Lefort 2 Fracture

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Lefort 2 Fracture

  1. 1.  32yo M presents after fall from scafold approximately 4 stories onto sidewalk. +LOC. +Headache. +Abdominal and Back Pain.  T98 HR 110 RR 20 PO2 98% NRB BP 110/70  GEN:airway intact  HEENT: instability of midface, significant edema, numbness of right cheek, subconjunctival hemorrhage b/l  Neuro: GCS 10
  2. 2. Open Arrows: inf orbit fx Star:Inferior orbit fx Closed Arrow: no fx to ant/lat nasal margin=no lefort I fx Arrow: B/l pterygoid fxs
  3. 3. Airway  May Require early intubation Trauma Assessment  High Mechanism=risk for associated injuries Optho C/S Admission  Open Reduction and Internal Fixation  Observation for Other Trauma Injuries
  4. 4. Physical Exam  Nose moves with tugging motion Fracture Line  Pyradmidal shape  Nasal bridge->maxilla frontal process->lacrimal bones/inf orbital floor->ant wall maxillary sinus>pterygoid plates Exclusions  anterolateral margins of the nasal fossa=Type I excluded  infraorbital rims are intact=Type 2 excluded
  5. 5. Ct Axial View Pyramidal Fracture Right LeFort I Left LeFort II
  6. 6. Rhea JT, Novelline RA: How to simplify the CT diagnosis of Le Fort fractures. AJR 2005;184:1700-1705 Moe, K. Maxillary and LeFort Fractures. Medscape http://radiopaedia.org/articles/le-fort-fractureclassification  Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter 257 Maxillofacial Trauma Akoglu, E. Heading the ball: a case of Le Fort II fracture in football match. BMJ, 2011.

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