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Case 5 - Bilateral Le Fort 1, Unilateral Le Fort 2 & 3

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0:01

As I mentioned earlier,

0:02

it's not unusual to see asymmetric Le Fort fractures.

0:07

Let's look at this individual's fracture pattern.

0:11

So if we look at the anterior maxilla,

0:15

we can see the comminuted fracture on the right side.

0:19

The left side also has a fracture,

0:22

and that's comminuted on the left, as well.

0:25

And this fracture fragment kind of crosses the midline.

0:29

So off the bat on the axials,

0:32

we're going to see that this patient has a Le Fort I

0:34

fracture. When we look at the orbital floor,

0:37

we can see that the orbital floor on the right

0:40

side has a comminuted fracture,

0:42

but the left side doesn't look all that bad.

0:45

Finally, when we look at the medial orbital wall,

0:47

we can see the irregularity of the medial orbital

0:49

wall on the right, but not on the left.

0:52

When we look at the lateral orbital wall on the left side,

0:55

this is intact with that normal suture.

0:58

However,

0:58

here we can see a comminuted fracture on the left side.

1:03

Let's look at the pterygoid plates.

1:06

Bilateral comminuted pterygoid plate fracture.

1:11

So we are in the category likely of a Le Fort fracture.

1:16

So we move to the coronal scan.

1:17

As I mentioned, the coronal scan,

1:19

because it shows those planes of the transverse buttresses,

1:23

is actually a better orientation to evaluate Le Fort fractures.

1:29

So here we have a fracture which goes across the

1:33

maxilla from one side to the other and out.

1:37

So fulfilling our criteria,

1:40

which you can see right across here,

1:42

fulfilling our criteria of a Le Fort I fracture.

1:46

If we look on the left side, this orbital floor,

1:51

although it seems as if we're missing an area of bone,

1:54

actually, on the thin section images,

1:57

you do not see a fracture in this location.

2:00

So the orbital floor on the left side was intact.

2:03

No edema in the fat nearby.

2:06

However, on the contralateral side,

2:08

you can see that there's orbital fat herniating through

2:12

this comminuted fracture of the right orbital floor.

2:16

So we have a fracture going through the maxilla

2:19

and going through the orbital floor.

2:21

And then we look at the medial orbital wall,

2:24

and that was shown here with the defect

2:27

that was also evident on the axial scans involving the medial

2:33

orbital wall. So we have a Le Fort II on the right side,

2:39

but just a Le Fort I on the left side.

2:42

But we're not done yet.

2:43

We mentioned the lateral orbital wall.

2:46

Here you can see the air and the widening

2:51

of the suture along the lateral orbital wall.

2:55

It's actually going into the zygoma and

2:57

the zygomatic of frontal suture, but

3:00

this lateral orbital wall is not intact.

3:03

And so if we have a lateral orbital wall and a medial

3:08

orbital wall fracture, then we have a Le Fort III.

3:12

So here's our medial orbital wall fracture.

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Here's our lateral orbital wall.

3:16

Le Fort III fracture. So bilateral, Le Fort I.

3:22

Unilateral, La Fort II. Unilateral, Le Fort III.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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