3. Definition
• Fracture of the mid facial region may be
limited to the maxilla alone or may be quite
variable but often follow the general patterns
classified by Leon le fort.
6. Le fort 1
• Horizontal
fracture in the
body of maxilla
that result that
results in the
detachment of
the alveolar
process of the
maxilla from the
middle face result
of a traumatic
force directed to
7. Clinical features
• Anterior open bite
• Retruded chin
• Long face
• Swelling and bruising about the eyes
• Pain over nose and face
• Epistaxis is in evitable
• Occasionally double vision
• Varying degrees of paresthesia
10. Le fort 2
• Pyramidal shape
on poster anterior
skull Images
• Violent force
applied posteriorly
and superiorly
through the base
of the nose.
11. Clinical features
• Edema
• Swelling of the middle third of the face
• Ecchymosis
• Cerebrospinal fluid rhinorrhea
• Double vision
• Variable degrees of paresthesia
12. Radiographic features
• Reveals fractures of
nasal bone frontal
process of maxilla,
infraorbital rim,
orbital floor. More
Inferiorly rim and
orbital floor.
13. Le fort 3rd craniofacial disjunction
• Separate the middle
third of facial
skeleton from the
cranium.
14. Clinical features
• Pyramidal fracture
• Severe massive edema
• Blocked with blood
• CSF Rhinorrhea
• Dish face
• Battle's sign
16. Examination after mid face trauma
• To clinically evaluate possible midfacial
injuries a standard examination protocol is
strongly recommended and has to include full
examination of the head, eyes, ears, nose,
throat, and neck.
• For the experienced surgeon, assessment of
midfacial injuries does not take very long.
17. Possible clinical signs for midfacial
fractures include:
Facial swelling (edema,
hematoma,
emphysema) (see
picture), and deformity
18. • Compromised ocular motility
• Double vision
• Sensory deficit (hypoesthesia,
anesthesia, paresthesia) of the
trigeminal nerve
• Localized pain
• Occlusal disturbance
• CSF leakage (in case of anterior
skull base involvement
34. CBCT
• CBCT has become increasingly important in
treatment planning and diagnosis in implant
dentistry, interventional radiology (IR), among
other things. Perhaps because of the
increased access to such technology, CBCT
scanners are now finding many uses in
dentistry, such as in the fields of endodontics
and orthodontics, as well. IN TRAUMA
35. CT IS DIAGNOSTIC METHOD OF
CHOICE
• Provides image in slices
• Gives sutiable details to detect bony fractures
and changes in the soft tissue,such as
herniation of orbital fat and extraocular
muscle and tissue swelling.
• Determing the spatial orientation of fracture
or bone fragments
• Reformatted in three dimensional images
44. conclusion
• Radiography play important role in the
diagnosis ,location and determination of the
extent of injury in cases of traumatic injuries
however there are serious limitation in the
study of bone and teeth for evidence of
fracturebut with the advent of newer imaging
modalites like CT and MRI AND CBCT
detection of minute fracture is posssible
45. • PRINCIPLES OF DENTAL
IMAGING – by Langland and
Langlais
• ORAL RADIOLOGY
PRINCIPLES AND
INTERPRETATIONS –by White
and Pharaoh
• TEXTBOOK OF DENTAL AND
MAXILLOFACIAL RADIOLOGY
–by Freny R. Karjodkar
REFERENCES
Editor's Notes
Coronal images reveal the plane of fracture extending posteriorly through the maxilla, wheres coronal or axial images together may reveal involvement of the pterygoid plate posteriorly both maxillary sinus are usually radiopaque and show fluid levels.
That separates the maxilla from the base of the skull.this force separates the maxilla from the base of skull by causing fractures of nasal bones and frontal process of maxilla.fracture extend laterally through the lacrimal bones floors of the orbit and inferiorly through zagomatic maxillary sutures.
Discontinuty in the lower borders of orbit
On the both sides.fractures of the zygoma or zygmatic process of the maxilla,seperation of the zygomatic maxillary suture on the both side deformity and discontinuty on the lateral wall of maxillary sinus
Results from when the trumatic force of sufficent magnitude to completely separate the middle third of the facial skeleton from the cranium.the fracture lines usually extends through the nasal bone and frontal process of the maxilla or nasofrontal and maxillofrontal sutures across the floors of the orbits and through the ethmoid and sphenoid sinuses and the zygomatic frontal sutures.
