Working as a nurse in an emergency room will expose you to all types of traumatic accidents; some complex and others not so much. Some of the most painful and, to be honest, most shocking traumatic experiences I've seen come in the form of facial fractures commonly known as Le Fort fractures. In this post I'm going to cover some pretty cool stuff. My goal is to briefly introduce you to these specific types of fractures, how they became identified and classified, and by whom this classification process was created. I'll also be leaving some links you can use to look more into this topic. Let's dig in shall we?
Rene Le Fort, following in his father's footsteps, became a french
physician who spent quite a bit of time in the military as a trauma surgeon in the late 1800s and early 1900s. His classification of midface fractures, known as Le Fort Fractures, became the gold-standard in recognition and treatment of these types of injuries.
Using 35 cadavers, Le Fort would experiment using techniques such as striking them in the face with a bat, or dropping cannonballs on them, or dropping them from high places. He would then boil the soft tissue from their skulls and record the data.
He determined from his experiments that the face was structured so that there were "pillars of resistance" that demonstrated the strongest regions of the face. The fractures that would result from his experiments would occur between these pillars. The most common patterns which emerged were classified as Le Fort I, Le Fort II, and Le Fort III fractures.
1. Le Fort I is a transverse fracture of the maxilla just above the teeth. This type of fracture results in a "floating palate."
2. Le Fort II is a pyramidal fracture of the maxilla which extends right above the bridge of the nose, which extends laterally and inferiorly through the infraorbital ring. This type of fracture results in a "floating maxilla."
3. Le Fort III, the worst of the three, is a complete craniofacial disruption and results in fractures of the zygoma, infraorbital rims, and maxilla. This type of fracture requires an extreme amount of force and is most common seen in motor vehicle accidents or blunt force trauma resulting from physical assaults. This type of fracture results in a "floating face" (Hacking & Galliard, 2017)
*Fracture of the pterygoid plates is mandatory to diagnose Le Fort fractures.
The good news is that the mortality rate is pretty low when it comes to these fractures. However, they rarely occur without comorbidities. Le Fort fractures are associated with serious injuries of the neck and head and therefore rapid recognition is SUPER important.
Some of these complications include extra-ocular muscle injury, orbital hematomas, global rupture (eyeball rupture), or impingement, optic nerve damage, malocclusion (difficulty closing mouth completely), dental fractures, diplopia, CSF rhinorrhea, lacrimal duct and sac injury, and sinus drainage obstruction, just to name a few (Phillips & Turco, 2017).
Since development of the Le Fort classification system over a century ago, many new facial fracture classification systems have been developed. According to Audigue, Cornelius, Di Ieva, & Prein (2014), many physicians and later authors feel Le Fort's classification system is "obsolete" because it doesn't "display the full variety of fractures" in all the many details that can occur. Despite this, the Le Fort system is still widely used today around the world.
I hope this brief overview of Le Fort fractures assists you in your efforts of increasing your knowledge of complex traumatic injuries, giving you further insight into your nursing practice while also increasing your ability to provide evidence-based treatment care and treatment.
If you've gotten all the way to the bottom here, I'd like to give you a little gift. If you're interested in learning a bit more about common cranio-facial fractures here's a 242 page reference called "Resident Manual of Trauma to the Face, Head, and Neck" from the American Academy of Otolaryngology-Head and Neck Surgery. Download it to iBooks and always have it with you for reference!
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Audigé, L., Cornelius, C. P., Di Ieva, A., & Prein, J. (2014). The first AO classification system for fractures of the craniomaxillofacial skeleton: rationale, methodological background, developmental process, and objectives. Craniomaxillofacial Trauma and Reconstruction, 7(S 01), S006-S014. Retrieved from
Hacking, C & Galliard, F. (2017). Le Fort fracture classification. Radiopaedia. Retrieved from https://radiopaedia.org/articles/le-fort-fracture-classification
Kim, H. S., Kim, S. E., & Lee, H. T. (2017). Management of Le Fort I fracture. Archives of Craniofacial Surgery, 18(1), 5-8. Retrieved from https://synapse.koreamed.org/DOIx.php?id=10.7181/acfs.2017.18.1.5
Patterson, R. (1991). The Le Fort fractures: Rene Le Fort and his work in anatomical pathology. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2025808
Phillips, B. J., & Turco, L. M. (2017). Le Fort Fractures: A Collective Review. Bulletin of Emergency And Trauma, 5(4 OCT). Retrieved from https://beat-journal.com/index.php/BEAT/article/view/499/767