Case 5 - Bilateral Le Fort 1, Unilateral Le Fort 2 & 3
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As I mentioned earlier,
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it's not unusual to see asymmetric Le Fort fractures.
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Let's look at this individual's fracture pattern.
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So if we look at the anterior maxilla,
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we can see the comminuted fracture on the right side.
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The left side also has a fracture,
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and that's comminuted on the left, as well.
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And this fracture fragment kind of crosses the midline.
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So off the bat on the axials,
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we're going to see that this patient has a Le Fort I
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fracture. When we look at the orbital floor,
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we can see that the orbital floor on the right
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side has a comminuted fracture,
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but the left side doesn't look all that bad.
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Finally, when we look at the medial orbital wall,
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we can see the irregularity of the medial orbital
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wall on the right, but not on the left.
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When we look at the lateral orbital wall on the left side,
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this is intact with that normal suture.
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However,
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here we can see a comminuted fracture on the left side.
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Let's look at the pterygoid plates.
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Bilateral comminuted pterygoid plate fracture.
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So we are in the category likely of a Le Fort fracture.
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So we move to the coronal scan.
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As I mentioned, the coronal scan,
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because it shows those planes of the transverse buttresses,
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is actually a better orientation to evaluate Le Fort fractures.
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So here we have a fracture which goes across the
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maxilla from one side to the other and out.
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So fulfilling our criteria,
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which you can see right across here,
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fulfilling our criteria of a Le Fort I fracture.
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If we look on the left side, this orbital floor,
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although it seems as if we're missing an area of bone,
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actually, on the thin section images,
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you do not see a fracture in this location.
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So the orbital floor on the left side was intact.
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No edema in the fat nearby.
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However, on the contralateral side,
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you can see that there's orbital fat herniating through
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this comminuted fracture of the right orbital floor.
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So we have a fracture going through the maxilla
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and going through the orbital floor.
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And then we look at the medial orbital wall,
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and that was shown here with the defect
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that was also evident on the axial scans involving the medial
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orbital wall. So we have a Le Fort II on the right side,
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but just a Le Fort I on the left side.
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But we're not done yet.
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We mentioned the lateral orbital wall.
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Here you can see the air and the widening
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of the suture along the lateral orbital wall.
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It's actually going into the zygoma and
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the zygomatic of frontal suture, but
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this lateral orbital wall is not intact.
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And so if we have a lateral orbital wall and a medial
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orbital wall fracture, then we have a Le Fort III.
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So here's our medial orbital wall fracture.
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Here's our lateral orbital wall.
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Le Fort III fracture. So bilateral, Le Fort I.
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Unilateral, La Fort II. Unilateral, Le Fort III.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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