Le fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base. As they state, the opensky approach provides excellent exposure of noe fractures. Treatment may include surgery andor external fixation. Current and evolving trends in the management of facial fractures. With the midfacial skeleton adapted to the vertical forces of mastication, it is the force delivered at other vectors that cause the bulk of midface fractures. The trauma has caused fractures at the le fort i, ii. The reported incidence of ocular injuries in patients with midfacial fractures ranges from 2. Fractures may be due to pathology, direct violence, indirect violence, or muscular contraction. Surgeons today are concerned with the comprehensive, threedimensional nature of the midface fracture so that restoration of the preinjury position can be. Level 1, an elementary system for fracture location, is appropriate for all trauma surgeons to describe the affection of the midface as one of the four main anatomical units of the facial skeleton. Etiology, incidence and patterns of midface fractures and. Common causes of facial fractures can include car accidents, sports injuries, falls, and assaults.
Oct 28, 2015 the midface fractures generally were used to be treated by closed reduction. A lefort 1 fracture is also known as a guerin fracture. Miniplates and screws these are monocortical, semirigid fixation device which provide 3d stability. The topography of the different midface regions central midface upper central midface, intermediate central midface, lower central midface incorporating the nasoorbitoethmoid region. The destruction of bone and injury to the surrounding soft tissues cause internal. What is mid face area between a superior plane drawn through the zygomaticofrontal sutures tangential to the base of the skull and an inferior plane at the level of the maxillary dental occlusal surfaces these planes do not parallel each other but converge posteriorly at a level approximating that of the foramen magnum triangular region with. The most common fractures were the zygomatic complex fractures 62. Fractures of the jaw and midface msd manual consumer version. We help you diagnose your midface case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Immediate first aid consists of splinting the bone with no attempt to. Central and lateral midface, orbital and zygoma region midface plates 0.
Le fort i and ii, nasal bone and sagittal maxillary fractures are differentiated. Midface fractures part ii free download as powerpoint presentation. A facial fracture refers to any injury that results in a bone or bones of the face being broken. The symptoms of fracture are severe local pain, deformation, abnormal mobility, and functional impairment of the extremity. External compression of a nasotracheal tube due to the. A comprehensive implant and instrument selection offers the ability to address most simple and complex. Zygomaticomaxillary complex fracture radiology reference. The forces from below upwards are well tolerated and distributed along the buttresses of the face but lateral and horizontal forces invariably leads to fracture of maxilla. Prior to computed tomography, twodimensional plain.
Blunt facial trauma can fracture the jaw and other bones of the midface. The hallmark of lefort fractures is traumatic pterygomaxillary separation, which signifies fractures between the pterygoid plates, horseshoe shaped bony protuberances which extend from the inferior. Fractures of the midfacial bones are most commonly due to blunt trauma from falls, altercations, and motor. Le fort i injury is defined as separation of maxilla from the midface figure 1a. Free transplantations form a firm connection with the underlying bone one week. Resident manual of trauma to the face, head, and neck aaohns. Traumatic craniofacial fractures summary nasogastric tube ngt and nasoenteric net placement is frequently indicated in the traumatically injured to achieve decompression of the stomach, prevention of aspiration, administration of enteral nutrition and medications, and gastric lavage. Mgt of midface fractures human head and neck human. We recommend three point rigid fixation of fractured zygoma after accurate. Midfacial fracture definition of midfacial fracture by. The fracture is approached by a vestibular incision. The term jaw fracture often refers to a break of the lower jaw mandible. Additionally, the fracture components may result in impingement of the.
The patterns of midface fractures were related to postoperative computed tomography scans and clinical results to assess the value of ordering fracture assembly in success of treatment methods. Courrent pinion current concepts in midface fracture. Department of craniomaxillofacial surgery, inselspital. Pdf on jan 1, 2010, schutz p and others published midfacial fractures find, read and cite all the research you need on researchgate. The elements of fracture fixation thakur free download. Center or cross drive standard selftapping screw center or cross drive emergency screw center or cross drive drill free screw maxdrive screws are also available for this system 2. Given their high incidence in craniofacial trauma, midface fractures are the focus of this content. Le fort classification of midface fractures can be used to describe midface fractures. Isolated le fort i, ii, and iii fractures are very rare 54. Diagnosis and treatment of midface fractures pocket. Alqurainy et al, in a prospective study on orbital injury with midfacial fractures of any type, have reported that 90% of patients had an ocular injury to some degree, 16% had moderate ocular. The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma.
