Maxillofacial Injury

Aka: Maxillofacial Injury, Maxillofacial Trauma, Maxillary Fracture, Le Fort Fracture, Le Fort's Fracture, Fracture of Face Bones, Facial Fracture

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II. History

  1. Le Fort was a French surgeon studying cadaver skulls he Traumatized in the late 1800s to early 1900s

III. Types

  1. Le Fort Fracture Type 1
    1. Horizontal Fracture between the teeth and the Palate
  2. Le Fort Fracture Type 2
    1. Pyramidal Fracture from the the mid-Maxillary Sinus, through the inferior orbital rim to the Nasal Bridge
  3. Le Fort Fracture Type 3
    1. Vertical Fracture through the Maxillary Sinus lateral aspect and horizontal through the orbits
    2. Fracture includes the medial and lateral orbital walls

IV. Associated Conditions

  1. Head Trauma including Intracranial Hemorrhage
  2. Basilar Skull Fracture
  3. Cervical Spine Trauma
  4. Neck Vascular Injury in Blunt Force Trauma
  5. Eye Trauma
    1. Evaluate for Diplopia and Visual Acuity
  6. Epistaxis

V. Imaging

  1. CT Maxillofacial
    1. Includes orbits, Maxilla, sinuses and Mandible
  2. Have a low threshold for contiguous imaging
    1. CT Head
    2. CT Cervical Spine

VI. Management

  1. Cervical Spine precautions
  2. ABC Management is paramount
    1. Ensure a patent and secure airway
    2. Avoid Nasogastric Tube, posterior Nasal Packing, nasal intubation (risk of Basilar Skull Fracture)
    3. Surgical airway (Cricothyroidotomy) may be needed
  3. Perform a complete Trauma Exam
    1. Neurologic Exam with careful Cranial Nerve exam
    2. Extraocular Movement, Pupil Reactivity, and ocular exam
    3. Evaluate for signs of Neck Vascular Injury in Blunt Force Trauma

VII. Resources

  1. Radiopaedia
    1. https://radiopaedia.org/articles/le-fort-fracture-classification
  2. University of Iowa
    1. https://medicine.uiowa.edu/iowaprotocols/facial-fracture-management-handbook-lefort-fractures

VIII. References

  1. Karic, Shannon and Kiel (2019) Crit Dec Emerg Med 33(11):12-3

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