Midfacial (Le Fort) Fractures
Le Fort fractures involve the maxilla and are often complex and asymmetric (Figs 6-1, 6-2). By definition, Le Fort fractures extend posteriorly through the pterygoid plates. These fractures may be divided into 3 categories, although clinically they often do not conform precisely to these groupings:
Le Fort I fractures are low transverse maxillary fractures above the teeth with no orbital involvement.
Le Fort II fractures generally have a pyramidal configuration and involve the nasal, lacrimal, and maxillary bones as well as the medial orbital floor.
Le Fort III fractures cause craniofacial disjunction, in which the entire facial skeleton is completely detached from the base of the skull and is suspended only by soft tissues. The orbital floor as well as the medial and lateral orbital walls are involved.
Treatment may include dental stabilization with arch bars and open reduction of the fracture with rigid fixation using titanium plating systems.
Figure 6-1 Le Fort fractures (lateral view). Note that all the fractures extend posteriorly through the pterygoid plates (arrow).
(Modified with permission from Converse JM, ed. Reconstructive Plastic Surgery: Principles and Procedures in Correction, Reconstruction, and Transplantation. 2nd ed. Philadelphia: Saunders; 1977:2.)
Figure 6-2 Le Fort classification of midfacial fractures. Le Fort I, horizontal fracture of the maxilla, also known as Guérin fracture. Le Fort II, pyramidal fracture of the maxilla. Le Fort III, craniofacial disjunction.
(Modified with permission from Converse JM, ed. Reconstructive Plastic Surgery: Principles and Procedures in Correction, Reconstruction, and Transplantation. 2nd ed. Philadelphia: Saunders; 1977:2. Illustration by Cyndie C. H. Wooley.)
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