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In preparing for this talk, I noticed that on my slides I had

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the Le Fort fractures spelled many different ways

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There was the capital L E, F O R T, all lowercase. There

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was the capital L E, then capital F O R T with no

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space in between the L E and the F. And then I had

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the L E and the space and then Le Fort. This is indeed

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René Le Fort. He was a facial surgeon

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and he spelled his name R E N E, with an accent aigu, and

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Le Fort, L E, with a space in between it. So this is

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the correct spelling of the Le Fort fractures. And most of us have

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heard the term for the Le Fort fractures in terms of fractures,

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Le Fort I, Le Fort II, and Le Fort III. Le Fort I are

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the lower ones, and those involve the hard palate going across the maxilla.

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And then we have the Le Fort II, which is a defect through

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the maxillary antrum and the inferior orbital rims and then crossing the

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midline through the medial orbital wall, the lamina papyracea. And then

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the Le Fort III, which go across the lateral orbital wall,

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medial orbit, and lateral orbital wall. Now, in the initial classic description,

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these cut across bilaterally, from side to side. However, sometimes you'll

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find a Le Fort III on one side and a Le Fort I on

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the other side, or you'll have a Le Fort II that's unilateral and

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doesn't have the contralateral side. One of the classic features of Le Fort

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Fractures, however, is that they should always go through the pterygoid

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plates. And you see this crossing of the pterygoid plates here,

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and on this diagram, and obliquely on this diagram. Let's see,

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one more diagram of the Le Fort fractures. Here is a 3D skull

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view, and you see the Le Fort I in the green line going

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across the base of the maxilla. The Le Fort II going from the

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maxilla across the orbital floor, medial orbital wall, and then the contralateral

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orbital floor. And here with the Le Fort III, going across the lateral

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orbit, medial orbit, medial orbit, and lateral orbit. So these are the classic

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lines of the Le Fort fractures. When we describe Le Fort fractures,

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I find that it's useful to initially describe where the fractures are

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and not just refer to them as Le Fort fractures, but maybe in

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the impression, you may use that term as part of the vernacular of

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maxilla facial trauma. By knowing the planes that you should see with Le

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Fort fractures, it will make you that much more aware of the potential

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for where the fractures are located. So obviously if we have a Le Fort II

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fracture, we're gonna look at the orbital floors and the medial orbital

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walls. The Le Fort I fracture, the main issue is malocclusion that's going

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across the maxilla and it may affect some of the teeth.

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And when you have a fracture that's impacted or incomplete, you may actually

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see that the patient's teeth do not close appropriately. Comminution is

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harder to fix, but it's more easy to mobilize the different fracture fragments

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to get them in alignment. With Le Fort II and Le Fort III, remember

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that they may be associated with other types of fractures, in particular

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the nasal ethmoidal ethmoid fractures, where the issue is the restoration

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of normal frontal sinus flow through the frontal ethmoidal recessor nasal

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frontal duct, and the normal flow of the tear duct, the nasal lacrimal duct,

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in the medial aspect of the orbits. Palate fractures may also coexist with

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the Le Fort fractures. Remember that if you have palate fracture, you may

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have swelling of the soft palate as well as the uvula, which can

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compromise the airway and lead to a hypoxic event.

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Here are some examples on slide presentation of the Le Fort fractures.

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So here you can see the Le Fort fracture type I going across

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the base of the maxilla. Now in this case, the patient does have

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orbital floor fractures. So if this goes across the orbital floor and into

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the medial orbital wall, we would say he had bilateral Le Fort I and a

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unilateral Le Fort II. In this case, I'm actually not seeing the medial

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orbital wall involvement. So this is just an orbital floor fracture.

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Here we have a Le Fort II fracture where we have involvement of

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the orbital floor. You see a little bit of air here,

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and then coming across the medial orbital wall.

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Here's the fracture, a little bit of air, bilateral involvement of the medial

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orbital wall, and then coming back down through the orbital floor to the

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maxilla. These would be the Le Fort II fractures.

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When you have a fracture that goes across the lateral orbit as well

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as the medial orbit, you have a unilateral Le Fort III fracture.

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In this right side, the medial orbit and the lateral orbit are intact.

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This is the normal suture that occurs here. Here is a widened displaced

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suture. Widened displaced suture, normal suture, fracture of the medial

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orbital wall. So a unilateral Le Fort III fracture. Notice that the sine

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qua non of... And it's appropriate for me to use a French accent

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when saying sine qua non fracture with a Le Fort fracture, is the

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involvement of the pterygoid plates. In this case, you see comminuted fracture

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of the pterygoid plates on the coronal image, and comminuted fracture of

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the pterygoid plates on the axial scans.