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Lefort 3 Fracture
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Lefort 3 Fracture

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  • 1. 38yo M presents unconscious after motorcycle accident. Pt found 40yds from scene. Obvious facial trauma and left lower extremity trauma.  T 98.6 HR 120 RR 12 PO2 90% NRB BP 95/60  GEN:GCS 8  HEENT: PERRLA, b/l ecchymosis, midface unstable, severe facial edema, blood in oropharynx
  • 2. Right type III Fx Bilateral pterygoid
  • 3. Intubation  GCS score plus significant facial instability Trauma Evaluation Ophthalmology c/s Admit  OR for open reduction and internal fixation  Trauma Observation for associated injuries  Airway Management
  • 4. Physical Exam  Entire face shifts including eyes and nose Fracture Line  Transverse  Nasofrontal/frontomaxillary sutures->orbit floor- >zygomatic arch Highest Rate of CSF Rhinorrhea
  • 5. Right: Type I Left: Type II and III w/zygomatic fx (arrow) Right Type III in pediatric patient
  • 6.  Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter 257 Maxillofacial Trauma http://www.urmc.rochester.edu/smd/Rad/neuroc ases/Neurocase488.htm  Rhea, J. How to Simplify the CT diagnosis of LeFort Fractures.AJR, 2005.184: 1700-1705. Alcala-Galiano. Pediatric facial fractures-children are not small adults.RadioGraphics, 2008.28: 441461