Le Fort Complex Fractures

Le Fort I Fracture : Clinical features & Management

Le Fort I fracture is also known as low level fracture or, dento-alveolar fracture. The Le Fort I fracture line is “It starts from the lateral wall of the floor of the base of the pyriform aperture, crosses laterally over the alveolar bone& ends by fracturing the lower 3rd of the pterygoid plate“.

Clinical feature:
1. Disharmony of the occlusion: anterior open bite, cross bite, reverse over jet etc
2. Swelling & edema of the lower part of the face including the upper lip.
3. Pain of the affected part, especially during speaking & moving the jaw.
4. Mobility of the dento-alveolar portion of the jaw.
5. Ecchymosis & epistaxis may be present.

Treatment:
After proper initial management Treatment is done by-
• IMF along with zygomatico-mandibular suspension wiring
• Open reduction followed by internal fixation by transosseous wiring & miniplate osteosynthesis.

Le Fort II fracture: Clinical features & Management

Le Fort II fracture is also known as mid-level fracture or, Sub zygomatic fracture. The Le Fort II fracture line is “It starts mid portion of the nasal bone as well as frontal process of maxilla & lacrimal bone. Then it appears in the floor of the orbit, runs anteriorly fracturing the inferior orbital rim & then passes downwards through the infraorbital foramen or, medial to it. Then it curves laterally below the zygomatic buttress & then fractures the posterior wall of maxilla & mid portion of the pterygoid plate “.

Clinical feature:
1. Epistaxis
2. Diplopia
3. Enopthalmus
4. Exopthalmus
5. Subconjuntival hemorrhage
6. Periorbital ecchymoses

Treatment:
After proper initial management Treatment is done by-
• Open reduction by sub cilliary or, sub conjunctival or, infraorbital rim incision & fixation of the fragmented bones by transosseous wiring & miniplate osteosynthesis. During this procedure assurance of the Diplopia correction is a must.
• For the control of epistaxis, nasal pack is needed.
• IMF along with zygomatico-mandibular suspension wiring
• If the orbital floor fracture is gross, then antral pack is needed especially for correction of Diplopia.

Le Fort III fracture: Clinical feature & Management

Le Fort III fracture is also known as high level fracture or, Supra zygomatic fracture. It is mainly separation of the face from the cranial base. The Le Fort III fracture line is- “The fracture or separation starts from the root of the nasal bone, runs laterally & posteriorly to the orbit. The optic canal & supra orbital fissures area are fractured and reaches the lateral wall of the orbit and fractures the front-zygomatic suture & finally separate the pterygoid plate from its roots“.

Clinical feature:
1. Lengthening/ hooding of the face
2. Epistaxis
3. CSF rhinorrhoea
4. Diplopia
5. Enopthalmus
6. Exopthalmus
7. Subconjuntival hemorrhage
8. Periorbital ecchymoses

Treatment:
After proper initial management Treatment is done by-
• Open reduction followed by internal fixation. By bicoronal incision lateral eyebrow incision along with incision over the root of the nasal bon
• After reduction CSF rhinorrhoea stopping is ensured
• Antibiotics to prevent meningitis
• IMF along with zygomatico-mandibular suspension wiring

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Authored By:
:: World Of Dentistry :: TEAM