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Le Fort fracture classification

Le Fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the maxilla from the skull base. The classification system attempts to distinguish Le Fort according to the plane of injury.  

Classification

The commonly used classification is as follows:

  • type 1
    • horizontal maxillary fracture, separating the teeth from the upper face
    • fracture line passes through the alveolar ridge, lateral nose and inferior wall of maxillary sinus
  • type 2
    • pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex
    • fracture arch passes through posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bones
  • type 3
    • craniofacial disjunction
    • fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall and zygomatic arch

History an detymology

Named after Rene Le Fort, French surgeon (1869-1951). Legend has it Le Fort did his work by dropping cannon balls on cadaver heads and then dissecting the results.

Practical points

  • fracture of the pterygoid plates is common to all Le Fort fractures
  • if the anterolateral margins of the nasal fossa are intact it excludes a type 1 fracture
  • if the infraorbital rims are intact it excludes a type 2 fracture
  • if the zygomatic arch is intact it excludes a type 3 fracture

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