What Is a LeFort Fracture?

The maxilla is the largest bone in the face, one on the left and one on the left, connected by a bone suture in the center. The maxillary bone is thin and hollow inside, and it is the maxillary sinus. The maxillary bone is connected with other surrounding bones by osteosynthesis and participates in the formation of the oral cavity, nasal cavity and orbit. Fractures are often complex. Due to its proximity to the skull base, craniocerebral injury is often associated. Maxillary blood is abundant, trauma can cause severe bleeding, strong anti-infective ability, and fast healing after injury, surgery should be performed as soon as possible.

Zhang Yi	(Chief physician)	Department of Maxillofacial Surgery, Peking University Stomatological Hospital
An King Kong	(Deputy Chief Physician)	Department of Maxillofacial Surgery, Peking University Stomatological Hospital

Maxillary fracture refers to the fracture of the maxilla when it is subjected to direct, inferior or lateral impact. The maxillary bone is located in the center of the middle part of the human face, and the position is more prominent. It is one of the parts prone to fracture in the middle part of the face.

Western Medicine Name: Maxillary fracture
Affiliated Department: Department of Physiology-Stomatology

Disease site: Facial
The main symptoms: Red, swollen, pain
Main cause: trauma

Maxillary Fracture Surgical Anatomy

Fracture classification of maxilla fracture

1. LeFort classification: proposed by Rene Le Fort (1901), divided into three types:

Le Fort type I: horizontal fracture of the alveolar process base, the fracture line passes through the lower edge of the piriform hole, the base of the alveolar process, around the alveolar ridge and maxillary nodule backward to the pterygoid;

Le Fort II: Central conical fracture of the maxilla, with the fracture line from the root of the nose to the sides, through the lacrimal bone, the infraorbital margin, and the maxillary suture, around the outer wall of the maxilla backward to the pterygoid;

Le Fort III type: high-level fracture. The fracture line passes through the nasal frontal suture, spans the eye socket, and then goes down through the zygomatic frontal suture to the pterygoid process, forming a craniofacial separation.

2. The improved classification is divided into the following four types:

(1) Low (horizontal) fracture: Le Fort type I horizontal fracture of the maxilla. The main clinical manifestations are relationship disorders. The principle of treatment is to restore relationships.

(2) High (horizontal) fracture: The maxillary fracture line is at the Le Fort type II and / or type III level. Clinical manifestations are: relationship disorders and facial deformities. The principle of treatment is to restore the relationship, while correcting facial deformities.

(3) Sagittal fracture: The maxilla was fractured vertically, and the fracture line was located in the middle or the middle. The clinical manifestations are widening of the dental arch, openings may occur, and fractures may hurt the skull base. The principle of treatment is to resolve the relationship and close the traumatic cleft palate.

(4) Alveolar process fracture: The fracture line is limited to the apical level and only affects the dental bone. The principle of treatment is reduction and fixation of the bone segment. ^[1]

Causes of maxillary fractures

The most common causes of maxillary fractures are motor vehicle traffic accidents and motorcycle accidents. They can also be caused by violence, falls, and sports injuries. Most maxillary fractures occur in young men aged 16 to 40. ^[2]

Diagnosis of maxilla fracture

1. The patient's history asks the cause of the injury in detail, the nature, size and direction of the injury, whether there is a history of coma after the injury, treatment after the injury, the patient's vision and whether there is diplopia, olfactory and nasal ventilation, and occlusion. Wait.

Clinical manifestations

(1) Fracture displacement and abnormal mobility

Fractures of the maxilla, especially those of the entire maxilla, generally shift backwards and downwards, causing the maxilla to fall. Sagittal fractures on both sides of the fracture are displaced outwards, and the arch is widened. If the fracture is not displaced, the patellar mucosa is usually intact; if the displacement of the fracture segment is obvious and the patellar mucosa is cracked, a "traumatic" Cleft. "

Clinically, when patients do chewing exercises, they can find the abnormal movement of the entire maxilla. When inspecting the maxillary bone for fracture, hold the head fixed, and hold the alveolar process of the anterior part of the maxillary body to shake back and forth, and feel whether there is obvious movement of the maxillary fracture segment. When examining a Le Fort type II or III fracture, place one hand on the nasal bridge and the other holding the upper jaw swaying back and forth. If there is movement at the forehead suture, it indicates the presence of a Le Fort type II or III fracture.

