AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 11

(Figure 11.5), which cause the hard palate and the bone above to be very mobile. Patients will tend to have an unstable bite and malocclusion. Le Fort I (Figure 11.6) is a palate-face disconnection and is a horizontal maxillary bone fracture. The fracture line runs above the maxilla alveolar ridge and maxillary sinus floor, through the pyriform aperture bilaterally, and across the septum and pter- ygoid plates. On examination, the hard palate is very mobile. Le Fort II (Figure 11.7) is a pyramidal disloca- tion (center of face surrounding the nasal anatomy). Classically, the fracture line goes through the nasofrontal suture, both lacrimal bones, and both lamina papyracea. It then extends to the orbital floors and medial/infe- rior orbital rims. As in Le Fort I, the fracture line will involve the nasal septum and ptery- goid plates. This triangular area of bone will be mobile on examination. Le Fort III (Figure 11.8) is a true craniofacial separation. The fracture line goes through the zygomatic arches bilaterally, frontozygo- matic suture, frontoethmoidal suture, and the nasofrontal suture. Like Le Fort I and II, the fracture line will go through the nasal septum and pterygoid plates. The whole midface is These midface fractures involve the zygoma bone (also known as zygomaticomaxillary complex). The zygoma bone attaches to the skull via three attachment points: (1) zygo- matic arch, (2) zygomaticofrontal suture, and (3a and 3b) maxillary bone (inferior orbital rim and zygomaticomaxillary suture) (Figure 11.9). Fractures to this area may cause mobile upon manipulation. Tripod/Tetrapod Fractures

Figure 11.5. Pterygoid plate fractures are seen in all Le Fort fractures. In this CT scan, the medial and lateral pterygoid plates are fractured on both sides. The pterygoid plates are not repaired because they are difficult to reach.

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Figure 11.6. Le Fort I fracture. Photo: Courtesy of Ashley Lloyd, MD.

Figure 11.7. Le Fort II fracture.

Primary Care Otolaryngology