Create account
All articles / Oral and Maxillofacial Surgery

Midface Fractures (Le Fort Fractures)

Midface fractures are classified by the Le Fort system (I-III). Symptoms include swelling, misalignment, and dental injuries. Treatment involves surgical repositioning, fixation, and antibiotics. Follow-up with X-rays is crucial to ensure healing and function.

Author: Payam Farzad • Oral and Maxillofacial Surgeon • PhD • Department of Craniofacial Diseases • Stockholm
Reviewed by: Robert Heymann • Oral and Maxillofacial Surgeon • PhD • Department of Oral and Maxillofacial Surgery • Karolinska University Hospital • Stockholm
4 min read
Table of contents

    This article is based on an original article in Swedish which can be found here

    BACKGROUND

    The maxilla is located between the skull base superiorly and the dental arch/occlusal plane inferiorly. Its immediate proximity to the oral cavity, nasal cavity, sinuses, and eye sockets makes the maxilla a functionally and cosmetically important structure. Midfacial fractures typically occur due to high-energy blunt trauma to the face. Typical mechanisms of injury include motor vehicle accidents, assaults, and falls.

    The French anatomist Le Fort published in 1901 the results of his attempts to analyze the weak points of the facial skeleton. Through this, he named the various fracture levels that can often be observed in facial trauma. However, the Le Fort classification is usually inadequate to describe the effects of high-velocity injuries.

    Epidemiology

    Midfacial fractures are seen to a significantly lesser extent compared to mandibular fractures. The results of epidemiological studies on midfacial fractures suggest that population density and socioeconomic status play a crucial role. Midfacial fractures account for just over 25% of all facial trauma and can occur in a mixed age group with a peak age of just over 21-25 years.

    Diagnosis/Classifications

    CT/CBCT of the face with thin slices is necessary for the best possible imaging diagnostics and, if needed, 3D reformating.

    The classic Le Fort classification is as follows (see image 1):

    • Le Fort I (maxillary fracture) Runs horizontally and separates the maxillary alveolar process and palatine plate from the upper parts of the maxilla. Posteriorly, the fracture engages the pterygoid plates and superiorly; often parts of the anterior wall of the maxillary sinus. Clinically, the fracture is recognized by the anterior open bite, an effect of the posterior parts of the maxilla being pushed down by the medial pterygoid muscles, resulting in primary contact occurring in the molar regions.
    • Le Fort II (pyramidal fracture) Engages the nose and the ethmoidal complex. The fracture lines run down through the inferior orbital fissure, breaking through the infraorbital margin and backward through the tuber maxillae and pterygoid plates. However, the lateral orbit and zygomatic arches remain intact.
    • Le Fort III (craniofacial disjunction) From the nasofrontal area, the fracture line runs down through the inferior orbital fissure and out through the lateral orbital wall and zygomatic arches bilaterally. The facial skeleton is dislocated from the skull base. Clinically, a lengthened face is observed. 
    Illustration of Le Fort fractures in the facial skeleton, showing type I, II, and III fractures
    Image 1: The image shows the different Le Fort fractures
    Table of contents