Figure 108-1 Fracture lines in Le Fort I, II and III fractures.

LE FORT FRACTURE Maxillary fractures are still classified according to the system of Le Fort ! Fig. 108.1 ", #$o defined t$ree %rinci%al %atterns of fracture after a%%l&ing 'lunt trau(a to t$e faces of cada)ers at t$e 'eginning of t$e *0t$ centur&. In a Le Fort I fracture ! Fig. 108.* ", t$e toot$-'earing %art of t$e (a+illa 'eco(es se%arated fro( t$e rest of t$e (a+illa '& fractures t$roug$ t$e (edial and lateral #alls of t$e (a+illar& sinuses, and '& a fracture t$roug$ t$e lo#er %art of t$e nasal se%tu(. T$e Le Fort II fracture ! Fig. 108., " is (ore e+tensi)e and t$e se%arated frag(ent is %&ra(idal. The apex of the pyramid is the lower part of the nasal bones, and t$e fracture lines run inferiorl& and laterall& t$roug$ t$e medial and inferior walls of the orbits, and t$en t$roug$ the anterior and posterolateral wall of the maxillary sinuses. T$e nasal se%tu( is fractured at a )aria'le le)el. In the Le Fort III fracture ! Fig. 108.- " t$ere is complete craniofacial dysjunction. T$e fracture line runs t$roug$ t$e nasal 'ones as in t$e Le Fort II fracture, and t$en %osteriorl& and laterall& t$roug$ t$e (edial and lateral #alls of t$e or'its, and t$roug$ t$e .&go(atic arc$es. T$e nasal se%tu( is fractured su%eriorl&.
Le Forte II facial fracture implies - (AIMS 84) a)Fracture running through alveolar ridge b)Fracture running through midline of the palate and ygomatico maxillary suture c)Fracture running through ygomatic process of the maxilla floor of orbit root of nose on one side only d)!imilar to " but on both sides #$ans

T$e Le Fort I fracture effecti)el& se%arates t$e al)eolus and %alate fro( t$e facial s/eleton a'o)e. T$e fracture line runs t$roug$ %oints of #ea/ness fro( t$e %&rifor( a%erture, t$roug$ t$e lateral and (edial #all of t$e (a+illar& sinus running %osteriorl& to include t$e lo#er %art of t$e %ter&goid %lates. T$e Le Fort II fracture is %&ra(idal in s$a%e. T$e fracture in)ol)es t$e or'it, running t$roug$ t$e 'ridge of t$e nose, and t$e et$(oids #$ose cri'rifor( %late (a& 'e fractured, leading to a dural tear and C F lea/. It continues to t$e (edial %art of t$e infraor'ital ri(, t$roug$ t$e infraor'ital fora(en and t$roug$ t$e infraor'ital fissure. T$e or'ital floor is al#a&s in)ol)ed. It continues %osteriorl& t$roug$ t$e lateral #all of t$e (a+illar& antru( at a $ig$er le)el t$an t$e Le Fort I to t$e %ter&goid %lates at t$e 'ac/. T$e nasal se%tu( is dis%laced and lateral #alls of t$e nose are fractured. T$e Le Fort III fracture effecti)el& se%arates t$e facial s/eleton fro( t$e 'ase of t$e s/ull 0 t$e fracture lines run $ig$ t$roug$ t$e nasal 'ridge, se%tu( and et$(oids, again #it$ t$e %otential for dural tear and C F lea/, and irregularl& t$roug$ t$e 'ones of t$e or'it to t$e fronto.&go(atic suture. T$e .&go(atic arc$ fractures, and t$e facial s/eleton is se%arated fro( t$e 'ones a'o)e at a $ig$ le)el t$roug$ t$e lateral #all of t$e (a+illar& sinus and t$e %ter&goid %lates. T$e nasal se%tu( #ill $e fractured and (a& 'e dis%laced. T$ese fractures are seldo( confined e+actl& to t$is classification and (a& 'e co('inations of an& of t$e a'o)e.