Midface Fractures

Evaluation and Management

E.RAZMPA M.D

OTOLARYNGOLOGIST

HEAD & NEACK SURGEON

ASSOCIATE PROFESSOR

TEHRAN UNIVERSITY OF MEDICAL SCIENCES

www.razmpa .com

Midface Fractures

Etiology

•Motor Vehicle Accidents

•Assault

•Sport

•Falls

•Work

•Pathological

Midface Fractures

•Osteology of the midface

–2 maxillae

–2 zygomata

–2 zygomatic proceses of temporal bone

–2 palatine bones

–2 nasal bones

–2 inferior conchae

–2 pterygoid plates of sphenoid bone

Midface Fractures

•Three buttresses allow face to absorb force

–Nasomaxillary (medial) buttress

–Zymaticomaxillary (lateral) buttress

–Pyterigomaxillary (posterior) buttress

Midface Fractures

Classification

•Anatomical

–Lefort

•I

•II

•III

•Unilateral

•Sagittal

–Wassmund

•Severity

–Cooter and David

–MFISS

Midface Fractures

Lefort Classification

•Weakest areas of midfacial complex when assaulted from a frontal direction at different levels (Rene’ Lefort, 1901)

–Lefort I: above the level of teeth

–Lefort II: at level of nasal bones

–Lefort III: at orbital level

Midface Fractures

Lefort Classification

–Provides uniform method to describe the level of major fracture lines

–Allows references regarding the probable points of stability for surgical treatment

–Does not incorporate vertical or segmental fractures, comminution or bone loss

Midface Fractures

•LeFort I : Transverse Maxillary

•Lefort II : Pyramidal

•Lefort III : Craniofacial Disjunction

•Zygomatic Complex

•Orbital Floor

•Nasal Fractures

•Naso-orbital/Ethmoid

Midface Fractures

Le Fort I

•Low level

•Often mobile

•Mild swelling

•Disturbed occlusion

•Deviated midline