Le Fort fracture of skull
The main goal of any surgical intervention is to re-establish occlusion, or the alignment of upper and lower teeth, to ensure the patient is able to eat.
Occlusion, or the alignment of upper and lower teeth, is vital following midface trauma to ensure a patient is able to eat and speak.
Although the biomechanics of the face are not fully understood due to their complex nature, several vertical and horizontal buttresses, or pillars, have been established.
[1] Le Fort studied the effect of facial trauma by dropping cadavers from various heights and recording the different fracture patterns observed.
[2] Today, with the evolution of high-speed motor vehicle accidents and advancements in medical imaging and surgical techniques, the low-speed fracture patterns originally described by Le Fort are not always applicable.
[7] Modern midface fractures typically do not neatly fit into one of the Le Fort classifications and often occur in combination with other craniofacial trauma.
[2] The surgeon will also examine the patient's mouth for bleeding, swelling, cuts, foreign objects, changes in bite, and newly lost teeth.
Additionally, an eye exam assessing vision and pupillary response may be warranted, especially in Le Fort II and III fractures due to the involvement of the orbit.
[2] If there is suspicion that the skull base has been injured, such as during a Le Fort III fracture, the patient should be examined for clear drainage from the ear or nose which may be caused by a cerebrospinal fluid (CSF) leak.
[1][6] If the eye exam reveals abnormalities in either vision or the pupillary response, prompt evaluation by a neurosurgeon and an ophthalmologist should occur.
[2] Skull base injuries can result in a cerebrospinal fluid (CSF) leak, which can present as a clear, metallic-tasting liquid draining from the nose or the ear.
A computed tomography (CT) of the face and skull is the imaging of choice for diagnosing Le Fort fractures.
It can be used in isolation or in combination with open reduction and internal fixation (ORIF) in treating Le Fort fractures.
[6] Several surgical techniques exist for establishing MMF, with selection relying on the individual patient injury and surgeon preference.
[1][2] MMF involves fixation of the upper and lower teeth for 6-8 weeks, which limits a patient's ability to speak, eat, breathe through their mouth, and maintain adequate oral hygiene.
It is required for correction of complex Le Fort fractures affecting facial function or involving neurological complications (visual changes, CSF leak).
Plates and screws are often permanently fixated to facial bones to stabilize the lateral and medial vertical buttresses bilaterally.
[2] Le Fort III fractures that injure the optic nerve or the extraocular muscles that move the eye may result in visual defects.
