Le Fort 3 fractures

Case contributed by Dr Heather Pascoe

Presentation

Trauma.

Patient Data

Age: 45 years
Gender: Male
CT

Comminuted pterygoid plate fractures bilaterally involving the medial and lateral pterygoid plates.

RIGHT:

There is a tripod fracture of the right zygomaticomaxillary complex, with mild diastasis of the zygomaticomaxillary and zygomaticofrontal sutures. Comminuted two part fracture of the zygomatic arch. Comminuted displaced fractures of all walls of the right maxillary sinus, with blood layering within the sinus.

'Blow out' fracture of the right orbital floor with multiple comminuted inferiorly depressed fragments. This involves the right inferior orbital foramen. There is fat entrapment without inferior rectus involvement.

Significant subcutaneous emphysema over the right malar region and within the orbit. No retrobulbar haematoma.

Thin extraconal haematoma demonstrated laterally adjacent to the right lateral orbital wall fracture.

LEFT:

Comminuted maxillary sinus fractures involving all walls. Undisplaced fracture involving the orbital floor, which extends into the infraorbital foramen.

Minimally depressed lateral orbital wall and zygomatic arch fractures.

No left retrobulbar / intraorbital haematoma. Moderate volume of intraorbital and left malar subcutaneous gas and inflammatory fat stranding.

Mildly displaced left nasal bone and angulated nasal septal fractures. Blood demonstrated within the paranasal sinuses.

The globes and optic nerves appear intact bilaterally. No mandibular fractures.

Case Discussion

Complex asymmetrical bilateral facial fractures involving the pterygoid plates, maxillary sinuses, zygomatic arches and lateral orbital walls in keeping with Le Fort 3 fracture classification.

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Case information

rID: 37488
Case created: 10th Jun 2015
Last edited: 13th Feb 2018
Inclusion in quiz mode: Included

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