Presentation
Pushbike accident with headstrike.
Patient Data
Brain
frontal scalp contusion
no intracranial haemorrhage
Face
bilateral Le Fort I and II fractures. Involvement of the right infraorbital nerve canal.
haemosinus.
depressed naso-orbitoethmoid fractures with bilateral frontal sinus fractures.
fracture of the anterior cortex of the mandible in the midline with debris. Fractured mandible incisors lying in mouth.
tooth 43 absent, empty socket
left periorbital preseptal soft tissue swelling.
C-spine
C6 extension tear drop fracture with C6/7 disc widening.
right C6 foramen transversarium minimally displaced fracture.
limbus C4 vertebra (mimicing a fracture).
These diagrams demonstrate the patterns of bilateral Le Fort 1,2 and 3 fractures.
Example of Le Fort II & III fractures in a different patient.
There are bilateral pterygoid plate fractures, common to all Le Fort type fractures.
Both zygomatic arches and lateral orbital walls are fractured indicating bilateral Le Fort III fractures are present.
Both orbital floors are fractured indicating bilateral Le Fort II fractures.
There is also separation of the nasofrontal sutures bilaterally, common to both type II and III Le Fort fractures.
Blood within both maxillary sinuses.
Solitary impacted left maxillary tooth surrounded by an apparent disrupted lucent cystic bony lesion, most likely a dentigerous cyst/odontogenic keratocyst. Otherwise edentulous.
This CT from a different patient due to hypoxia.
On this CT, a tooth is seen lodged in the left lower lobe bronchus. When a empty tooth socket is identified, an attempt must be made to locate the tooth either in the oral cavity or the chest.
An example of mandibular fractures in a different patient.
Bilateral mandibular condyle and right body of mandible fractures.
Case Discussion
There are three types of Le Fort fractures but they rarely occur in their pure form. The types were originally described as being bilateral however the classification is now commonly used to describe unilateral injuries or combined types. Depending on the distribution of forces through the facial skeleton, multiple Le Fort fracture patterns may occur at the same time. Different combinations may occur at the same time and different combinations may occur on the two sides of the face (e.g. type I and II on the left and type II and type III on the right) 1,2.
In this case, there are bilateral Le Fort I fractures as there are fractures bilaterally of the anterolateral margin of the nasal fossa. There are bilateral Le Fort II fractures as the inferior orbital walls are fractured. There is no fracture of the zygomatic arch or lateral orbital walls, excluding a Le Fort III fracture. There are bilateral pterygoid fractures which are present in all types of Le Fort fractures.
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