AtlasTraumaLe Fort Fractures

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.

I
Floating palate
II
Pyramidal
III
Craniofacial disjunction

§ 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:

References

  1. Le Fort R. Rev Chir 1901
  2. Fonseca RJ. Oral & Maxillofacial Trauma

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.