OMFS-0113Maxillofacial traumaTraumaadvancedMidface

Midface mobility and malocclusion after a high-speed collision

36-year-old male

Draft — educational study aid, pending faculty review.

§Chief complaint

Face feels loose, teeth do not meet after a car crash

§Medical & dental history

01Polytrauma patient, GCS 15 after resuscitation
02Intact dentition pre-injury

§Clinical examination

01Mobility of the whole midface on grasping the maxillary alveolus, with movement at the nasofrontal region
02Bilateral periorbital ecchymosis (raccoon eyes) and CSF rhinorrhoea
03Anterior open bite with a retruded, lengthened midface
04Battle sign absent; cervical collar in situ

§ figuresFigures (4)

Le Fort Fractures — clinical image: Classification of Le Fort fractures of skull — Fig. 1Classification of Le Fort fractures of skull
“Clasificación de le fort” · Chelepepino · CC BY 3.0 · Wikimedia Commons

Le Fort Fractures — clinical image: Le fort Fracture Diagnosis — Fig. 2Le fort Fracture Diagnosis
“LeFortA” · RosarioVanTulpe · CC BY-SA 3.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Le Fort Fractures figures pending faculty review.

§Differential diagnosis

Le Fort III (craniofacial disjunction)Movement at the nasofrontal suture and zygomatic arches

Le Fort IIPyramidal, movement at the nasal bridge only

Le Fort IOnly the alveolus and palate move

Isolated palatal fractureSplit palate, no global mobility

§Final diagnosis

Le Fort III craniofacial disjunction with an associated Le Fort I segment and CSF leak

Grasping the maxilla and observing where movement occurs localises the level: nasofrontal and zygomatic arch movement means Le Fort III. Le Fort patterns are often mixed and asymmetric — describe each side.

§Investigations

01ATLS primary survey with cervical spine and airway priority
02CT head, face and cervical spine with 3D reconstruction
03Beta-2 transferrin on nasal fluid to confirm CSF
04Ophthalmology and neurosurgery review

§Treatment plan

01Stabilise the patient before the face — airway, haemorrhage, C-spine, head injury
02Conservative management of the CSF leak with head elevation and avoidance of nose-blowing
03Definitive ORIF once neurologically stable, typically within 7-10 days
04Restore facial height, projection and occlusion from stable to unstable

§Surgical procedure

01Intermaxillary fixation to re-establish occlusion
02Coronal flap for nasofrontal and zygomatic arch exposure
03Fixation at frontozygomatic sutures, infraorbital rims, nasofrontal region and maxillary buttresses
04Bone grafting of comminuted buttresses

§Follow-up & outcome

01CSF leak stopped by day 5 without lumbar drainage
02Occlusion restored, elastics for 3 weeks
03Facial projection acceptable at 6 months; residual infraorbital numbness

§Clinical pearls / learning points

01Le Fort fractures are rarely pure or symmetrical — classify each side separately.
02CSF rhinorrhoea is a marker of anterior skull base injury; avoid nasal tubes and nasal packing.
03Reconstruct in the order outer facial frame, then buttresses, then occlusion.

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 1
L6 · Textbook — 5

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

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Current Classification