LeFort III Fracture

Definition

LeFort III fracture is also known as transverse fracture, suprazygomatic fracture or high-level facial fracture. It is characterized by a fracture that extends above the zygomatic bones on both the sides of the face. The fracture involves nasal bones, frontonasal suture, maxilla, orbital plates of ethmoid bone and pterigomaxillary fissure. The fracture leads to detachment of the entire middle third of the face from the cranial base.

Symptoms

The symptoms of LeFort III fractures are similar to other mid-face fracture but are more severe and associated with serious complications. If the head is stabilized and maxillary teeth are gripped with one hand, movement of the entire middle third of the face can be felt on manipulation.

The patient’s face is described as ‘panda facies ‘and is associated with gross edema and bilateral swelling around the eyelids. The swelling around the eyelids is associated with bilateral ecchymosis and is commonly referred as ‘raccoon eyes’. The edema may be so severe that it can interfere with the eye opening movements. These patients also exhibit hemorrhages on the conjunctiva of both the eyes.

LeFort III fractures may be associated with tenderness and separation at the level of frontozygomatic suture. This leads to elongation of the face and lowering of the eye level. Hooding of the eye may be seen on one or both the sides. The middle third of the faces is depressed giving a characterized dish face deformity appearance.

As the fracture lies very close to the eyes diplopia (double vision), blurry vision, other visual disturbances and temporary blindness may be experienced by the patien  .The nasal bridge becomes flat and widened. The nasal bridge appears to be deviated on one side. Bleeding from the nose may also be present. Leakage of cerebrospinal fluid though the nostrils (CSF rhinorrhea) may also be present.

Causes

Generally LeFort III fractures are associated with high velocity trauma.LeFort III fracture line extends above the zygomatic bones on both sides of the face as a result of trauma being inflicted over a larger surface area at the level of orbit. The forces are generally applied from a lateral direction with a severe impact. The initial impact is taken by the zygomatic bone resulting in a depressed fracture and later the entire middle third of the face gets involved leading to craniofacial disjunction.

Treatment

The treatment of LeFort III fracture is complex and involves various factors. Any complication if present should be treated as a priority. Generally, the treatment is aimed at stabilizing the mobile fracture segment with the help of maxillo-mandibular fixation. Surgical approach may be from existing lacerations or through different types on incisions such as bicoronal flaps.

The treatment includes intraosseous wiring at the zygomaticofrontal suture and bilateral frontomolar suspension after applying the arch bars. If step pattern deformity is present at the lower border of orbit, introsseous wiring may be done at the infraorbital margins. To reattach the fracture segment miniplates fixation is used.

Post-operative care and orthodontic treatment in later stages is also important aspect of the treatment.

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