATION
LE FORT CLASSIFICATION
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CLASSIFICATION
LE FORT CLASSIFICATION MODIFICATION BY MARCIANI
• LE FORT I : Low maxillary fracture
LE Fort I (a) : LE fort I + Multiple Segments
• The frontal area and supraorbital rim is examined first, with progression
• Periorbital edema and ecchymosis are often initial signs of orbital trauma .
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GENERAL EXAMINATION
FACIAL EXAMINATION
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GENERAL EXAMINATION
FACIAL EXAMINATION
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GENERAL EXAMINATION
RADIOGRAPHIC EXAMINATION
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GENERAL EXAMINATION
RADIOGRAPHIC EXAMINATION
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MCGREGOR-CAMPBELL LINES
These lines were described by McGregor and Campbell for ease of searching on an
occipitomental view 10-degree frontal projection.
1. First line = across the zygomaticofrontal, the superior margin of the orbit and the frontal
sinus.
2. Second line = across the zygomatic arch, zygomatic body, inferior orbital margin and nasal
bone
3. Third line = across the condyles, coronoid process and the maxillary sinus / Zygomatic
buttress region
5. Fifth line (Trapnell’s line, added later) across the inferior border of the mandible from
angle to angle
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MCGREGOR-CAMPBELL LINES
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DOLAN’S LINES
• Three lines described by Dolan and Jacoby that aid in evaluating for maxillofacial
fractures on an occipitomental skull radiograph.
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DOLAN’S LINES
Orbital line (line 1): traces the inner margins of the
lateral, inferior and medial orbital walls and the nasal
arch.
In PNS view, the following four features are to be verified/compared with the
unaffected side (4 S’s described by Delbalso, Hall and Margarone)
1. Symmetry
2. Sharpness
3. Sinus
4. Soft tissues
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LE FORT I
FRACTURE LINES
• Fracture line extends backwards from the lateral margin of the anterior
nasal aperture below the zygomatic buttress to cross the lower third of
• It also passes along the lateral wall of the nose and the lower third of
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LE FORT I
SIGNS AND SYMPTOMS
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LE FORT II
FRACTURE LINES
• Fracture extends from the thin middle area of the nasal bones down
either side, crossing the frontal processes of the maxillae into the
• Within each orbit, fracture line crosses lacrimal bone behind lacrimal
with base of skull and involves full depth of ethmoid bone including
cribriform plate.
• Within the orbit, the fracture passes below optic foramen, into posterior
• CSF rhinorrhea
• Hematoma in palate. 31
SIGNS AND SYMPTOMS
PECULIAR TO LEFORT II
FRACTURES
• Step deformity at infraorbital margins.
• Mobility of midface detectable at nasal bridge and infra-orbital margins.
• Anesthesia/Paresthesia of cheek.
• Possible diplopia.
• CSF rhinorrhoea may not be clinically detectable.
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SIGNS AND SYMPTOMS
PECULIAR TO LEFORT III
FRACTURES
• Tenderness and separation at frontozygomatic suture.
• Lengthening of face.
• Enophthalmos.
• Hooding of eyes.
• Battle’s sign
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MANAGEMENT OF LE
FORT FRACTURES
GENERAL PRINCIPLES OF TREATMENT
REDUCTION :
LEFORT I
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT II
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT III
Upper part of central midfacial fracture can be usually reduced via same
approach.
After main fragments of central block have been fixed, NOE fractures
are treated.
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MANAGEMENT OF LE
FORT FRACTURES
REDUCTION BY TRACTION
1. DIRECT OSTEOSYNTHESIS
TRANSOSSEOUS WIRING
TRANSFIXATION WITH
A. HIGH LEVEL KIRSCHNER
MINIPLATES
B. MID LEVEL WIRE/STEINMANN PIN
C. LOW LEVEL A. TRANSFACIAL
B. ZYGOMATIC-SEPTAL
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MANAGEMENT OF LE
FORT FRACTURES
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MANAGEMENT OF LE
FORT FRACTURES
IMMOBILIZATION OF LEFORT FRACTURES
Internal Wire Suspension – Involves connecting the lower jaw by wires within the
tissue to areas of facial skeleton above fracture line so sandwiching the fractured
portion between mandible and that part of facial skeleton which is not inbolved in
fracture.
1. SUSPENSION WIRES
TO MANDIBLE
FRONTAL-CENTRAL/
INFRAORBITAL PYRIFORM APERTURE
LATERAL ZYGOMATIC
CIRCUMZYGOMATIC
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MANAGEMENT OF LE
FORT FRACTURES
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MANAGEMENT OF LE
FORT FRACTURES
IMMOBILIZATION OF LEFORT FRACTURES
EXTERNAL FIXATION
1. CRANIOMANDIBULAR CRANIOMAXILLARY
A. BOX FRAME A. SUPRAORBITAL PINS SUSPENSION BY CHEEK WIRES
B. HALO FRAME B. ZYGOMATIC PINS FROM HALO-FRAME OR
C. PLASTER OF PARIS HEADCAP C. HALO FRAME HEADCAP
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MANAGEMENT OF LE
FORT FRACTURES
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT I
• Early reduction of Le Fort type I injuries presents minimal difficulty but, beyond 7
to 10 days, increasing amounts of force are required because of the natural
healing process.
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT I
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT I
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT II
• However, the orbital floor, inferior orbital rim, or nasofrontal region often
requires exploration and repair. In these situations, additional access is required.
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT II
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT III
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.
MANAGEMENT OF LE
FORT FRACTURES
LEFORT III
• Once the outer framework has been established, one can proceed to
reconstruct, in order, the nasal skeleton and floors of the orbits, correct any
lacrimal system disorders, and reestablish the proper positioning of the medial
canthal ligaments.
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT III
• Marciani and Gonty have summarized the four factors contributing to positive
outcomes following reconstruction of craniomaxillofacial trauma.
• These are early definitive treatment, anatomic and functional repair of NOE
injuries, wide exposure of fractured segments, and anatomic repositioning
and stable fixation in all planes.
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MANAGEMENT OF LE
FORT FRACTURES
LEFORT III – SURGICAL APPROACH
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
MALUNION OF MIDFACE FRACTURES
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
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COMPLICATIONS AFTER
TREATMENT OF MIDFACIAL
FRACTURES
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EMERGING TECHNIQUES
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TO SUMMARIZE
• A number of surgical approaches are present for fracture fixation and the
surgeon’s skill and experience will determine the best approach for the same.
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