Clinical feature of Rene le

fort fracture
Presentation By:
Nikunj Sorathiya
(Final Year)
Content
1. Aetiology
2. Classification of fracture
3. Clinical feature of le fort fracture
4. Le fort fracture line
 Aetiology

Assault
Gunshot wounds
RTA
Sports
Industrial accidents
Falls
• Low level fracture • Pyramidal fracture • High level fracture
• Guerin fracture • Sub-zygomatic fracture • Supra-zygomatic fracture
• Floating fracture • Mid-level fracture • Craniofacial disjunction
 Clinical feature of Le fort type I
Extraoral
• Inspectory findings
• Swelling and oedema of upper lip
• Bilateral epistaxis
• Palpatory findings
• On palpation tenderness over
buttress area
Intraoral
• Inspectory findings
• Mobility of maxillary alveolar segment
(floating fracture)
• Pain and tenderness while speaking or
clenching
• Ecchymosis or laceration in labial or
buccal vestibule
• Ecchymosis at GP foramen (Guerin sign)
• Mal occlusion
• Brusing of palatal tissues (15-20% of cases)
• Percussion findings
• On Percussion of teeth – cracked pot
sound
 Clinical feature of Le fort type II

Extraoral findings Intraoral findings

• Inspectory findings • Inspectory findings
• Oedema mid third of face (Moon
face) • Mal occlusion
• Bilateral circumorbital ecchymosis • Step deformity at IO margins
• Bilateral subconjunctival • Mobility of fractured fragment at nasal
haemorrhage bridge and IO margins
• Dish face deformity
• Depressed nose • Percussion findings
• Epistaxis • Percussion of teeth – cracked pot sound
• CSF rhinorrhea
• Limited ocular movement (Diplopia)
• Inability to open mouth
• Palpatory findings
• Paresthesia of cheek
 Clinical feature of Le fort type III

Extraoral findings Intraoral findings

• Inspectory findings • Inspectory findings
• Oedema of face (Panda facies)
• Mal occlusion – posterior gagging of occlusion
• Bilateral periorbital edema
• Bilateral circumorbital ecchymosis (Racoon eyes)
• Bilateral subconjunctival haemorrhage
• Dish face deformity
• Depressed nose, flattening of nose
• Epistaxis
• CSF rhinorrhea
• Inability to open mouth

• Limited ocular movement (Diplopia, Enophthalmos)

• Dystopia, hooding of eyes with antimongloid slant
• CSF otorrhoea
• Haemotympanum
• Mobility of fractured fragment at NF, FZ sutures
• Tenderness over zygomatic bone, arch and FZ suture
• Ecchymosis at mastoid process (Battle’s sign)
Le fort fracture type I

• This is a horizontal fracture above the level of nasal floor. The

fracture line extend backward from the lateral margin of the
anterior nasal aperture below the zygomatic buttress to cross the
lower third of pterygoid laminae. The fracture line passes along the
lateral wall of nose and lower third of the nasal septum to join the
lateral fracture behind the tuberosity.
Le fort fracture type I

Medial fracture Lateral fracture

Direction Position Landmark Direction Position Landmark
Backwards Above Level of the nasal Horizontal Above Level of the nasal floor
floor Backwards - Lateral margin of
Along the lateral anterior nasal aperture
wall of nose Below The zygomatic buttress
Lower 1/3rd of Cross the lower third of
nasal septum pterygoid laminae
To join the lateral fracture behind the tuberosity
Le fort fracture type II

• This fracture runs from the thin middle area of the nasal bone down
either side, crossing the frontal processes of the maxillae into the
medial wall of each orbit. Within each orbit, the fracture line
crosses the lacrimal bone behind the lacrimal sac, before turning
forward to cross infra-orbital margin slightly medial to or through
the infra-orbital foramen. The fracture now extends downwards
and backwards across the lateral wall of antrum below the
zygomaticomaxillary suture and divides the pterygoid laminae
above halfway up. Separation of block from the base of the skull is
completed via the nasal septum and may involve the floor of the
anterior cranial fossa.
 Le fort type II

Direction Position Landmarks

Nasal Septum Floor of the anterior
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
cranial fossa
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Direction Position Landmarks

Nasal Septum Floor of the anterior
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
cranial fossa
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Nasal Septum Floor of the anterior

cranial fossa
Direction Position Landmarks
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Floor of the anterior

cranial fossa
Direction Position Landmarks
Nasal Septum
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Direction Position Landmarks

Nasal Septum Floor of the anterior
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
cranial fossa
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Direction Position Landmarks

Nasal Septum Floor of the anterior
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
cranial fossa
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
Le fort fracture type III

• The fracture runs from near the fronto-nasal suture transversely

backward, parallel with the base of the skull and involves the full
depth of the ethmoid bone, including cribriform plate. Within the
orbit, the fracture passes below the optic foramen into the
posterior limit of inferior orbital fissure. From the base of the
inferior orbital fissure the fracture line extends into two
directions ; backwards across the pterygomaxillary fissure to
fracture the roots of the pterygoid laminae and laterally across
lateral wall of orbit separating the zygomatic bone from the frontal
bone. In this way the entire middle third of the facial skeleton
becomes detached from the cranial base.
 Le fort fracture type III

Direction Position Landmarks

Near Fronto-nasal suture
Transversely and backwards Parallel Base of the skull
Involves the full depth of the ethmoid bone
Cribriform plate
Below Optic foramen
Posterior limit of the inferior orbital fissure

Direction Position Landmarks

Direction Position Landmarks
Backwards Across Pterygomaxillay fissure Laterally Across Lateral wall of orbit separating
To fracture the root of pterygoid the zygomatic bone from the
laminae frontal bone
Refrence

• Killey’s Fracture Of The Middle Third Of The Facial Skeleton