UMEM Educational Pearls

Category: Airway Management

Title: Le Fort Fractures

Keywords: Le Fort, fracture, facial (PubMed Search)

Posted: 4/19/2009 by Michael Bond, MD (Updated: 8/28/2014)
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The French Surgeon Rene Le Fort first described these facial fracture patterns.   Reportedly he made the observations after dropping numerous skulls from the wall of a castle.  This might be why we don't see pure Le Fort fractures in our patients most of the time as they are not likely to be falling off castle falls head first.

The classic fracture patterns are:

  1. Le Fort I fractures extends from the nasal septum to the lateral pyriform rims, travels horizontally above the teeth apices, crosses below the zygomaticomaxillary junction, and traverses the pterygomaxillary junction to interrupt the pterygoid plates.
  2. Le Fort II fracture has a pyramidal shape and extends from the nasal bridge at or below the nasofrontal suture through the frontal processes of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor and rim through or near the inferior orbital foramen, and inferiorly through the anterior wall of the maxillary sinus; it then travels under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.
  3. Le Fort III fractures (transverse) are otherwise known as craniofacial dissociation and involve the zygomatic arch.  These fractures start at the nasofrontal and frontomaxillary sutures and extend posteriorly along the medial wall of the orbit through the nasolacrimal groove and ethmoid bones. The fracture continues along the floor of the orbit along the inferior orbital fissure and continues superolaterally through the lateral orbital wall, through the zygomaticofrontal junction and the zygomatic arch.