Le Fort II
Definition
The Le Fort II fracture is also referred to as a pyramidal fracture. It commonly extends from the pterygoid plate through the maxilla, through the nasal orbital ethmoid area, and nasofrontal bone.
Patients with Le Fort II injuries are often admitted to hospital unconscious and intubated. Special attention has to be paid to foreign bodies such as teeth or tooth fragments obstructing the airways.
Severe bleeding and/or CSF leakage may accompany Le Fort fractures and affect the treatment and outcome.
It should be recognized that Le Fort II fractures involve the orbit. Basic assessment of visual acuity is mandatory in the conscious patient. In the unconscious patient the swinging-flashlight test can be helpful to give evidence to or exclude afferent pupillary defects (Marcus Gunn Pupil).
It should be emphasized that all of the Le Fort fractures go through the pterygoid plates.
When assessing Le Fort fractures it is important to ascertain the patient’s premorbid occlusion.
CSF leak
The following diagnostic procedures can be performed if there is a suspected CSF leak (clinical sign: straw-colored nasal drainage):
- Application of fluorescent dyes
- Comparison of the concentration of glucose between fluid and patient’s serum
- Laboratory analysis for beta-transferrin
- Specialized neuroradiological imaging with intrathecal contrast medium
Radiographic findings
CT slices of a Le Fort II fracture.
