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.

Classification

The commonly used classification is as follows:

• Le Fort 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
• 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.It should be noted that Le Fort fractures are often associated with other facial fractures, neuromuscular injury and dental avulsions.

History and etymology

They are named after René Le Fort, French surgeon (1869-1951). Le Fort conduced experiments on 35 cadavers inflicting varying facial trauma by dropping cannon balls and striking them with a bat. He would then boil the heads to remove soft tissue and record the results ^4,5.

Practical points

• 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