Facial Fractures

Question 1

Which of the Lefort, ZMC and nasorbitoethmoid is least likely to cause orbital injury

Answer 1

Lefort 1

Question 2

LeFort 1

Answer 2

inferior aspects of the vertical maxillary buttress

Le Fort I: Transverse fx of maxilla above maxillary teeth
Involves medial & lateral maxillary sinus walls, septum, pterygoid plates
Most common Le Fort type
Mobile hard palate on physical exam

Question 3

LeFort 2

Answer 3

(Medial and inferior orbital wall)

Le Fort II: Pyramid fx of maxilla
Apex above nasal bridge with inferolateral extension through infraorbital rims
Mobile maxilla & subconjunctival hemorrhages on physical exam

Question 4

LeFort 3

Answer 4

Le Fort III: Craniofacial disruption

Requires significant causative force
Fx involves maxilla, zygoma, lateral orbital walls
Mobility of all facial bones relative to cranium on physical exam

Question 5

ZMC

Answer 5

Lateral orbital wall

Zygoma is exposed facial bone
Fx results from forceful blow to cheek
Central depression with fx at both ends
Isolated zygoma fx is rare
Trismus results from impingement on temporalis muscle
Lateral orbital fx fragments may impinge lateral rectus
Imaging: “Tripod” or “tetrapod” fx involves separation of 3 major attachments of zygoma from face
Fx of maxillary sinus & lateral orbital wall (diastasis of zygomaticofrontal suture) in addition to zygoma
Look for involvement of orbital apex/optic canal

Question 6

Nasoorbitoethmoid

Answer 6

Fracture, Nasoethmoid Complex
Results from trauma to nasal bridge
Fx extends into nose through ethmoids
Widening of nasal bridge on physical examination
More serious than isolated nasal bone fx
Imaging: Fx of nasal bone & ethmoid sinuses ± cribriform plate
Cribriform plate fx ⇒ CSF rhinorrhea