Download Document

‫به نام خداوند بخشنده و مهربان‬
MAXILLARY FRACTURES
Midface Fractures
LEFORT - AP VIEW
Le Fort I (low level or
Guerian fracture)
Unilateral/ bilateral


Horizontal fracture
through the maxilla
above the level of the
nasasl floor and alveolar
process
Piriform rims
Anterior maxilla
Zygomatic buttresses
Ptrygoid laminae




4

Slight swelling of upper lip

Ecchymosis in upper lip sulcus

Hematoma intra-orally over zygoma and in palate

Disturbed occlusion

Mobility of teeth of the involved segment of maxilla

Combination of soft tissue laceration

Impacted type of fracture is oftenly not mobile and teeth cusps
may be damaged
5

Le Fort II
(pyramidal or subzygomatic)
Separation of NF suture,
medial orbital walls (lacrimal
bone), inferior orbital floor and
rim (adjacent to infrorbital
canal and foramen), anterior
maxilla below zygomatic
buttress and ptrygoid laminae
about halfway up.
Separation of the block from the base of skull is completed
via the nasal septum and may involve the floor of the
anterior cranial fossa
7

LeFort III
(cranifacial dysjunction, high
transverse, suprazygomatic)
Separation of NF suture, medial
orbital walls (involve the depth of
the ethmoid bone and cribriform
plate, pass below optic foramen and
cross the inferior orbital fissur),
inferior orbital floor, lateral orbital
wall, ZF suture, zygomatic arch,
suprazygomatic to the root of
ptrygoid plate.
9











Gross edema of soft tissue
Bilateral circumorbital
ecchymosis
Bilateral subconjunctival
hemorrahge
Obvious deformity of the nose
Nasal bleeding and obstruction
CSF leak rhinorrhea
Dish-face deformity
Limitation of ocular movement
Possible diplopia and
enophthalmous
Retropostioning of the maxilla
with anterior open bite
Lengthening of the face










Difficulty in mouth opening
Mobility of the upper jaw
Occusional hematoma of the
palate
Cracked-pot sound on
percussion
Step deformity at infra-orbiatal
margin
Anasthesia of midface
Nasal bone moves with mid-face
as a whole
Tenderness and sepration at FZ
suture
Tenderness and deformity of
zygomatic arch
Depression of occular level and
pseudoptosis
11
DIAGNOSIS OF MAXILLOFACIAL
INJURIES
Inspection
Palpation
Diagnostic Imaging
Plain films
CT
INSPECTION
Sublingual ecchymosis
Step defects, ridge
discontinuity, malocclusion
DIAGNOSIS OF MAXILLOFACIAL
INJURIES
PALPATION
“Step” Defect
Crepitus
Bony segments
Subcutaneous emphysema
Mobility
FACIAL EXAMINATION
PALPATION OF MIDFACE/BRIDGE OF
NOSE
FACIAL EXAMINATION
ORBITS EVALUATION
FACIAL EXAMINATION
Orbits evaluated
Periorbital edema and ecchymosis
Gross visual acuity determined
Diplopia
Pupillary size & shape
Subconjunctival hemorrhage
FACIAL EXAMINATION
Orbits evaluated
Lid lacerations
Attachment of medial canthal tendon
Rounding of lacrimal lake
Increased intercanthal distance
Epiphora
Prompt Ophthamology consult
FACIAL EXAMINATION
Evaluate mandibular opening
Palpation of buccal vestibule
Crepitus of lateral antral wall
Occlusion evaluated
Absence and quality
of dentition noted
Ecchymosis common finding
Pharynx evaluated for laceration
& bleeding

Physical signs of a fracture of the maxilla.

Evidence of a fractured maxilla on imaging.

Disruption of the occlusion of the teeth.

Displacement of the maxilla.

Post traumatic facial deformity.
24

Fractured or displaced teeth.

Cerebrospinal fluid leak.

Abnormal eye movement or restriction of eye movement.

Occlusion of the nasolacrimal duct.

Sensory or motor nerve deficit.

Other evidence of loss of function
25

Relieve pain

Restore function.

Restore bone anatomy.

Prevent infection

Restore the dental occlusion

Restore jaw movement at the earliest possible stage

Restore normal nerve function
26

Association with multiple injuries.

Presence of uncontrolled haemorrhage

Impairment of the airway.

Association with a dural tear.

Association with a base of skull fracture.
27

Presence of a pre-existing dentofacial deformity.

Time elapsed since the injury.

Presence of a medical or surgical factor which would
delay general anesthesia

Presence of any factor which would delay healing. (eg
nutritional deficiency or alcoholism)

Stage of dental development (deciduous, mixed or
permanent dentition)
28

Presence of fractured teeth.

Total absence of teeth (edentulous)


Inability of the patient to co-operate with treatment.
Association with fractures of the mandible especially
bilateral fractures of the condyles.
29
Closed reduction may be appropriate in cases
 Simple uncomplicated fractures
 Complex or comminuted fractures
 Medical or surgical contraindications to open
reduction
 Maxillary fractures in children
31
Open reduction may be appropriate where
 Immediate or early jaw function is desirable
 Difficulty is encountered in reducing the
fracture by a closed method
 The fracture is unstable
32

Reduction
Manual manipulation
Use of dis-impaction forceps
33
Extraoral fixation
Craniomandibular fixation
Box-frame (pin fixation)
Halo-frame
Plaster of paries headcap
Craniomaxillary fixation
Supra-orbital pins
Zygomatic pins
Halo-frame
34
Cont:
Management
Techniques



Plate Fixation (Miniplates)
Interosseous Wire Fixation
Bone Grafts
Management by Le Fort Classification

Le Fort I: reduced digitally, MMF, fixation of ZM

Le Fort II: stabilization of the ZM buttress, MMF , nasofrontal
process and inferior orbital rim.

Le Fort III: usually requires coronal flap for adequate
exposure for exploration and miniplate fixation
‫با تشکر از صبر و حوصله‬
‫شما‬