Le Fort III

The Le Fort III fracture is also referred to as craniofacial dysjunction. The fracture line begins at the frontozygomatic suture along the lateral aspect of the internal orbit along the sphenozygomatic suture line to the inferior orbital fissure, extends medially across the floor of the orbit up the medial wall of the orbit towards the dorsum of the nose where it crosses and proceeds to the opposite side in the same manner.

Patients with Le Fort III 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 III 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.

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

CT slices showing the typical fracture pattern of a Le Fort III fracture.