This results in complete craniofacial dysjunction. These fractures result from an impact to the nasal bridge or upper maxilla. On the lateral aspect, it travels under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plate. Inferolaterally, the fracture extends through the lacrimal bone and inferior orbital floor near the inferior orbital foramen and inferiorly through the anterior wall of the maxillary sinus. This fracture has a pyramidal shape and extends from the nasal bridge at the nasofrontal suture through the maxilla. These fractures result from a force to the lower or mid maxilla. Fractures extend from the nasal septum to lateral pyriform rims, and extend horizontally above the teeth, crossing below the zygomaxillary junction, then traversing the pterygomaxillary junction interrupting the pterygoid plates. These fractures result from a force directed low on the maxillary rim in a downward direction. This may be associated with a cerebrospinal fluid (CSF) leak. This discontinuity between the skull and the face is termed craniofacial dissociation. The fractures run parallel with the base of the skull, separating the entire midfacial skeleton from the cranial base. This type of fracture starts at the bridge of the nose and extends posteriorly along the medial wall of the orbit and the floor of the orbit, and then through the lateral orbital wall and the zygomatic arch. They are pyramidal fractures with teeth at the base and nasal bone at the apex. These fractures extend superiorly in the midface to include the nasal bridge, maxilla, lacrimal bones, orbital floor, and rim. Transverse fracture through the maxilla above the roots of the teeth, separating teeth from the upper face. It then continues posteriorly in a horizontal fashion above the hard palate to involve the pterygomaxillary buttresses, resulting in a disarticulation of the pyramid-shaped facial skeleton from the remainder of the skull. Note that the zygoma remains attached to the cranium.Īlso called cranial-facial separation, the fracture line in this injury passes from the nasofrontal area across the medial, posterior, and lateral orbital walls, the zygomatic arch, and through the upper portion of pterygoid plates. The fracture line begins in the region of the bridge of the nose (nasion) and extends obliquely through the medial aspect of the orbits and inferior orbital rims. This pyramidal fracture occurs due to trauma to the midface. However, this fracture does not involve the glabella or zygoma. This occurs in the horizontal plane at the level of the base of the nose. A direct blow to the lower face causes fractures that involve all 3 walls of the maxillary sinus and pterygoid processes. The fracture extends around both maxillary antra, through the nasal septum and the pterygoid plates. This causes palate-facial separation. These fractures (trans-maxillary fracture) result from a force directed low on the maxillary rim in a downward direction. Beware that these complex injuries seldom occur in isolation and are often associated with concomitant or life-threatening injuries. Le Fort injuries occur with high-impact force when energy transfer to the body exceeds the tolerance of impacted tissue. These may be potentially life-threatening and disfiguring in patients in whom the injury is significant. Le Fort fractures account for 10% to 20% of all facial fractures. Le Fort type III fractures are caused by impact to the nasal bridge and upper part of the maxilla.Le Fort type II fractures result from a force to lower or mid maxilla.Le Fort type I fractures may result from a force directed in a downward direction against the upper teeth.Patients with Le Fort fractures often have associated head and cervical spine injuries. Le Fort fractures can also occur secondary to motor vehicle collisions, assault, and fall from a substantial height. A high percentage of facial injuries occur secondary to injuries, from sports such as football, baseball, and hockey.
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