Le fort fractures
Dr. Debraj Shome is an highly skilled facial plastic surgeon who specializes in all kinds of facial reconstructive surgeries including Le Fort Fractures. We understand the need of doing the correct corrections in order to restore the natural look of the facial features and at the same time giving the patient the comfort and look that they desire.
Le fort fractures are a type of fracture which occur on the midfacial region and involve the maxillary bone and the structures which surround it. They occur in pyramidal, horizontal or transverse direction. The horseshoe shaped bony protrusions which extend from the maxillary inferior region and the maxillary sinuses are known as the pterygoid plates. Typically, pterygomaxillary separation marks the range of le fort fracture. This midfacial structure has to be continuous in order for the midface to be stabilized. If we view the face from anterior side the pterygoid plates lay posterior to the upper dental row or the alveolar ridge.
If the temporal, sphenoid, ethmoid or palatine bones are fractured on the face, the fracture can be called the Le Fort fracture.
The le fort fractures have been named after Rene Le Fort who was a French surgeon and was the youngest person in France to get a medical degree. He was the first person to observe the pattern in the fractures in cadavers with fractured faces.
Classification of le fort fractures
The le fort fractures are classified in to three categories:-
Signs and symptoms of the Le Fort fractures:-
The signs and symptoms of The Le Fort fractures depend upon the class of the fractures they belong to.
Le fort I fracture signs and symptoms: – malocclusion, teeth are mobile, slight swelling of the upper lip are some of the more common symptoms. Sometimes impact fracture may be completely immobile. The fracture can only be diagnosed by applying a little pressure so that a grate can be felt which is characteristic and also by grasping the maxillary teeth. If the percussion of the upper teeth occurs the jaw makes a sound similar to that of a cracking pot. Presence of ecchymoisis in the greater palatine vessel region is the indication of Guerin’s sign.
There are some signs and symptoms which are common to both Le Fort II and III fractures. Diplopia, dish face deformity, enophthalmos and the sound of cracked pot are some of the symptoms.
After the stabilization of the life threatening injuries, the treatment is mostly done by surgery. The surgery requires orthopedic intervention. Use of titanium fixation plates and screws is very common in addition to use of open reduction technique. The zygomaticofacial sutures are replaced first for stability and at the end of the procedure the palate and the alveolar ridge are fixed. At the end of the procedure, the orbital fractures are repaired.