A Pediatric Radiology Textbook and Pediatric Radiology Digital Library
Pediatric Le Fort Fracture
Etiology: — Trauma causing fractures of midface which involve separation of all or a portion of midface from skull base — To be separated from skull base the pterygoid plates of sphenoid bone need to be involved as they connect midface to sphenoid bone dorsally
Imaging CT: — Pterygoid process (sphenoid) separated and fractured from maxilla — Must have a pterygoid fracture to be classified as a Le Fort fracture
Imaging CT Le Fort Type I: — Horizontal maxillary fracture separating teeth from upper face — Fracture line passes through alveolar ridge and lateral nose and inferior wall of the maxillary sinus (I – anterolateral nasal fossa (moustache))
Imaging CT Le Fort Type II: — Pyramidal fracture with the teeth at pyramid base and nasofrontal suture at its apex — Fracture arch passes through posterior alveolar ridge and lateral walls of maxillary sinuses and inferior orbital rim and nasal bones — Uppermost fracture line can pass through nasofrontal junction or frontal process of maxilla (II – inferior orbital rim (nose))
Imaging CT Le Fort Type III: — Craniofacial disjunction — Transverse fracture line passes through nasofrontal suture and maxillo-frontal suture and orbital wall and zygomatic arch and zygomaticofrontal suture — Because of involvement of zygomatic arch there is risk of temporalis muscle impingement — Have the highest rate of cerebrospinal fluid leak (III – zygomatic arch (glasses))
Note: On maxillofacial trauma CT an air-fluid level in sinus is a clue that a fracture is present
DDX:
Complications: If there is extension into a paranasal sinus the fracture is considered dirty
Treatment:
Clinical: — Le Fort Type I is floating palate (horizontal) — Le Fort Type II is floating maxilla (pyramidal) — Le Fort Type III is floating face (transverse)
