Maxillary and Le Fort Fractures Workup

Updated: Jun 17, 2018
  • Author: Kris S Moe, MD, FACS; Chief Editor: Deepak Narayan, MD, FRCS  more...
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Workup

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. [10]

    • 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. [11]