Management And Complications of Le Fort Fractures |
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Diagnostic Imaging of the mid-face
¨ In the tooth-bearing part of the maxillae separation at the le fort I level is often a clinical diagnosis ¨ Intra-oral films however may be valuable in localising alveolar fractures or a midline split of the palate ¨ True lateral projection is often the only plain film which clearly demonstrates a Le Fort I fracture ¨ Two occipitomental projections 10’ and 30’ demonstrate most mid-facial fractures ¨ For higher le fort II and III fractures it is particularly important to determine the overall fracture pattern ¨ When there is comminution and displacement in the naso-ethmoid region or extensive damage to the orbital integrity a CT scan is necessary
Management
¨ Undisplaced/minimally displaced, resulting in minimal occlusal derangement, conservative treatment may be appropriate ¨ Minimally displaced le fort I fractures may require 3 weeks of intermaxillary fixation ¨ Indications for operative intervention are asymmetry, displacement, comminution, and occlusal derangement ¨ In common with other fractures surgery consists of reduction and alignment, with immobilisation of the fragments until union has occurred (open reduction and internal fixation)
Complications
¨ Nasal haemorrhage usually managed by simple anterior nasal packing ¨ Retrobulbar haemorrhage following reduction of zygomatic complex surgery an acute emergency treated by decompression ¨ Nerve damage sensory loss over the skin of the mid-face is relatively common due to neuropraxia of the infra-orbital nerve
Late Complications
¨ Malunion can occur if the fracture has been inadequately reduced leading to bony deformity of the face ¨ Inadequately reduced le fort fractures may leave the patient with an overlong face or flattening of the entire profile ‘dish face’ deformity ¨ Gagging on the molar teeth and an anterior open bite
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