The peak incidence of midfacial trauma is between the ages of fifteen and thirty. Males make up 60-80% of those sustaining these injuries. The most common mechanisms of injury are motor vehicle accident, assault, falls, sports related injuries, gunshot wounds, and industrial accidents. Mechanisms are of two main types, high energy and low energy. Approximately 20% of all trauma patients have facial injuries. The zygoma is second only to the nasal bones in the most frequently fractured facial bones. High energy mechanisms like motor vehicle accidents result in the more severe, comminuted fractures while lower energy trauma, such as an assault, will result in less severe injuries.

Renee LeFort (1901) provided the earliest classification system of maxillary fractures. His model described "great lines of weakness in the face" using low-velocity impact forces directed against cadaver skulls. A discussion of fractures of the maxilla would not be complete without a description of LeFort's work.

Maxillary and Le Fort fractures in facial trauma. Horizontal buttresses of facial skeleton Le Fort III Le Fort II Le Fort I

Le Fort I Fractures Low-level / Guerin type fractures Horizontal fracture of the maxilla immediately above the teeth and palate Piriform fossa across maxilla to pterygoid fissure May occur as a single entity or in association with le fort II and III fractures Not infrequently present in association with a downwardly displaced fracture of the zygomatic complex

Le Fort II Fractures Pyramidal or suprazygomatic fractures Fracture extends from dorsum of nose, across medial walls of orbit across the maxilla below the zygomatic bone to the pterygomaxillary fissure

Le Fort III Fractures High level or suprazygomatic fractures The facial bones, including the zygomas are detached from the anterior cranial base Fracture line extends from the dorsum of the nose and cribiform plate along the medial and up the lateral wall of the orbit to the ZF suture

Occipitomental radiograph demonstrates a zygomatic fracture. White arrows indicate the fractures in the region of the orbital, maxillary and temporal connections of the zygomatic bone.

Mandibula fracture

Sixty-six year old female sustaining complex comminuated fractures to all bones of the face.

Cranial injures

This graphic illustrates the kind of secondary cranial fracturing that can occur with gunshot wounds. The cerebrospinal fluid surrounding the brain absorbs the force of the blast distributing shock waves throughout the endocranium. The resulting pressure causes this kind of fracturing from the inside out.

The gunshot wounds

Sword wound the skull (X century a.c.)

Old wound the skull (cicatrization bone)

Cranial trauma observed in the Iron Age

Chronic subdural hematoma with mass effect.