Hazy due to extensive tissue injury ,extremely difficult difficult to document these multiple fractures with plain films alone ,therefoe ct images along with the clinical information are very important.the main radiographic finding are seoaraeted naso frontal ,maxillo frontal zygomaticofrontal and zygomatic cotemporal sutures
Every patient with orbital fractures should have an examination that includes gross visual acuity testing (remember: preexisting optical correction by glasses or contact lenses or ocular disorders such as cataract, glaucoma, and retinal disorders can compromise basic visual acuity testing), visual field testing, ocular motility, binocular vision, globe position, pupillary reaction, intraocular pressure testing……..Every patient with orbital fractures should have an examination that includes gross visual acuity testing (remember: preexisting optical correction by glasses or contact lenses or ocular disorders such as cataract, glaucoma, and retinal disorders can compromise basic visual acuity testing), visual field testing, ocular motility, binocular vision, globe position, pupillary reaction, intraocular pressure testing.
The illustrations show the step-wise examination of the midfacial skeleton focusing on fracture end movement at the infra- and supraorbital rim.
Illustration shows the palpation in the region of the zygomatic complex and zygomatic arch.
Illustration shows testing for mobility of the maxilla.
Mobility of the midface may be tested by grasping the anterior alveolar arch and pulling forward while stabilizing the patient with the other hand.
The level of a Le Fort fracture (ie, I, II, III) can often be determined by noting the structures of the midface that move in conjunction with the anterior maxilla.
Illustration shows testing for mobility of the central midface ,mobility of the midface
Palpate the posterior neck for any signs of cervical spine trauma
Examine for a hematoma of the auricular cartilage. If there is a hematoma it needs to be drained and a ‘through-and-through’ bolster dressing is recommended. This is to prevent the permanent deformity of a cauliflower ear, with a possible compromise of the external canal
Examination of the nose starts with inspection for swelling or asymmetry, followed by palpation. Characteristic signs for nasal fractures are:
Pain
Bleeding
Swelling
Compromised nasal airway
Crepitation
Palpable bony dislocation
The illustrated testing of the nasal airway passage is a simple method to gather information on the function of the internal patency of the nose.
If the nasal airway passage is compromised the reason has to be investigated
Nasal inspection using a speculum with appropriate light (headlights are recommended) allows for examination of the nasal cavity. If further clinical examination of more posterior or cranial parts have to be performed, additional nasal endoscopy may be indicated.
It is very important to rule out a septal hematoma, as this has to be drained to avoid an infection which can result in septal perforation. Nasal packing or splints should be inserted to prevent recurrence of hematoma.
Campbell's and trapnell's lines:
1- First line across the zygomaticofrontal, the sup
erior margin of the orbit and the
frontal sinus.
2- Second line across the zygomatic arch, zygomatic
body, inferior orbital margin
and nasal bone.
3- Third line...across the condyles, coronoid proce
ss and the maxillary sinus.
4- Fourth line across the mandibular ramus, occlusa
l plane.
5- Fifth line (trapnell's line) across the inferi
or border of the mandible from angle to angle
The Midface fractures generally were used to be treated by closed reduction. As a
result, the preoperative imaging needs were only those that can identify the
presence of the fracture. Surgeons today are concerned with the comprehensive, three-dimensional nature of the midface fracture so that restoration of the
preinjury position can be accomplished. Imaging of the middle third can include
the following
Image receptor and patient placed in front of the pateint and prependicular to the mid sagital plane.the patient’s head is tilted upward so that the canthomeatal line form 37 degreeangle with image receptor.if the mout is open tha sphenoid sinus will superimposed
Bean I position centrally in the area of the maxillary sinuses.
Resultant image the mid sagittal plane should divided the skull in 2 halfs.
Patient placement to the film parallel to mid sagittal plane
Central beam beam prependicular to film
Pateint position to the canthomeatal line parallel to film
Beam perpendicuolar film
