Pediatric emergency medicine trisk 3300 3300

FIGURE 107.5 The Le Fort classification of fractures. With type I, the maxilla is separated
from its attachments. Type II (pyramidal) produces a mobile maxilla and nose. With type III
(craniofacial disjunction), all attachments of the midface to the skull have been separated.
Traction on the anterior maxilla produces motion up to the inferior orbital rims and zygoma.
These fractures are not mutually exclusive. For example, Le Fort II fracture may exist on the
one side with type III on the other side.

In 1901, Le Fort described three fracture patterns that occurred in patients with
midface trauma ( Fig. 107.5 ). The Le Fort I fracture pattern involves only the
maxilla and extends through the zygomaticomaxillary region to the base of the
pyriform aperture. It allows motion of a segment of alveolar bone and teeth when
examined. The Le Fort II pattern, also called a pyramidal fracture, is similar but
extends more superiorly to the infraorbital rims and across the nasofrontal
sutures. The maxilla, nasal bones, and the medial orbital wall are separated from
the facial skeleton. The nose and the upper jaw are movable, whereas the
zygomas are stable. The Le Fort III pattern, also called craniofacial dissociation,
extends across the zygomatic arch, zygomaticofrontal region, floor of the orbit,
and nasofrontal sutures, effectively separating the midface from the skull base.
When the nose or upper jaw is moved, the entire midface, including the zygoma,
moves with it. These fractures are quite rare in children, and when they do occur,
they are most often asymmetric because impact is sustained from the side rather
than head on.
Patients with midface fractures typically have significant swelling over the
maxilla and severe epistaxis. Particular attention to the airway is of paramount
importance in these children because significant bleeding and a disruption in the
normal anatomic structures may threaten the patency of the airway. Nasal
manipulation should be avoided because these fractures may be associated with
cribriform plate injuries and passage of a nasogastric or endotracheal tube may