They were most frequently employed in the orbit and less frequently in the lower midface. There are three types of lefort fractures, which are fracture patterns of the midface. Lefort classification of facial fractures uw emergency. Significant force delivered to the lower anterior midface, in addition to generating the classic fracture patterns described by le fort, may less commonly cause fractures of the palate. Miniplates and screws are used to anchor free segments at the nasofrontal suture. Two hundred patients were included in this study, amongst those who reported to the department of omfs, college of. Etiologically, traffic and sports accidents as well as interpersonal violence are on top of the list of different trauma situations 111, 118, 119. External compression of a nasotracheal tube is more likely to occur after the polyvinyl chloride tube has been warmed and softened by the patients body heat. Isolated orbital fractures are treated for one of three reasons. Craniofacial approaches to midfacial fractures trauma. This tutorial outlines the details of the aocmf imagebased classification system for fractures of the midface at the precision level 3. A prospective study on midface fractures was carried out in the department of oral and maxillofacial surgery at college of dentistry, indore, from august 2007 to september 2009 to analyze etiology, incidence and patterns of midface fractures and associated ocular injuries.
If you would like a large, unwatermarked image for your web page or. Pdf incidence and patterns of fractures of mandible. Fractures of the upper jaw part of the bone called the maxilla are sometimes called jaw fractures but are usually considered facial fractures. Part ii of a 2 part presentation on midface fractures. A working understanding of evaluation, assessment, management, and prevention of further injury when dealing with these fractures is vital. Midface fracture article about midface fracture by the. The aim of present study was to assess the incidence of fractures of maxillofacial region in kashmir population and to compare the results with worldwide incidence of maxillofacial trauma cases. Fractures of the lower jaw mandible are suspected in patients with posttraumatic. Kawamoto, jr, md, dds secondary deformities that result from midface fractures are seen even after proper care is delivered by the best physicians. Midface trauma and approaches to the facial sceleton. Open reduction of the condyle was employed in five concomitant le fort and subcondylar fractures with a loss of ramus height to prevent superior and posterior displacement of the middle and lower face. This presentation will demonstrate the appropriate technique for the fixation of a complex midface fracture with 1.
Fractures of the midface, which includes the area from the superior orbital rim to the maxillary teeth, can cause irregularity in the smooth contour of the cheeks, malar eminences, zygomatic arch, or orbital rims. However, if the maxilla has been displaced the following can be described. In patients with midface fractures such as lefort and noe fractures because of risk of intracranial placement. They are the second most common facial bone fracture after nasal bone fractures pathology. Because of the prominent position of the zygoma in the midface, fractures 2 of it are the most common in the midface after those of the nasal bone. The importance of sagittal buttresses, softtissue reductions, and sequencing treatment of segmental fractures. Manson pn, clark n, robertson b, slezak s, wheatly m, kolk cv, iliff n. In midface fractures involving multiple buttresses and damage to the. Complex midfacial fractures consist of multiple facial fractures that cannot be classified as any of the defined complex facial fracture e. Facial fractures in pediatric patients do not follow the le fort pattern, but have oblique fracture lines. In complex midface injuries with multiple fractures, it is important to distinguish those that have direct surgical relevance 6. Two hundred patients were included in this study, amongst those who reported to the department of omfs, college. Criteria for selective management of the orbital rim and.
A le fort fracture of the skull is a classic transfacial fracture of the midface, involving the maxillary bone and surrounding structures in either a horizontal, pyramidal or transverse direction. Fractures of the upper jaw part of the bone called the maxilla are sometimes called jaw fractures but. Selection of midface approaches based on fracture pattern. The management of midfacial fractures includes the treatment of facial fractures. Complex midfacial fracture radiology reference article. As a result, the preoperative imaging needs were only those that can identify the presence of the fracture. In a pathological fracture, bones break, spontaneously and without trauma, due to certain diseases and conditions like cancer, osteomalacia, syphilis, and osteomyelitis, in a fracture due to direct violence, the bone breaks at the spot where the force. Fcacial elongation and facial retrusion excluded 3. The purpose of this article is to describe the major fracture patterns of the midface buttresses and their surgical relevance. May 21, 2016 such fractures permit separate mobility of the maxilla relative to the rest of the midface. Ophthalmic consequences of maxillofacial injuries 19. The primary treatment of frontobasal and midfacial fractures in patients with head injuries.
