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e-CASES: Le Fort Classification of facial fractures

Dr Antoine Micheau , CHU ARNAUD DE VILLENEUVE , Montpellier , Herault , FRANCE

Le Fort I fractures (horizontal):

- Result from a force of injury directed low on the maxillary alveolar rim in a downward direction. - Also known as a Guerin fracture or 'floating palate', and usually involves the inferior nasal aperture.

- Fracture extends from the nasal septum to the lateral pyriform rims, travels horizontally above the teeth apices, crosses below the zygomaticomaxillary junction, and traverses the pterygomaxillary junction to interrupt the pterygoid plates.

 

 

Le Fort II fractures (pyramidal):

- Result from a blow to the lower or mid maxilla and usually involve the inferior orbital rim.

- Pyramidal shape

- Fracture extends from the nasal bridge at or below the nasofrontal suture through the frontal processes of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor and rim through or near the inferior orbital foramen, and inferiorly through the anterior wall of the maxillary sinus; it then travels under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.

 

 

Le Fort III fractures (transverse):

- Otherwise known as craniofacial dissociation and involve the zygomatic arch.

- May follow impact to the nasal bridge or upper maxilla.

- Start at the nasofrontal and frontomaxillary sutures and extend posteriorly along the medial wall of the orbit through the nasolacrimal groove and ethmoid bones. The thicker sphenoid bone posteriorly usually prevents continuation of the fracture into the optic canal. Instead, the fracture continues along the floor of the orbit along the inferior orbital fissure and continues superolaterally through the lateral orbital wall, through the zygomaticofrontal junction and the zygomatic arch. Intranasally, a branch of the fracture extends through the base of the perpendicular plate of the ethmoid, through the vomer, and through the interface of the pterygoid plates to the base of the sphenoid.

 

 

Source : wikipedia