0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

LEFORTII

■ Involves the maxilla, nasal bones, and medial aspects of the orbits (pyrami-

dal fracture)

■ Upper dental arch and the nose are mobile.

LEFORTIII

■ Involves the maxilla, zygoma, nasal bones, ethmoids, vomer, and lesser

bones of the cranial base

■ The entire face is mobile: Craniofacial dysjunction.

SYMPTOMS/EXAM

■ Soft-tissue swelling of the face

■ Midface mobility is assessed by moving the upper teeth.

■ Malocclusion

■ CSF rhinorrhea is seen with Le Fort II and III.

■ Usually these fractures occur in combination: Uni- or bilateral.

DIAGNOSIS

■ Mobility of the maxilla relative to the rest of the head can be assessed by

moving the upper incisors.

■ Facial CT is used to confirm the diagnosis and define the extent of injury.

I

II

II

III III

FIGURE 14.14. Le Fort fractures.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski SJ. Emergency

Medicine: A Comprehensive Study Guide, 6th ed.New York: McGraw-Hill, 2004:13.)