The surgical treatment of displaced craniofacial fractures centers. Xray diagnosis must be used to determine the site of the fracture, the type of displacement of the fragments, and the method of treatment. Fracture of the craniofacial skeleton can similarly be divided into these three regions. A midface fracture can be treated surgically, but surgery usually is done only if the fracture causes problems other than pain and swelling, such as facial deformity. Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Incidence and etiology of unplanned cast changes for fractures in the pediatric population. In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bone dorsally.
Midface fractures part ii oral and maxillofacial surgery. Lefort, zmc and sinus fractures orbital floor repair fixation of bone blocks and distraction devices. The mandible is most often broken as a result of blunt trauma, such as being punched or hit with a baseball bat or other object. The le fort classification system attempts to distinguish according to the plane of injury.
The scan revealed numerous fractures of the facial bones, including left le fort ii and iii, right le fort i and ii, right lateral maxillary sinus fracture, right nasal bone. Thirtyfour percent of the study patients 30% of the patients with zmc fractures and 44% of the patients with midface fractures underwent orbital rim exposure and orbital floor exploration as part of their fracture management. Le fort fractures constitute a pattern of complex facial injury that occurs. Condyle fractures are the injuries that most require hospitalization and treatment. In this issue of the archives, cultrara et al 1 demonstrate the usefulness of the midfacial degloving mfd approach for the reduction of nasoorbitalethmoid noe and midface fractures. The fractures of midface are generally comminuted esp bones of nasoethmoid and anterior maxilla creating typical dish face deformity. The face has traditionally been divided into upper face, midface, and lower face. A palatal fracture can cause widening of key points knowledge of the facial skeletal buttress system is important. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries. Lefort ii fracturesinvolve seperation of the nasofrontal suture anteriorly.
The classical description of le fort fractures is based on a symmetric arrangement of the fracture lines on the right and left side. Ct, even minor, clinically irrelevant fractures of the facial skeleton can be visualized. Alphonse guerin in 1886 described fracture of the toothbearing portion of the maxilla without displacement, then in 1901 rene le fort investigated the facial skeleton of 35 cadavers that had subjected to a variety of traumas then dissected and he found the typical three classes of weak lines of the midface fractures. Dec 22, 2015 le fort fractures belong the central le fort i and ii and centrolateral le fort iii fractures of the midface. Ocular injury is present in most midfacial fractures and is common in midfacial trauma. Any information contained in this pdf file is automatically generated from digital material. Fracture above the zygomatic arch, through the lateral and medial orbital walls and nasofrontal suture. Sixtysix percent of these patients 70% of the patients with zmc fractures and 56% of the patients with. Evaluation and management of frontal sinus injuries 20. Le fort fracture, zygomaticomaxillary complex fracture, nasoorbitalethmoid fracture. Tend to present greenstick fractures for the incomplete ossification.
This twopart series detailing the management of midface. The role of postoperative prophylactic antibiotics in the. Facial fractures are a common source of emergency department consultations for the plastic surgeon. The fracture of the midface is completed by the fracture of the zygomatic arch and the cranial bony part of the nasal septum. Pattern of fractures in nonaccidental injuries in the pediatric population in singapore. While they may occur in isolation, palatal fractures tend to accompany extensive facial injuries 9. Midface fractures are therefore classified according to their general position. Alqurainy et al, in a prospective study on orbital injury with midfacial fractures of any type, have reported that 90% of patients had an ocular injury to some degree, 16% had moderate ocular injuries, and 12% had severe injuries. Midface fractures are common sequelae of motor vehicle accidents, falls, assaults, and other blunt trauma, 1, 2.
Le fort iii complex fractures of maxilla, zygomatic bone and nasal skeleton are relatively rare. Request pdf complications of midface fractures the midface relies on key vertical and horizontal buttresses for proper function and appearance. The role of preoperative imaging is to identify fractures, determine the extent of fracture displacement, and visualise stable bone for repair while also ruling out other injuries. Disruption of these rigid structures may produce the midface. Because the obstruction of the nasotracheal tube can develop insidiously and at any time during the procedure, constant vigilance is required. Pdf authors report their experience in the treatment of midfacial fractures in 201. However, the fracture of the pterygoid plate is not can occur if the patient is not placed in intermaxillary fixation limited to le fort. You may not embed one of our images on your web page without a link back to our site. A total of 550 midface fractures were studied for their midface components and the presence of fractures in the adjacent frontal bone or mandible. The reason for central or centrolateral fractures is a direct trauma with high impact to the maxilla le fort i fracture or to the whole midface in most cases le fort iiiii fractures. Midface fractures require a customized treatment plan.