A LeFort fracture, also known as a midface fracture, is a severe injury that involves fracturing the facial bones in the upper jaw and midface region. This type of fracture is named after René LeFort, a French surgeon who first described these fractures in the early 20th century. LeFort fractures can result from high-impact trauma, such as a motor vehicle accident, sports injury, or fall.
The midface region consists of several bones that play a crucial role in facial structure and function. These bones include the maxilla (upper jaw), zygomatic arches (cheekbones), orbital floors (eye sockets), and nasal bones. A LeFort fracture can involve one or more of these bones, leading to significant facial deformity and potential complications.
There are three main types of LeFort fractures, classified according to the level and degree of injury:
1. LeFort we Fracture:
– A LeFort we fracture, also known as a horizontal or low maxillary fracture, involves a separation of the maxilla from its attachments to the skull.
– This fracture line extends horizontally, passing above the level of the teeth, and can extend through the upper jaw and across the nose.
– LeFort we fractures commonly present with facial numbness, nasal bleeding, malocclusion (misalignment of the bite), and mobility of the facial bones.
2. LeFort II Fracture:
– A LeFort II fracture, also known as a pyramidal fracture or a central midface fracture, extends from the nasal bones through the orbits and into the maxilla.
– This fracture line runs through the nasal bones, along the sides of the nose, through the ethmoid bone located between the eyes, and passes to the lateral walls of the eye sockets.
– LeFort II fractures can cause severe eye injuries, including damage to the optic nerve, double vision, and orbital compartment syndrome (increased pressure within the eye socket).
– Patients may also experience nasal deformity, CSF (cerebrospinal fluid) leakage through the nose, and changes in vision.
3. LeFort III Fracture:
– A LeFort III fracture, also known as a craniofacial dysjunction or craniofacial disjunction, is the most severe and complex type of midface fracture.
– This fracture involves a complete separation between the facial skeleton and the skull base.
– The fracture line extends through the ethmoid bone, orbits, zygomatic arches, and passes through the sphenoid bone located at the skull base.
– LeFort III fractures are often associated with severe facial swelling, vision loss, CSF leakage through the nose or ears, nasal deformity, malocclusion, and difficulty with mastication and speech.
– Additionally, LeFort III fractures can be associated with intracranial injuries, including traumatic brain injury and skull base fractures.
It is important to note that LeFort fractures are considered high-energy injuries involving significant force, and they are usually associated with other facial fractures, head injuries, or systemic injuries. These fractures require immediate medical attention and often require a multidisciplinary approach involving oral and maxillofacial surgeons, ophthalmologists, neurosurgeons, and other specialists.
Diagnosis of LeFort fractures is primarily based on clinical evaluation and radiographic imaging. Physical examination findings, such as facial swelling, tenderness, mobility of facial bones, malocclusion, and changes in vision, can suggest the presence of a LeFort fracture. Radiographic studies, including X-rays, computed tomography (CT) scans, and sometimes magnetic resonance imaging (MRI), help confirm the diagnosis, assess the extent of the fracture, and evaluate associated injuries.
Treatment of LeFort fractures is primarily surgical and aims to restore the normal anatomy and function of the midface region. The exact surgical approach and technique depend on the type and severity of the fracture, as well as the presence of associated injuries. Surgical management may involve open reduction and internal fixation (ORIF), which involves realigning the fractured bones and securing them in place using metal implants such as plates, screws, or wires.
Postoperative management of LeFort fractures often includes a period of immobilization with the use of rigid fixation to allow for proper healing and stability. Patients may require a liquid or soft diet during the initial weeks to avoid excessive pressure on the healing bones. Pain management, monitoring for complications, and close follow-up with the healthcare team are essential for optimal recovery.
Complications associated with LeFort fractures can vary depending on the severity, type, and location of the fracture. Potential complications include infection, malunion (improper bone healing), nonunion (failed bone healing), facial deformity, loss of sensation in the face, nasal obstruction, dental problems, vision impairment, and psychological distress. A prompt and appropriate surgical intervention, coupled with comprehensive postoperative care, can help minimize the risk of complications and optimize the overall outcome.
A LeFort fracture is a severe injury involving fractures in the midface region, specifically the upper jaw and surrounding bones. These fractures can lead to significant facial deformity and functional impairments. Prompt diagnosis, appropriate surgical intervention, and comprehensive postoperative care are essential for successful management of LeFort fractures. It is crucial for individuals experiencing facial trauma to seek immediate medical attention to prevent potential complications and promote optimal recovery.