Maxillary and Le Fort Fractures Workup

  • Author: Kris S Moe, MD, FACS; Chief Editor: Al Aly, MD, FACS   more...
 
Updated: Feb 2, 2012
 

Imaging Studies

  • Plain radiographs
    • Plain films are limited by their ability to penetrate through extensive soft tissue edema and to help distinguish between multiple planes of complex bony framework.
    • Historically, plain radiographs with Waters and submental-vertical views of the paranasal sinuses, lateral skull, and lateral cervical spine were used as screening examinations.
    • Sinus films provide information regarding the zygomatic arches, nasal bones, lateral and anterior sinus walls, and orbital rims. Most of the anatomic bolsters described above should be visualized.
    • Lateral skull films provide information about the global anteroposterior position of the mid face and the integrity of the inner and outer tables of the frontal sinus.
    • Cervical spine films are important to exclude injury to the vertebral column. Otherwise, standard radiographs are little used for craniofacial injuries.
    • For more information, see eMedicine Radiology article Le Fort Fractures.
  • CT scans
    • CT scan images are the imaging modality of choice for facial fractures.[5]
    • CT imaging is superior to plain films for delineating multiple fractures, evaluating associated cartilaginous or soft tissue injury, and assessing for the presence of impingement into the optic canal.
    • Thin (2-mm) cuts in both the coronal and axial planes are needed to obtain adequate detail of fractures. See the image below.(A) Axial CT scan. Note that determining whether t(A) Axial CT scan. Note that determining whether the vertical buttresses have been compromised is difficult using the axial image. (B) Coronal CT scan. This view demonstrates fractures through the nasomaxillary and zygomaticomaxillary buttresses. (C) Coronal CT scan. This more posterior view demonstrates fractures through the pterygoid plates.
    • Three-dimensional CT scans are highly recommended for the treatment planning of fractures of moderate or greater complexity.[6]
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Kris S Moe, MD, FACS  Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine

Kris S Moe, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Society for Head and Neck Surgery, and North American Skull Base Society

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick Byrne, MD  Associate Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine

Patrick Byrne, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American College of Surgeons

Disclosure: Nothing to disclose.

David W Kim, MD  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Director, Division of Facial Plastic and Reconstructive Surgery, University of California at San Francisco

David W Kim, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery and American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Adel R Tawfilis, DDS  Assistant Clinical Professor, Department of Surgery, Division of Plastic Surgery, University of California at San Diego Medical Center

Adel R Tawfilis, DDS is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, and American Society of Maxillofacial Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

James F Thornton  MD, MD, Associate Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jaime R Garza, MD, DDS, FACS  Consulting Staff, Private Practice

Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS  Clinical Professor of Plastic Surgery, University of California, Irvine, School of Medicine

Disclosure: Ethicon Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Angiotech Consulting fee None

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Kristin K Egan, MD, to the writing and development of this article.

References

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Typical Le Fort I fracture pattern.
Typical Le Fort II fracture pattern.
Typical Le Fort III fracture pattern.
Vertical buttresses of facial skeleton.
Horizontal buttresses of facial skeleton.
(A) Axial CT scan. Note that determining whether the vertical buttresses have been compromised is difficult using the axial image. (B) Coronal CT scan. This view demonstrates fractures through the nasomaxillary and zygomaticomaxillary buttresses. (C) Coronal CT scan. This more posterior view demonstrates fractures through the pterygoid plates.
Cadaver demonstration of sublabial approach to rigid titanium plate and screw fixation of Le Fort I fracture.
 
 
 
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