A 32-year-old male presented after falling approximately 4 stories from a scaffold onto the sidewalk. He was experiencing headache, abdominal pain, and back pain. On examination, he had midface instability, edema of the right cheek, subconjunctival hemorrhages bilaterally, and a Glasgow Coma Scale of 10. CT imaging revealed fractures of the inferior orbits bilaterally and pterygoid plates bilaterally consistent with a LeFort II fracture pattern. The patient required admission for open reduction and internal fixation surgery and observation for potential additional injuries from the high-energy mechanism of injury.

2.  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

4. 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

5. 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

6. 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

7. Ct Axial View
Pyramidal Fracture
Right LeFort I
Left LeFort II

8. 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.