Clinical feature of René le

fort fracture
Presentation By:
Nikunj Sorathiya
(Final Year)
Guide: DR Kiran Patel
Content
1.Aetiology
2.Classification of fracture
3.Clinical feature of le fort fracture
4.Le fort fracture line
 Aetiology

Assault
Gunshot wounds
RTA
Sports
Industrial accidents
Falls
• Low level fracture • Pyramidal fracture • High level fracture
• Guerin fracture • Sub-zygomatic fracture • Supra-zygomatic fracture
• Floating fracture • Mid-level fracture • Craniofacial disjunction
 Clinical feature of Le fort type I
Extraoral
• Inspectory findings
• Swelling and oedema of upper lip
• Bilateral epistaxis
• Palpatory findings
• On palpation tenderness over
buttress area
Intraoral
• Inspectory findings
• Mobility of maxillary alveolar segment
(floating fracture)
• Pain and tenderness while speaking or
clenching
• Ecchymosis or laceration in labial or
buccal vestibule
• Ecchymosis at GP foramen (Guerin sign)
• Mal occlusion
• Brusing of palatal tissues (15-20% of cases)
• Percussion findings
• On Percussion of teeth – cracked pot
sound
 Clinical feature of Le fort type II

Extraoral findings Intraoral findings

• Inspectory findings • Inspectory findings
• Oedema mid third of face (Moon
face) • Mal occlusion
• Bilateral circumorbital ecchymosis • Step deformity at IO margins
• Bilateral subconjunctival • Mobility of fractured fragment at nasal
haemorrhage bridge and IO margins
• Dish face deformity
• Depressed nose • Percussion findings
• Epistaxis • Percussion of teeth – cracked pot sound
• CSF rhinorrhea
• Limited ocular movement (Diplopia)
• Inability to open mouth
• Palpatory findings
• Paresthesia of cheek
 Clinical feature of Le fort type III

Extraoral findings Intraoral findings

• Inspectory findings • Inspectory findings
• Oedema of face (Panda facies) • Mal occlusion – posterior gagging of occlusion
• Bilateral periorbital edema
• Bilateral circumorbital ecchymosis (Racoon eyes)
• Bilateral subconjunctival haemorrhage
• Dish face deformity
• Depressed nose, flattening of nose
• Epistaxis
• CSF rhinorrhea
• Inability to open mouth
• Limited ocular movement (Diplopia, Enophthalmos)
• Dystopia, hooding of eyes with antimongloid slant
• CSF otorrhoea
• Haemotympanum
• Mobility of fractured fragment at NF, FZ sutures
• Tenderness over zygomatic bone, arch and FZ suture
• Ecchymosis at mastoid process (Battle’s sign)
Le fort fracture type I

Lateral fracture
Direction Position Landmark

Horizontal Above Level of the nasal

floor
Backwards - Lateral margin of
anterior nasal
aperture
Below The zygomatic
buttress
Cross the lower
third of pterygoid
laminae
Le fort fracture type I
Medial fracture
Direction Position Landmark

Backwards Above Level of the

nasal floor

Along the lateral

wall of nose

Lower 1/3rd of
nasal septum
 Le fort type II

Direction Position Landmarks

Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Direction Position Landmarks

Nasal Septum Floor of the anterior
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
cranial fossa
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Direction Position Landmarks

Nasal Septum Floor of the anterior
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
cranial fossa
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Nasal Septum Floor of the anterior

cranial fossa
Direction Position Landmarks
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Floor of the anterior

cranial fossa
Direction Position Landmarks
Nasal Septum
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Direction Position Landmarks

Nasal Septum Floor of the anterior
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
cranial fossa
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
 Le fort type II

Direction Position Landmarks

Nasal Septum Floor of the anterior
Thin middle are of nasal bone
Down Crossing Frontal processes of maxillae
cranial fossa
Into Medial wall of orbit
Crosses Lacrimal bone
Behind Lacrimal sac
Cross Infra-orbital margin
Forward Through/Medial Infra-orbital foramen
Downwards + Across Lateral wall of antrum
Backwards
Below Zygomaticomaxillary suture
Divide the pterygoid laminae
about ½ way
Le fort fracture type III
 Le fort fracture type III

Direction Position Landmarks

Near Fronto-nasal suture
Transversely and backwards Parallel Base of the skull
Involves the full depth of the ethmoid bone
Cribriform plate
Below Optic foramen
Posterior limit of the inferior orbital fissure

Direction Position Landmarks

Direction Position Landmarks
Backwards Across Pterygomaxillay fissure Laterally Across Lateral wall of orbit separating
To fracture the root of pterygoid the zygomatic bone from the
laminae frontal bone
Le fort fracture type III
Refrence

• Killey’s Fracture Of The Middle Third Of The Facial Skeleton