(2) Bite disorder

The typical manifestation of occlusal disorder after maxillary fracture is early contact of the posterior teeth, anterior teeth opening or closing; if the maxillary bone is displaced laterally as a whole, an anomaly occurs; if the sagittal fracture of the maxillary bone, a fractured section of one side Sagging, there will be early contact of the affected side teeth, and the healthy side teeth will be opened and closed.

(3) Dysfunction

Speech disorders, dysphagia, and chewing disorders can occur after a maxillary fracture. The chewing disorders are mainly manifested as weak occlusion. When the maxillary bone is fractured and the displacement is obvious, it can cause breathing difficulties or even suffocation.

(4) Facial deformities

After a maxillary fracture, the mouth often cannot be closed, salivation, 1/3 of the face becomes longer, and the front collapses. The facial deformities of the low fractures may not be obvious, and the high fractures often show a depression in the middle of the face, showing a "disc-shaped face" shape. The maxilla can be shifted to one side, causing distortion in the middle of the face.

(5) Eye symptoms and signs

High-level fractures often affect the periorbital and orbital bony structures. Periorbital swelling, bruising, subconjunctival hemorrhage, and typical spectacle signs appear. When the fracture spreads to the orbital wall, it can cause eyeball displacement and diplopia. The infraorbital nerve was injured, and the infraorbital area and upper lip were numb.

3. The fractures diagnosed clinically by imaging studies need to be confirmed by imaging studies.

(1) Plain film Fahrenheit and lateral skull can be used to diagnose maxillary fractures. They are mostly used without CT examination. The disadvantage is that the details of the fracture cannot be seen.

(2) Axial and coronal CT scans of the middle of the opposite CT can show the fracture of the maxillary sinus walls, whether the maxillary sinus has effusion, and the bone orbital and orbital contents damage. For severe midfacial trauma or maxillary displacement, 3D CT is valuable for clear diagnosis and grasping the fracture characteristics as a whole. ^[3]

Maxillary Fracture Fracture Treatment

1. Treatment of low-level fractures. Simple maxillary fractures can be reduced with a hood cap or intermaxillary traction, and then fixed between the jaws for 3 to 4 weeks. The maxillary fracture with obvious displacement needs incision and reduction to restore the occlusal relationship, and is fixed with bone plates at the edge of the alveolar ridge and the piriform hole.

2. Treatment of high-level fractures Once a high-level fracture is displaced, it usually requires an open reduction. Surgery should be performed as soon as possible. The fracture was exposed through a combination of a coronary incision, an intraoral incision, and a small facial incision, and was fixed. If it is accompanied by orbital floor fracture, the infraorbital or conjunctival incision should be used to reduce the orbital contents and repair the orbital floor.

3 The focus of sagittal fracture treatment is to restore the maxillary dental arch width and occlusal relationship.

4 Treatment of old fractures Old fractures of the maxilla usually require LeFort type osteotomy reduction according to the surgical design of the model and the positioning plate. When sagittal fractures are displaced, LeFort type I osteotomy is required to further divide the osteotomy.

Precautions after maxillary fracture

Antibiotics were applied for about 3 days after surgery to prevent infection. According to the specific conditions of the occlusion after surgery, the occlusion is appropriately adjusted, and the intermaxillary elastic traction is performed for about 1 week. Maintain oral hygiene after surgery. Take soft food for 2-3 weeks. Postoperative CT examination confirmed the reduction and fixation of the fracture. Review at 3 months after operation, check occlusion and mouth opening, review CT, observe fracture healing, and whether maxillary sinus has inflammation. ^[3] ^[2] ^[1]