Impacted type of fractures may be almost immobile and it is only by grasping the maxillary teeth and applying a little firm pressure that a characteristic grate can be felt which is diagnostic of the fracture. Percussion of upper teeth results in cracked pot sound. Le Fort II and Le Fort III common — Gross edema of soft tissue over the middle third of the face, bilateral circumorbital ecchymosis, bilateral subconjunctival hemorrhage, epistaxis, CSF rhinorrhoea, dish face deformity, diplopia, enophthalmos, cracked pot sound. Le Fort II — Step deformity at infraorbital margin, mobile mid face, anesthesia or paresthesia of cheek.
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The fracture affects multiple facial bones and is also termed as pyramidal or subzygomatic fracture. It is caused due to a violent force from a forward direction. Generally the force may be delivered at the level of the nasal bones. Therefore it is sometimes referred to as a broken nose but this is an inaccurate term. The affected structures in the fracture line includes frontal process of the upper jaw maxilla , lacrimal bones, nasal bones, zygomatic buttress and pterygomaxillary fissure area.
The swelling develops within a short time after the injury. The area surrounding the eye on both sides shows ecchymosis and edema. The ecchymosis tpresents as black eye. The swelling around eyes develops rapidly after the injury. Hemorrhages seen on the conjunctiva of both the eyes are confined to the median half.
The fracture near the nasal bones and frontonasal suture causes depression of the nasal bridge, leading to nasal disfigurement and a flat appearance to the face. If the fractures fragment is depressed backwards, dish face deformity is seen. When the fractured segment gets impacted against the cranial base then the face appears shortened and anterior open bite is experienced by the patient. There is usually dental malocclusion and complications such as airway obstruction may arise if the fractured segment gets displaced in posterior and downward direction, impinging on the dorsum of the tongue.
Few patients with LeFort II fractures may present with bilateral bleeding form the nose and difficulty in speech and jaw movements. Anesthesia or tingling sensation of the cheek may also be associated symptoms. Causes The main cause of LeFort II fractures is application of violent force usually from a frontal direction which sustained by the central region of the middle third of the face. A force at downward direction at the nose level is also capable of producing LeFort II fracture.
The fracture is generally pyramidal in shape and the area of application of the force is larger. The injury is generally caused by blunt objects and may be associated with falls. The typical instances of trauma to middle third of the face include altercations and vehicle accidents.
Treatment As the fracture lies very close to the orbit socket for the eye the patient should be examined for signs of visual disturbances such as double vision. The cerebrospinal leak should also be diagnosed using fluorescent dyes, laboratory analysis and other diagnostic tests. The life threatening complications such as airway obstruction should be corrected immediately.
The treatment varies according to presence and extent of the associated complications. X-rays and CT scans are performed to visualized the full extent of the fracture and determine the approach to treatment. The general approach includes zygomatic arch suspension or frontal bone suspension.
Removal of the impaction of the fractured segment using special forceps can also be carried out. Intraosseous wiring may be done at the inferior margins of the orbit. Malocclusions that develops may require orthodontic corrections in later stages of the treatment.
LeFort II Fractures
Menu Le Fort Fractures The mid-face is a complex anatomic region consisting of the maxilla and its multiple complex articulations with the adjacent upper and lower facial skeleton. The maxilla helps form the oral cavity, orbit, and nasal cavity; connects the cranial base with the occlusal plane; and allows proper anterior projection of the face. The maxilla along with the rest of the mid-face consists of multiple thickened buttresses running vertically, sagittally, and transversely that provide support for the underlying air-filled sinuses. The buttresses are protective against superior forces but are vulnerable to frontally and laterally directed forces. It is rare that fractures obey the classifications set forth by Le Fort.
TC : Classification de LEFORT
There are 3 types of Le Fort surgery. Each type of surgery moves different bones in your face. During Le Fort I surgery, your maxillary bone area just above your upper teeth is fractured. During Le Fort II surgery, fractures are made above your nose and in your upper jaw. During Le Fort III surgery, fractures are made through your cheekbones and the bones around your eyes. Informed consent means you understand what will be done and can make decisions about what you want.
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