Reconstructive Surgery For Midface Fractures

What is a midface fracture?

Midface fractures, also known as Le Fort fractures, are caused by high-energy blunt force impacts to to the face typically resulting from motor vehicle accidents, altercations and falls.

The ‘middle of the face’ is considered the area from the maxilla (upper jaw) and dental plane (teeth in the upper jaw) up to the cranium (just above the eyebrows). Its intimate association with the oral cavity, nasal cavity, orbits (eyes), and the multitude of structures contained within make the middle of the face a functionally and cosmetically important structure. Fracture of these bones are life-threatening as well as disfiguring. Timely repair of these fractures is a necessity to correct deformities and loss of function

Why is a midface fracture referred to as a LeFort fracture?

In the early 20th century a french surgeon, by the name of Rene Le Fort, utilized a rather controversial method by inflicting traumatic injuries to cadaver heads and then studying the injuries to determine the common patterns of fractures that occur. In 1901 he developed three types of classifications based on these patterns, Le Fort I, II, and III. Although this type of research would never occur in current times, the LeFort classifications are still widely used for clinical purposes.

What are the different types of midface fractures?

Le Fort I: Upper lip swelling and numbness of the upper teeth. Percussion (tapping with a special instrument) of the upper teeth results in a cracked pot sound.

Le Fort II: Edema (swelling) of the soft tissue over the middle third of the face, bilateral orbital ecchymosis, subconjunctival hemorrhage,(bleeding around and in the eyes, and under the skin, discoloration of skin due to the internal bleeding), CSF rhinorrhea (fluid draining from the nose), diplopia (double vision) and a bloody nose. Numbness of the cheek may also be present.

Le Fort III: tenderness of the frontal sinus, lengthening of the face, hooding of the eyes, and sagging on the side of the injury.

How is a midface fracture diagnosed?

A full medical history and physical exam is necessary for a preliminary diagnosis. Then a CT scan of the head and face is needed to confirm diagnosis.

How is a midface fracture treated?

Once all life threatening injuries are stabilized, the treatment of the fractures is surgical and planned based on the individual patient’s injuries.

If you or your family member is currently in the emergency room for a suspected facial fracture, and you would like Dr. