Le Fort Fractures
Le Fort fractures are classic patterns of transverse mid‑facial disruption that involve the maxilla and, by definition, include fractures of the pterygoid plates. They provide a pragmatic anatomic classification of mid‑face trauma into three ascending levels (I → II → III).
Le Fort injuries imply high energy transfer and often coexist with other facial, cranial and cervical injuries; management in the emergency department follows major‑trauma principles (airway, haemorrhage control, imaging, disposition) (NICE NG39, NG232).
Anatomy and mechanism
- The pterygoid plates form a posterior buttress anchoring the maxilla; disruption of the pterygoid plates is the diagnostic hallmark of a true Le Fort injury on CT.
- Force vectors determine the level of fracture: inferior blows (above the dental row) produce lower fractures (Le Fort I); more superior and central impacts produce Le Fort II and III patterns.
- Consequences include loss of stability of the tooth‑bearing maxilla, orbital rim and floor disruption, naso‑ethmoid or skull‑base injury, and injury to neurovascular structures such as the infraorbital nerve or nasolacrimal apparatus.
Clinical patterns (what to recognise)
Le Fort I - “floating palate”
- Fracture: transverse through the maxilla above the teeth, through pterygoid plates; separates the inferior dental/maxillary segment from the midface.
- Typical features: mobile tooth‑bearing segment, malocclusion, upper‑lip swelling, buccal sulcus ecchymosis (Guerin’s sign), mobile teeth with crepitus, “cracked‑pot” sound on dental...