Trauma
Le Fort Fractures
aka Midface Fractures
Three classical transverse patterns of midface fracture described by René Le Fort (1901) — each separates the maxilla from the cranial base at a different level.
§ figuresFigures (4)
Fig. 1Classification of Le Fort fractures of skull
“Clasificación de le fort” · Chelepepino · CC BY 3.0 · Wikimedia Commons
Fig. 2Le fort Fracture Diagnosis
“LeFortA” · RosarioVanTulpe · CC BY-SA 3.0 · Wikimedia Commons
Fig. 3Le fort Fracture Diagnosis
“LeFortB” · 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.
§ overviewOverview
Transverse fractures of the maxilla that separate all or part of the maxilla from the skull base along lines of structural weakness.
§ etiologyEtiology
- 01High-energy blunt trauma: RTA, assault, fall from height
§ clinicalClinical Features
- 01Facial oedema, ecchymosis
- 02Malocclusion, anterior open bite
- 03Mobile midface on rocking maxilla (I) or nasofrontal complex (II/III)
- 04CSF rhinorrhoea (II/III)
- 05Battle sign, raccoon eyes (III)
- 06Elongated (donkey) face
- 07Numbness in V2 distribution
§ investigationsInvestigations
- 01ATLS primary survey
- 02CT face with 3D reconstruction (gold standard)
- 03Beta-2 transferrin for CSF rhinorrhoea
§ classificationClassification
- 01Le Fort I (Guerin, floating palate): horizontal above dental apices; separates alveolus & palate from midface
- 02Le Fort II (pyramidal): through nasal bones, medial orbit, infraorbital rim, lateral maxillary wall
- 03Le Fort III (craniofacial disjunction): through nasofrontal suture, medial and lateral orbital walls, zygomatic arch — complete separation of face from skull
§ treatmentTreatment
- 01Airway priority (may need surgical airway)
- 02Cervical spine clearance
- 03Reduction and rigid internal fixation via facial buttress reconstruction
- 04Access: sublabial (I), subciliary/transconjunctival + sublabial (II), coronal + additional approaches (III)
- 05IMF or MMF as required
- 06Post-op: elemental diet, oral hygiene, IMF release protocol
§ complicationsComplications
- 01Airway obstruction
- 02Malunion, malocclusion, facial elongation
- 03Enophthalmos, diplopia
- 04CSF leak, meningitis
- 05Infraorbital numbness
- 06Non-union
§ prognosisPrognosis
Good with early anatomical reduction; delayed treatment leads to permanent facial elongation and malocclusion.
§ examKey Examination Points
- 01Rock the maxilla to detect level
- 02Assess CSF rhinorrhoea
- 03Check vision and eye movements
§ revisionQuick Revision Summary
- 01I floating palate · II pyramidal · III craniofacial disjunction · buttress reconstruction
§ vivaBDS Viva Questions
- 01Describe the three Le Fort levels.
- 02Approach to CSF rhinorrhoea?
- 03Facial buttresses to reconstruct?
§ mcqsMCQs — Assessment (3)
Question 1
Le Fort III is also called:
Question 2
CSF rhinorrhoea test:
Question 3
Le Fort I passes:
§ 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.
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
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Hupp JR, Ellis E, Tucker MR. Elsevier · 2019
Core surgical textbook covering exodontia, infection, trauma and preprosthetic surgery.
Ehrenfeld M, Manson PN, Prein J. Thieme / AO Foundation · 2012
Reference standard for craniomaxillofacial trauma osteosynthesis principles and techniques.
Additional sources cited on this page
- Le Fort R. Rev Chir 1901
- Fonseca RJ. Oral & Maxillofacial Trauma
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.