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
    • horizontal maxillary fracture, separating the teeth from the upper face
    • fracture line passes through the alveolar ridge, lateral nose and inferior wall of the 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 the posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bones
    • uppermost fracture line can pass through the nasofrontal junction or the frontal process of the maxilla 3
  • Le Fort type 3
    • craniofacial disjunction
    • 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.

They are named after René Le Fort, French surgeon (1869-1951). Le Fort conducted 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.

  • 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
  • if the nasofrontal suture is involved, then it either a type 2 or 3 fracture
Fractures
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Article information

rID: 1317
Synonyms or Alternate Spellings:
  • Le Fort fractures
  • Le Fort fracture
  • Le Fort fracture types

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Cases and figures

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    Figure 1: type 1
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    LeForte 1 fracture
    Case 1: type I
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    Figure 2: type 2
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    Le Fort Type I
    Case 2: type I
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    Figure 3: type 3
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    Case 3: type II CT reconstruction
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    Case 5: type II
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    Case 6: type I
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    Case 7: type II
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    Case 8: type I
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