Fractures of the maxillary facial bones, also described as lefort fractures, are potentially disfiguring and potentially lethal injuries that require careful examination and expectant management skills. Find powerpoint presentations and slides using the power of, find free presentations research about lefort fracture. Bahrain, computed tomography, facial bones, le fort fracture. Anterior a and lateral b views of a le fort i fracture red. 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.
So malocclusion is an important sign in diagnosing the le fort fractures. Lefort fracture free download as powerpoint presentation. Pathologic fractures are those caused by disease such as cancer that weakens the bones and can occur with little or no trauma. Le fratture di lefort anche scritto come le fort sono fratture tipiche nei traumi facciali. The classical description of le fort fractures is based on a symmetric arrangement of the fracture lines on the right and left side. Isolated le fort i, ii, and iii fractures are very rare. The management of midfacial fractures includes the treatment of facial fractures, dentoalveolar trauma, and softtissue injuries, as well as associated injuries, mainly of the head and neck 1. Conversely, if the ct scan does not reveal pterygoid fractures, the le fort fractures can be excluded 3. A total of 94 patients therefore completed the study. The occurrence of such combination of fractures represents a challenge for the maxillofacial surgeon due to the great index of comminuted and displacement fragments. However, the zygoma is roughly the equiva lent of a foursided pyramid because of its articulation with the frontal, temporal, and sphenoid bones and the maxilla. This is especially true in the case of le fort ii and iii fractures.
The classification of these fractures includes le fort i, ii, and iii types of fractures. 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. The le fort classification system attempts to distinguish according to the plane of injury. Facial trauma, maxillary and le fort fractures author. The purpose of this pictorial essay is to illustrate the use of these unique components to easily and quickly identify which type of le fort fracture is present. Airway management in a patient with le fort iii fracture. After the establishment of maxillomandibular fixation mmf, the mandible is internally fixated prior to fixation of the le fort fractures. Fractures of the zygomatic complex may involve one or.
Although visualization of injury to the struts and buttresses of the face is. Fractures are usually caused by a fall, blow, or other traumatic event. Le fort i linear fracture le fort i with unilateral comminution with or without defect le fort i with bilateral comminution with or without defect le fort i. Establishing maxillarymandibular relationships in edentulous fractures, therefore, seems to have the same importance as establishing occlusion in dentulous patients as an. If there is a bilateral pterygoid fracture, a le fort fracture is likely present.
Epistaxis is a common sign in all three patterns of le fort fractures. The role of postoperative prophylactic antibiotics in the. Fractures commonly happen because of car accidents, falls, or sports injuries. 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. Our case is the first report of le fort ii fracture from bahrain. If the broken bone punctures the skin, it is called an open or compound fracture. 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. Le fort fractures belong the central le fort i and ii and centrolateral le fort iii fractures of the midface. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as. Le fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base. 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. External compression of a nasotracheal tube due to the. Anaesthesia and common oral and maxillofacial emergencies.
The management of fractures of the maxillofacial complex remains a challenge for the oral maxillofacial surgeon, demanding both skill and expertise 2. However, the fracture of the pterygoid plate is not limited to le fort fractures. Although most facial fractures do not follow the patterns described by le fort precisely, the system is still used to categorize injuries. Fractures are typically reduced and fixated with a bottom. The pterygoid plates are always involved in leforts fracture. In more severe cases, the bone may be broken into several pieces. Pdf the difficult le fort i osteotomy and downfracture.
Overuse can cause stress fractures, which are very small cracks in the bone. Management of lefort fractures biomedpharmajournal. Patients with le fort iii fracture present a specific challenge to the anesthesiologist. The zygomatic complex is often referred to as a tripod. 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. This is the highest level lefort fracture and essentially separates the maxilla from the skull base. Rene le fort described the planes of injury that result from significant force to the midface. Management of le fort i fracture department of plastic and reconstructive surgery, pohang semyeong christianity hospital, pohang, korea among the classification of maxillary fracture, the le fort classification is the bestknown categorization.
