LeFort Fractures Flashcards
Description of photo image
Anterior open bite with repaired R brow laceration
Description of CT
- Transverse fracture across maxilla involving the ZM and NM buttresses bilaterally, c/w a LeFort I fracture
- Fracture extending from R NM buttress to the infraorbital rim w/o displacement of the NF junction, c/w a type IA naso-orbital ethmoid (NOE) fracture
What CT images are necessary to confirm the diagnosis?
Coronal images on CT
On history, important are the
MOI to help determine the severity of impact and trajectory of force - changes in vision, occlusion, breathing, and hearing -and previous facial trauma
On examination, I would start with a trauma work-up
starting with the ABCs and in order to identify any potentially life-threatening injuries, ensuring to take spinal precautions and r/o a cervical injury
After the trauma work-up, I would perform a detailed examination of the face
- palpating for tenderness/crepitus/step-offs
- sensory and motor examinations
- eye, nasal, and intraoral examinations -and examinations of the the ears and tympanic membrane
After performing a detailed examination of the face, I would evaluate the state of dentition
-looking for fractured, missing, or rotten teeth, as well as the occlusal pattern
After evaluating the dentition, I would assess mid face instability by
-stabilizing the face at the nasal root (w/ L hand) and grasping the upper anterior alveolar arch (w/ R hand) and pulling forward and down
If the mid face is mobile with stability at the nasal root, it is indicative of
a LeFort I fracture
If there is also mobility at the NF suture, it is indicative of
a LeFort II fracture
If there is also mobility at the ZF suture, it is indicative of
a LeFort III fracture
The imaging of preference would be a
high-resolution maxillofacial CT scan with axial and coronal images
The sine qua non of LeFort fractures on (coronal) CT
is fracture of the pterygoid plates
On CT, a LeFort I fracture would present as
a transverse fracture fo the maxilla involving the ZM and NM buttresses
On CT, a LeFort II fracture would present as
a pyramidal fracture involving the ZM buttresses, inferior orbital rim, inferior and medial orbital wall, and NF region