Maxillofacial fractures

Question 1

Give the bones in Le Fort type 1
Signs

Answer 1

Le Fort 1 - Horizontal maxillary fracture (floating palate)
Fracture line through alveolar ridge, lateral nose and inferior wall max sinus

Swelling upper lip
Malocclusion
Mobility of teeth

Question 2

Give the bones in Le fort type 2
Signs

Answer 2

Le fort 2 - Pyramidal fracture (floating maxilla)
Fracture through posterior alveolar ridge, lat walls max sinus, inferior orbital rim and nasal bones

Deformity and swelling midface
epistaxis
Periorbital oedema and ecchymosis
Malocclusion

Question 3

Give the bones in Le Fort Type 3
Signs

Answer 3

Le fort 3 - Transverse (floating face)
Fracture through nasofrontal suture, maxillo frontal suture, orbital wall and zygomatic arch

Lengthening of face
Orbital hooding
Epistaxis
Periorbital oedema and echhymosis

Question 4

You suspect a pt has Zygomatico-orbital fracture

i. Give 5 signs of this fracture.

ii. How would you clinically assess for this fracture?

iii. What radiograph is used for this fracture?

iv. What initial management should you carry out?

v. What are the definitive management options?

Answer 4

Signs
- Depressed arch
Depressed malar eminence
Diplopia
Enophthalmos
Subconjunctival haemorrhage
Paresthesia in V2 distribution
Trismus

Clinically assess
- Extraocular movement
- V2 sensation
- Mandible movement (rule out)

Radiographs
- X2 PA diff views
- CBCT

Management
- ABCDE
- Analgesics
- AB if grossly contam
- Referral to OMFS with letter
- Warn of signs of retrobulbar haemorrhage such as Eye bulging, vom, vision loss