This document discusses different types of facial fractures including Le Fort I, II, and III fractures as well as frontal sinus fractures. It provides details on: - The anatomical locations and characteristics of each fracture type - Typical clinical features and signs/symptoms - Diagnosis using imaging such as CT scans - Treatment options including closed or open reduction and internal fixation using plates or wires - Surgical considerations for repair such as reference points, sequence of repair, and anesthesia needs

2. Le Fort I Fracture:

3. Fracture
outline
Pterygoid plate
 Anterior nasal aperture
 Above nasal floor
 Above canine eminence
 Lateral antral wall
 Below zygomatic buttress
 Pterygomaxillary fissure
 Pterygoid plate of bone

4. Clinical features
Diagnosis

5. Imaging:
Coronal cut CT
Three D CT.
Diagnosis

6. Treatment
Closed treatment:
Mandibulomaxillary fixation (MMF)
Either using arch bars or alveolar screws
Better using elastic traction
Suspension wires required to fix fractured
maxilla to the nearest unbroken structure

7. Different sites for suspension

8. Open surgical treatment

9. Open surgical treatment
Two to four
plates used for
maxilla
fixation
The most
common sites
of fixation
Malar bone
and Arround
Anterior nasal
aperture

10. Le Fort II Fracture:
 Above nasal bone
(glabella).
 Lacrimal ethmoid bony
orbit.
 Infra-orbital rim.
 Above canine eminence.
 Lateral antral wall.
 Below zygomatic
buttress.
 Pterygomaxillary fissure.
 Pterygoid plate of bone
Fracture
outline
Le fort II pyramidal fracture

11. Clinical features
Diagnosis

12. Surgical management
Disimpaction

13. Surgical management
Closed
reduction &
suspension
Less effective if
there is delay in
treatment
or
unstable
reduction

14. Surgical management
Open reduction
Multiple
points of
fixation
ensure
better
results

15. Le Fort III Fracture:

16.  Above nasal bone (glabella).
 Frontal ethmoid and sphenoid
bony orbit.
 Zygomatico frontal suture.
 Zygomatico temporal suture.
 Pterygomaxillary fissure.
 Pterygoid plate of bone
Fracture
outline

17. Clinical features:
Edema
Paraesthesia
Circum-orbital ecchymosis
Subconjunctival hemorrhage
Depressed nose.
Epistaxis
CSF
Malocclusion.
Step deformity at zygomatico-frontal
suture

18. Open reduction &
internal fixation
Multiple points of
fixation ensure
better results

20. Frontal sinus injuries :
 Anterior table fracture.
 Posterior table fracture
 Frontal recess.
 Orbital roof fracture.
 Skull base fracture.
 Dural tear.
 CSF leak.
 Brain injury

21. Imaging:
CT Axial cut
Coronal cut

22. Indications for treatment:
 Reestablishment of an
aesthetic facial contour.
 Return of normal sinus
function.
 Management of dural tear
or brain injury.
 Prevention of short term
complications. [infection-
bleeding-CSF leak]

23. Treatment modalities:
 Anterior table fracture polyethylene
implant to camouflage a frontal sinus
fracture.

24.  Return of normal sinus function.
Treatment modalities:

25. Treatment modalities:
If non stop CSF leak for
more than five days
frontal sinus
obliteration is
mandatory.

27. Anatomical considerations:

28. Signs and symptoms:
 Rhinorrhea.
 Raccoon eyes.
 Loss of smell[olfactory damage].
 Manifrstations of occulomotor nerve damage.
Anterior fossa
 Otorrhea.
 Battle's sign.
 Hearing loss.
Middle fossa
 Hypotension.
 Tachycardia.
 Alteration in respiration
Posterior fossa [compression of the brainstem.]

29. Imaging:

32. Fractures involving
the upper, middle and
lower third of face
Definition:
The surgeon not only have to deal with the
management of facial fractures, but also restore the
facial functions and features such as visual
[diplopia], airway management, mastication, control
of bleeding, and ethetic requirements.

33.  Dental arches [proper function- occlusion]
 Mandibular condyle [relation of the mandible to
the base of the skull].
 Sphenozygomatic suture [orbital cavity-adjust
relation of mid face to the base of the skull].
 Intercanthal distance [mid face measurement]-
NOE [ethoid bone is part from base of the skull
Important landmarks that help in establishing
the proper positioning of facial skeleton.

34. Advantages of using bicoronal flap for
multiple correction of facial fractures:

35. Sequence of repair
“Bottom up & inside out
Or
“Top down & outside in”
Base of the skull is the main fixed part of the
head, even fractured, no displacement
reported.
It is considered the reference point that all
facial bones should be oriented to it.

36. Sequence of repair
 Repair of frontal bone fracture [nearest to the
skull base]
 Repair of zygomatico-frontal-[adjust width of
face]
 Repair of NOE [adjust inter canthal dimension]
 Repair of Le fort III [ZF+NOE+Orbital cavity]
 Repair of Le fort II [NOE]
 Repair of Le fort I.
 Repair of condyle fracture.
 MMF and achievement of occlusion
 Repair of mandibular fracture.

37. Anesthesia
Extensive injury of facial bones make nasal
intubation difficult
MMF is mandatory for occlusal adjustment
so oral intubation is not indicated.
Submental intubation is better for such
management
Sometimes tracheostomy facilitates
management.

38. Surgeons after
operation and
medical students
after exams say
the same thing......
“We tried our
best”