Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Maxillary and Le Fort Fractures Workup

  • Author: Kris S Moe, MD, FACS; Chief Editor: Deepak Narayan, MD, FRCS  more...
 
Updated: Feb 08, 2016
 

Imaging Studies

See the list below:

  • 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 Medscape Reference Radiology article Le Fort Fractures Imaging.
  • CT scans
    • CT scan images are the imaging modality of choice for facial fractures.[8]
    • 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.[9]
 
 
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 Head and Neck Society, American Academy of Otolaryngology-Head and Neck Surgery, North American Skull Base Society

Disclosure: Nothing to disclose.

Coauthor(s)

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, American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

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, American College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Texas Society of Plastic Surgeons

Disclosure: Received none from Allergan for speaking and teaching; Received none from LifeCell for consulting; Received grant/research funds from GID, Inc. for other.

Chief Editor

Deepak Narayan, MD, FRCS Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center

Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Plastic Surgery Research Council, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Indian Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Nothing to disclose.

Acknowledgements

Kristin K Egan, MD Chief Resident, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine

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.

References
  1. Frakes MA, Evans T. Evaluation and management of the patient with LeFort facial fractures. J Trauma Nurs. 2004 Jul-Sep. 11(3):95-101; quiz 102. [Medline].

  2. Aksoy E, Unlu E, Sensoz O. A retrospective study on epidemiology and treatment of maxillofacial fractures. J Craniofac Surg. 2002 Nov. 13(6):772-5. [Medline].

  3. Ruslin M, Wolff J, Boffano P, Brand HS, Forouzanfar T. Dental trauma in association with maxillofacial fractures: an epidemiological study. Dent Traumatol. 2015 Aug. 31 (4):318-23. [Medline].

  4. Roumeliotis G, Ahluwalia R, Jenkyn T, Yazdani A. The Le Fort system revisited: Trauma velocity predicts the path of Le Fort I fractures through the lateral buttress. Plast Surg (Oakv). 2015 Spring. 23 (1):40-2. [Medline].

  5. Mundinger GS, Dorafshar AH, Gilson MM, Mithani SK, Manson PN, Rodriguez ED. Blunt-mechanism facial fracture patterns associated with internal carotid artery injuries: recommendations for additional screening criteria based on analysis of 4,398 patients. J Oral Maxillofac Surg. 2013 Dec. 71 (12):2092-100. [Medline].

  6. Bozkurt M, Kapi E, Karakol P, Yorgancilar E. Sudden rupture of the internal maxillary artery causing pseudoaneurysm (mandibular part) secondary to subcondylar mandible fracture. J Craniofac Surg. 2009 Sep. 20(5):1430-2. [Medline].

  7. Hwang K, Choi HG. Bleeding from posterior superior alveolar artery in Le Fort I fracture. J Craniofac Surg. 2009 Sep. 20(5):1610-2. [Medline].

  8. Mehta N, Butala P, Bernstein MP. The imaging of maxillofacial trauma and its pertinence to surgical intervention. Radiol Clin North Am. 2012 Jan. 50(1):43-57. [Medline].

  9. Li WZ, Zhang MC, Li SP, Zhang LT, Huang Y. Application of computer-aided three-dimensional skull model with rapid prototyping technique in repair of zygomatico-orbito-maxillary complex fracture. Int J Med Robot. 2009 Jun. 5(2):158-63. [Medline].

  10. Markowitz BL, Manson PN. Panfacial fractures: organization of treatment. Clin Plast Surg. 1989 Jan. 16(1):105-14. [Medline].

  11. Fischer K, Stenberg T. Prospective 10-Year Cohort Study Based on a Randomized, Controlled Trial (RCT) on Implant-Supported Full-Arch Maxillary Prostheses. Part II: Prosthetic Outcomes and Maintenance. Clin Implant Dent Relat Res. 2011 Aug 11. [Medline].

  12. Singh V, Sharma B, Bhagol A. Evaluating the applicability of a biodegradable osteosynthesis plating system in the management of zygomatico-maxillary complex fractures. Otolaryngol Head Neck Surg. 2011 Dec. 145(6):924-9. [Medline].

  13. Barone CM, Boschert MT, Jimenez DF. Usefulness of endoscopy in craniofacial trauma. J Craniomaxillofac Trauma. 1998 Fall. 4(3):36-41. [Medline].

  14. Chen CT, Lai JP, Chen YR, Tung TC, Chen ZC, Rohrich RJ. Application of endoscope in zygomatic fracture repair. Br J Plast Surg. 2000 Mar. 53(2):100-5. [Medline].

  15. Lee C, Jacobovicz J, Mueller RV. Endoscopic repair of a complex midfacial fracture. J Craniofac Surg. 1997 May. 8(3):170-5. [Medline].

  16. Kokoska MS, Hardeman S, Stack BC. Computer-aided reduction of zygomatic fractures. Arch Facial Plast Surg. 2003 Sep-Oct. 5(5):434-6. [Medline].

  17. Abou-Madina MM, Ozcan M, Abdelaziz KM. Influence of Resin Cements and Aging on the Fracture Resistance of IPS e.max Press Posterior Crowns. Int J Prosthodont. 2012 Jan-Feb. 25(1):33-5. [Medline].

  18. Cortese A, Savastano M, Savastano G, Claudio PP. One-step transversal palatal distraction and maxillary repositioning: technical considerations, advantages, and long-term stability. J Craniofac Surg. 2011 Sep. 22(5):1714-9. [Medline].

  19. Czerwinski M, Lee C. The rationale and technique of endoscopic approach to the zygomatic arch in facial trauma. Facial Plast Surg Clin North Am. 2006 Feb. 14(1):37-43. [Medline].

  20. Heschl A, Haas M, Haas J, Payer M, Wegscheider W, Polansky R. Maxillary rehabilitation of periodontally compromised patients with extensive one-piece fixed prostheses supported by natural teeth: a retrospective longitudinal study. Clin Oral Investig. 2012 Jan 31. [Medline].

  21. Yonezawa H, Yanamoto S, Hoshino T, Yamada SI, Fujiwara T, Umeda M. Management of maxillary alveolar bone fracture and severely intruded maxillary central incisor: report of a case. Dent Traumatol. 2012 Jan 11. [Medline].

Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.