The le fort i osteotomy approach gains access to the posterior nasal cavity and the skull base. Also known as guerins fracture or floating palate, this is an example of lefort type i fracture with bilateral hemosinus. Lefort medical definition merriamwebster medical dictionary. Throat packs should be removed at the end of the operation and the oropharynx suctioned for debris and clots. Clinical associate professor of surgery, division of head and neck surgery, university.
The association of le fort fractures and those of the nasoorbitoetmoidal complex represent severe injuries usually associated to traffic accidents or physical violence. A thorough search of the worlds literature following. The le fort i maxillary osteotomy is a versatile and simple procedure, which has gained popularity nowadays, to correct a wide range of malocclusion and maxillofacial deformities. Le fort fracture classification radiology reference. Sports like football, baseball and hockey account for a high percentage of facial injuries among young adults. Le fort i osteotomy an overview sciencedirect topics. Fratture del massiccio facciale e loro tratta mento iss. Fratture di lefort in traumatologia craniofacciale il dentista moderno.
Fracture above the zygomatic arch, through the lateral and medial orbital walls and. How to simplify the ct diagnosis of le fort fractures. Lowvelocity mechanism fall from standing, blunt trauma resulted in the majority of le fort i fractures 56%. Le fort classification of midface fractures can be used to describe midface fractures. This type is characterized by a dissociation of the maxilla, the nasal bones, and the nasal septum from the cranial skull and. View and download powerpoint presentations on lefort fracture ppt. A horizontal osteotomy is performed with a microsaw or. 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.
Facial fracture management handbook lefort fractures. External compression of a nasotracheal tube due to the displaced bony fragments of multiple lefort fractures you will receive an email whenever this article is corrected, updated, or cited in the literature. In addition, each of the le fort fractures has a unique component. Trauma velocity predicts the path of le fort i fractures through the lateral buttress. There were 35 in the le fort fracture group 30 of whom were male and 59 in the zygomatic fracture group 44 of whom were male, and their ages ranged from 14 to 77 years. A subperiosteal flap is raised, and the piriform aperture as well as the zygomatic crest are exposed.
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. Unique component of each type of le fort fracture figures 1, 2, and 3 illustrate the. Lefort iii fractures result in craniofacial disjunction. Le fort fractures constitute a pattern of complex facial injury that occurs secondary to blunt facial trauma. Attention to positioning the maxilla by relating it to the mandible through maxillomandibular fixation minimized these deformities.
The fracture line extends through the lateral orbital wall, the orbital floor, the medial orbital wall and the rhinobase to the contralateral side, as well as through the zygomatic arches. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Soetomo terbanyak adalah fraktur maxilla dan mandibula. Transverse fracture through the maxillary sinuses, lower nasal septum, pterygoid plates. Frattura lefort ii o iii non cumulabili tra loro ne con lefort i. Finally, only the le fort iii fracture involves the zygomatic arch and the lateral orbital wall. 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.
There is a pterygomaxillary dysjunction with fracture of the inferomedial and lateral maxillary buttress. In le fort fractures, lateral and medial pterygoid muscles pull the fracture segment posteriorly and inferiorly lead to an anterior open bite deformity. When midfacial fractures are present and a le fort fracture pattern is suspected, the authors recommend first looking at the pterygoid plates. Il testo completo di questo articolo e disponibile in pdf. Lefort classification of facial fractures uw emergency. Oblique fracture crossing zygomaticomaxillary suture, inferior orbital rim, nasal bridge. Fractures of the midface, which includes the area from the superior orbital rim to the maxillary teeth, can cause irregularity in the smooth contour of the cheeks, malar eminences, zygomatic arch, or orbital rims. Lefort ii fractures transect the nasal bones, medialanterior orbital walls, orbital floor, inferior orbital rims and finally transversely fracture the posterior maxilla and pterygoid plates. The patient is prepped and draped to include both the oral cavity and the maxillofacial skeleton.
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