Makindo Medical Notes

🦴 Le Fort I: A floating palate (horizontal).
🦴 Le Fort II: A floating maxilla (pyramidal).
🦴 Le Fort III: A floating face (transverse).
👉 Mnemonic: “Speak no evil” (I), “See no evil” (II), “Hear no evil” (III).

📖 About Le Fort Fractures

• Le Fort fractures are classical midface fractures caused by blunt trauma.
• They disrupt the structural pillars of the face → instability, malocclusion, airway risk.
• Common causes: road traffic accidents 🚗, assaults 👊, and falls 🤕.
• Airway protection and haemorrhage control are the first priorities in management.

📜 Historical Background

• Described by René Le Fort, a French surgeon, in 1901.
• He dropped cannonballs onto cadaver skulls (!) to study fracture propagation patterns.
• He boiled off soft tissues to clearly observe fracture lines — showing remarkable consistency.

🦷 Le Fort Fractures of the Maxilla

• Le Fort I – “Floating Palate”
  • Horizontal fracture above the teeth → separates hard palate from maxilla.
  • Mobility of the upper dental arch when pulled.
  • Often low-velocity trauma (falls, punches).
• Le Fort II – “Floating Maxilla”
  • Pyramidal fracture → involves maxilla, nasal bridge, lacrimal bones, orbital floors/rims.
  • Midface (nose + upper jaw) moves as a unit.
  • Caused by higher-velocity impacts.
• Le Fort III – “Floating Face”
  • Transverse fracture → includes nasal bridge, orbital walls, zygomatic arches.
  • True craniofacial disjunction — face separates from skull base.
  • Often associated with CSF leak 💧 and severe trauma.

👁️‍🗨️ Clinical Presentation

• Follow ATLS principles: Airway, Breathing, Circulation, Disability, Exposure.
• Signs: midface mobility, malocclusion, epistaxis, rhinorrhoea, facial bruising, periorbital swelling.
• Look for Battle’s sign, CSF leak, loose teeth, periorbital ecchymosis (“panda eyes”).
• Check GCS and pupils – associated head injury is common.

🧪 Investigations

• CT Facial Bones – gold standard for fracture definition.
• Plain films are obsolete in modern trauma practice.
• Consider CT head/c-spine if high-velocity injury.

🩺 Management of Le Fort Fractures

• Airway first 🚨
  • Airway obstruction is the leading cause of death in facial trauma.
  • Avoid nasotracheal intubation if skull base fracture suspected (risk of intracranial intubation).
  • Consider surgical airway (tracheostomy) if needed.
• Bleeding: pack nasal/oral cavities; correct shock early.
• Secondary survey: check mobility by gently pulling on incisors.
• Give IV antibiotics (prophylaxis) and tetanus cover if indicated.
• If CSF leak present → neurosurgical referral.
• Definitive treatment: Open Reduction and Internal Fixation (ORIF) in ~60%.
  30% conservative, 10% no treatment required.

📚 References

• Le Fort Fractures: A Collective Review