Boundaries of Midface

Midface Fracture

09.09.2020

Maxillofacial Trauma

Boundaries of Midface

Superior:

 FZ---FM-FN-FM—---FZ

 Spheno-ethmoidal--junction with---SE

Inferior:

 Occlusal---Incisal---Occlusal

Surgical Anatomy

 Paired Bone (16) Unpaired Bone (2)

▪ Nasal bone Vomer

 Maxilla Ethmoid

 Zygomatic

 Inferior concha

 Lacrimal Bone

 Zygomatic process of temporal bone

 Palatine

 Pterygoid plate of sphenoid

Tripod Fracture

Classification of Midface # (Row

& William 1986)

 # Not involving the occlusion

A. Central region:

a. Nasal bone: Anterior Lateral

b. Frontal process of maxilla

c. a+b+Ethmoid (Nasoethmoid)

d. a+b+c+Frontal (Fronto-Naso-Orbital)

B. Lateral region:

Zygomatic complex #

 # involving the occlusion:

A. # Dentoalveolar

B. Subzygomatic:

Lefort I Lefort II

C. Suprazygomatic Lefort III

LeFort Fractures

# Lefort I/low level #/Guerin

#/horizontal # of

maxilla/subzygomatic/floating maxilla

 Rene Le Fort in 1901

 Cadaver study

 Removal of the soft tissue

Le fort I

 # line Start from inferio-lateral margin of anterior nasal aperture, passes laterally

above the canine fossa and then below the zygomatic buttress and posteriorly crosses the pterygo-maxillary fissure and fracture the pterygoid lamina at the

junction of upper 2/3^rd and lower 1/3^rd.

Le Fort II

Le fort II/ Pyramidal

 # line start from Nasal bone at the

junction of superior 1/3^rd and inferior 2/3^rd extend either side downward to enter the medial wall of the orbit involving the

lacrimal bone. Then the # line passes

downward laterally crosses the infraorbital margin slightly medial to the infraorbital

foramen crosses the zygomaticomaxillary sutures. Then the # line goes downward backward to cross the pterygomaxillary fissure & fracture the pterygoid lamina about ½ way up.

Le Fort III/ Transverse #/ Surrazygomatic #/ craniofacial dysjunction/Parallel # run with the base of the skull

 # line start from the F-N junction passes downward laterally crosses the frontal process of maxilla. into the orbit it passes posteriorly through the orbital plate of ethmoid bone along the medial wall of orbit leavinf the optic foramen.

 A-Downward—passes the posterior aspect of maxilla through the pterygomaxillary fissure

fracturing the ptreygoid lamina at the junction of superior 1/3^rd and inferior 2/3^rd.

 B- Laterally –passes the lateral wall of orbit then crosses the zygomatico-sphenoid sutures and

fracture the F-Z sutures by separating the frontal bone from zygomatic bone.

Clinical features (le Fort I)

 Pain

 Swelling

 Bleeding

 Deranged occlusion

 Cracked pot syndrome

 floating maxilla

 Guerin’s sign

Le fort II, III

 Sub conjunctival hemorrhage

 Circum-orbital ecchymosis

 Black eye

Management

 Primary

 Definitive

Management

 3-R

1. Reduction 2. Retention

3. Rehabilitation

 Closed Reduction

 Open Reduction

Surgical Protocol (Open Reduction)