CLASSIFICATION OF FRACTURES AFTER LE FORT

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Presentation transcript:

CLASSIFICATION OF FRACTURES AFTER LE FORT Prof. Peter Stanko, MD, PhD Oral and Maxillofacial Surgeon Dpt. of Stomatology & Maxillofacial Surgery Comenius University, St Elisabeth Hospital

Comparison of fractures: Mandible ↔ Midface (maxilla) In contrast to mandibular fractures the midfacial fractures involve always a group of bones which are in close topographical relation. That means: -both maxillas, -both ossa palatina, -vomer, -both processus pterygoidei and allae majores ossis sphenoidalis (major wings of the sphenoidal bone), -both ossa nasalia (eventually with pars nasalis ossis frontalis), -os ethmoidale, -both ossa lacrimalia, -both ossa zygomatica including arcus zygomaticus bilaterally. Therefore in these fractures the walls of sinus maxillaris, nasal cavity with nasal septum, cellulae ethmoidales (ethmoidal cells) and walls of the orbit are effected.

HISTORY ► French anatomist Le Fort in 1901 realized a research on cadavers by: -falling them with face on margin of an abduction table -blowing them with an oak stick in the face. ► He evaluated statistically the usual course of fracture lines on the midfacial skeleton and established three main patterns of fractures.

CLASSIFICATION AFTER LE FORT (1901) It includes three fracture patterns of the midfacial skeleton: ► Le Fort I pattern "Lower subzygomatic fracture - horizontal, Guerin" ► Le Fort II pattern "Upper subzygomatic fracture - pyramidal" ► In Le Fort III pattern "Suprazygomatic, subbasal fracture, craniofacial separation".

CLASSIFICATION AFTER LE FORT ► In the Le Fort I pattern "Lower subzygomatic fracture - horizontal, Guerin„ the upper jaw is detached at a horizontal fracture through: -lower part of the piriform aperture, -fossa canina, -the zygomatic buttress (i. e. crista infrazygomatica seu zygomaticoalveolaris), -and the pterygoid plates (lower third).

CLASSIFICATION AFTER LE FORT ► In the Le Fort II pattern "Upper subzygomatic fracture - pyramidal„ the fracture line is running across -the nasal bones, -through the ossa lacrimalia -and the lamina orbitalis (syn. lamina papyracea) of ethmoidal bone, -the inferior orbital rims, -fossa canina, -through the zygomatic buttresses -and pterygoid plates (in the half).

CLASSIFICATION AFTER LE FORT ► In Le Fort III pattern "Suprazygomatic, subbasal fracture, craniofacial separation“ the upper jaw is detached from the base of the skull at a fracture line running through: -the nasofrontal suture, -the ethmoid bone, -lateral orbital wall, -the frontozygomatic sutures, -the arches of zygomas -and the pterygoid plates (highly near to the cranial base).

Le Fort pattern 1, 2, 3