Le Forte Fractures (1).pptx

midface trauma is a commonly encountered fracture, this presentation entails all the clinical features and treatment of midface fractured

1. Le Forte Fractures Presented by: Gauri Bargoti Moderated by: Dr shivam Aggarwal

2. Contents Introduction Anatomy of mid-face Leforte 1 and treatment Leforte 2 and treatment Leforte 3 and treatment References

3. Introduction The midface is important functionally and cosmetically. It serves an important role in vocal resonance within the sinuses of the facial bones as well as in the function of the ocular, olfactory, respiratory, and digestive systems The face is also fundamental to interpersonal recognition and the perception of self-image

4. Anatomy The midfacial complex is constructed of a series of vertical pillars that primarily provide protection from vertically directed forces. These include the nasomaxillary (nasofrontal), zygomaticomaxillary, and pterygomaxillary buttress These vertical pillars are further supported by the horizontal buttresses—the supraorbital or frontal bar, infraorbital rims, and zygomatic arches.

5. Classification Of Leforte Rene Le Fort’s cadaver studies in the early twentieth century defined the three weakest levels of the midfacial complex when assaulted from a frontal direction. He defined the three most common “ linea minoros resistentiae ,” which are classified as the Le Fort I, Le Fort II, and Le Fort III fractures .

6. EMERGENCY CARE Initial evaluation of the severely injured midface can be an intimidating experience. Emergency care should be immediately initiated, applying the principles of Advanced Trauma Life Support (ATLS). The airway is immediately evaluated for obstruction The oropharynx must be manually cleared of any fractured teeth, dentures, and/or blood clots. If stable, the patient may be placed in a lateral decubitus position and mild Trendelenburg position to allow optimal drainage. If oral or nasal bleeding is encountered, these sites should be packed. If bleeding is uncontrollable, a definitive airway should be established immediate

7. Emergency care Any patient with facial trauma is presumed to have a cervical spine injury and should be stabilized with a rigid collar until ruled out by appropriate examination A cricothyroidotomy is also an appropriate option for establishing an emergency definitive airway in this setting. If nonurgent airway control is needed in the setting of cervical spine fracture, an awake fiberoptic intubation is likely the safest option because no atlantooccipital extension is required with this technique After definitive airway control is obtained, the ATLS protocol may continue

8. Facial examination

9. Le Forte 1 fractures Le Fort type I fractures are caused by a force delivered above the apices of the teeth

10. Clinical examination of Leforte 1

11. Treatment Of Leforte 1 Fractures

12. LeForte II Fracture This fracture pattern involves the nasofrontal suture, nasal and lacrimal bones, infraorbital rim in the region of the zygomaticomaxillary suture, maxilla, and pterygoid plates

13. Clinical presentation of LF 2

14. Treatment ORIF is advantageous for treatment of these fractures. If the nasofrontal suture area is intact and continuous with the maxillary segment, bilateral intraoral exposure allows appropriate four-point fixation. However, the orbital floor, inferior orbital rim, or nasofrontal region often requires exploration and repair

15. Basic Incisions

16. LE FORT TYPE III FRACTURE

17. Clinical Features Of Leforte 3 Classic dish face deformity Mobility of the zygomaticomaxillary complex CSF leakage, edema, periorbital ecchymosis, traumatic telecanthus , and epiphora may be observed

18. Treatment As a general principle, treatment should begin once the edema from the initial insult has begun to subside but should not be delayed for more than 10 to 14 days. Gruss et al have proposed a method of reconstruction whereby reconstruction begins with the outer framework and progresses to the inward facial structures, from stable to unstable areas A second school of thought, popularized by Markowitz and Manson,2 focused on reestablishing facial width at the NOE complex and proceeding in laterally Marciani and Gonty have summarized the four factors contributing to positive outcomes following reconstruction of craniomaxillofacial trauma. These are early definitive treatment, anatomic and functional repair of NOE injuries, wide exposure of fractured segments, and anatomic repositioning and stable fixation in all planes

19. Complications Complications following midfacial trauma are fairly common. A retrospective study of 20 patients requiring secondary reconstruction for periorbital deformities following initial midfacial trauma repair has concluded that the primary reason for orbital complications is a malpositioned zygoma. Other notable complications include paresthesia of the infraorbital nerve, orbital dystopia, enophthalmos, diplopia, malunion, and lacrimal system dysfunction. These are discussed in the following sections.

20. References Oral and Maxillofacial Trauma,Fonseca Walker 4E (2013)