Presentation
Rider in a motorbike accident.
Patient Data
Comminuted fractures of the medial and lateral pterygoid plates bilaterally. There is also bilateral fracture through all the walls of the maxillary sinuses. There is bilateral involvement of the zygomatic bones with involvement of the orbital floors, as well as the medial and lateral orbital walls. There is extension into the body of the maxilla (with involvement of the alveolar processes) and vomer. There is fracture of the body of each mandible, with involvement of the alveolar processes with some misalignment on the right. A vertically oriented fracture line is seen through the right mandible condylar process.
The Zygomatic arch is bilaterally preserved. Moderate intracavitory collection is noted in both maxillary sinuses. There are extensive soft tissue swelling and subcutaneous emphysema in the face bilaterally, worse on the left. Air densities are noted in both orbits. The brain parenchyma however appears structurally preserved.
Case Discussion
Le Fort fractures are known as facial fractures in which the midface is separated from the skull base. There must however be a fracture of the pterygoid plates before any fracture is classified as such. A recent study shows Le Fort and maxillary fractures to constitute about 25.5% of all facial fractures 2,3. The Le Fort type 1 seems to be the commonest type, followed sequentially by types 2 and 3. Because of the traumatic etiologies, they are known to be associated with other secondary injuries to adjacent structures in the head and neck region.
This patient is seen to demonstrate fractures through the pterygoid plates and maxillary bones, as well as the floor and medial walls of the orbits in keeping with a type 2 Le Fort fracture pattern.
Unable to process the form. Check for errors and try again.