Le Fort fracture classification
Le Fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base. In order to be separated from the skull base the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bone dorsally. The Le Fort classification system attempts to distinguish according to the plane of injury.
The commonly used classification is as follows:
- Le Fort type 1
Le Fort 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
Le Fort type 3
- craniofacial dysjunction
- fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch / zygomaticofrontal suture
A memory aid is:
- Le Fort 1 is a floating palate
- Le Fort 2 is a floating maxilla
- Le Fort 3 is a floating face
Any combination is possible. For example there may be type 2 on one side and type 3 on the other, or there may be type 1 and type 2 on the same side. Also Le Fort fractures can be associated with other facial fractures, neuromuscular injury and dental avulsions.
History and etymology
They are named after René 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.
- fracture of the pterygoid plates is mandatory to diagnose 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
- 1. Dähnert W. Radiology review manual. Lippincott Williams & Wilkins. (2007) ISBN:0781738954. Read it at Google Books - Find it at Amazon
- 2. Rhea JT, Novelline RA. How to simplify the CT diagnosis of Le Fort fractures. AJR Am J Roentgenol. 2005;184 (5): 1700-5. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Hopper RA, Salemy S, Sze RW. Diagnosis of midface fractures with CT: what the surgeon needs to know. Radiographics. 2006;26 (3): 783-93. doi:10.1148/rg.263045710 - Pubmed citation