Maxillary factures

Lefort I fracure

• Here part of the body of maxilla is separated from he base of the skull above the level of palate and below the attachment of Zygomatic process
• Horizontal fracture running above the nasal floor diving the nasal septum crosses lateral towards Zygomatic bone towards Zygomatic buttress and runs posteriorly towards maxillary tuberosity diving lower 3rd of pterygoing lamina

Lefort II fracture

• Pyramidal fracture
• Involves SUP alveolar ridge and passes obliquely upwards across the maxilla and nasal bone usually dividing the nose inwards
• Vertical fractures thru the facial aspect of maxilla
• Usually extends thru to the maxillary antrum
• Nasal bone laterally towards medical wall of orbit: infraorbital rim: below Zygomatic buttress

Lefort III fracture

• A traumatic fracture it is a high fracture that extends across the orbit thru inferior orbital fissure
• Fractures at the base of nasal bone and ethmoid region to the Zygomatic arches
• Bony orbit fracture
• Lateral rim of the orbit separated : face becomes elongated
• Fronto maxillary suture fracture: lachrymal bone fracture: INF Orbital tissues: frontozygomatic suture, INF orbital rim

Clinical features

Lefort I fracture: swelling of upper lip

• Ecchymosis in upper vestibule
• Ecchymosis in greater palatine foramen which is known as gurien’s sign (low level fracture)
• Gagging of occlused (ANT open bite) as maxilla falls down posterior teeth clutches so ant mouth remains open causing lengthening of face

Lefort II and III:

• Swelling of mid face
• Subconjunctival hemorrhage
• Teleconthus: widening of medial anthus : globe is attached laterally to the bone by a suspensory ligament of locaud if fracture occurs above the attachment: eye drops down: diplopia
• Enophthalmous: fracture in orbital rim
• Cribriform fracture: CSF rhinorrhoea: tram like effect: salty taste
• INF orbital rim fracture: entrapment of inferior rectus: difficulty in upward gaze

Radiographic view

• Occipitomental view/PNS view , Occlusal view, CT scan

Management:

• Internal fixation: indirect osteocanthesis and direct osteocanthesis
• External fixation