![]() ![]() CSF rhinorrhea, or leakage of the nutrient laden fluid that bathes the brain, is more commonly seen with these injuries due to ethmoid air cell disruption, as the air cells are located immediately beneath the skull base. As with the other fractures, it also involves the junction of the pterygoids with the maxillary sinuses. Within the nose, the fracture extends through the base of the perpendicular plate of the ethmoid air cells, the vomer, which are both part of the nasal septum. Instead, the fracture continues along the orbital floor and infraorbital fissure, continuing through the lateral orbital wall to the zygomaticofrontal junction and zygomatic arch. The sphenoid is thickened posteriorly, limiting fracture extension into the optic canal. These fractures begin at the nasofrontal and frontomaxillary sutures and extend posteriorly along the medial wall of the orbit, through the nasolacrimal groove and ethmoid air cells. The salient feature of these fractures, beyond pterygoid plate involvement, is that they invariably involve the zygomatic arch, or cheek bone. Le Fort III fracture (transverse), otherwise known as craniofacial dissociation, may follow impact to the nasal bridge or upper maxilla.This finding can be inconsistent due to the midfacial bleeding and swelling that typically accompany such injuries, and so confirmation is usually needed by radiograph or CT. Diagnosis A 3-D CT reconstruction showing a Le Fort type 1 fracture ( fracture line is marked by an arrow )ĭiagnosis is suspected by physical exam and history, in which, classically, the hard and soft palate of the midface are mobile with respect to the remainder of facial structures. As a result, there is gagging on the side of injury. Le Fort III – Tenderness and separation at frontozygomatic suture, lengthening of face, depression of ocular levels ( enophthalmos), hooding of eyes, and tilting of occlusal plane, an imaginary curved plane between the edges of the incisors and the tips of the posterior teeth. Le Fort II – Step deformity at infraorbital margin, mobile mid face, anesthesia or paresthesia of cheek. ![]() Le Fort II and Le Fort III (common) – Gross edema of soft tissue over the middle third of the face, bilateral circumorbital ecchymosis, bilateral subconjunctival hemorrhage, epistaxis, CSF rhinorrhoea, dish face deformity, diplopia, enophthalmos, cracked pot sound. Guérin's sign is present characterised by ecchymosis in the region of greater palatine vessels. Percussion of upper teeth results in cracked pot sound. Impacted type of fractures may be almost immobile and it is only by grasping the maxillary teeth and applying a little firm pressure that a characteristic grate can be felt which is diagnostic of the fracture. Le Fort I – Slight swelling of the upper lip, ecchymosis is present in the buccal sulcus beneath each zygomatic arch, malocclusion, mobility of teeth. The fractures are named after French surgeon René Le Fort (1869–1951), who discovered the fracture patterns by examining crush injuries in cadavers. The pterygoid plates lie posterior to the upper dental row, or alveolar ridge, when viewing the face from an anterior view. Continuity of this structure is a keystone for stability of the midface, involvement of which impacts surgical management of trauma victims, as it requires fixation to a horizontal bar of the frontal bone. 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 margin of the maxilla, and the maxillary sinuses. Skull & Bones 骷髏會 Skull & Bones Skull & Bones Skull and Bones Skull & Bones Skull and Bones Лобања и кости 骷髅会 Skull and Bones Skull and Bones スカル・アンド・ボーンズ Skull and Bones אחוות הגולגולת והעצמות 骷髏會 骷髅会 Skull and Bones Skull and Bones Skull and Bones Skull and Bones Skull and Bones Skull and Bones Skull and Bones Коски и череп Skull and Bones Skull & Bones Череп и кости Skull and Bones Skull and Bones Kaukolė ir kaulai 骷髏會 Skull and Bones محفل مخفی جمجمه و استخوان 骷髅会 骷髏會 Czaszka i Kości Skull and Bones Kəllə və Sümüklər Skull and Bones Лобања и кости Lobanja i kosti Череп і кістки Skull and Bones جمعية الجمجمة والعظام 骷髅会 스컬 앤 본스 confraternita e società segreta société secrète de l'université Yale aux États-Unis tajno društvo osnovano u 1832.Le Fort I (red), II (blue), and III (green) fracturesĪ 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. ![]()
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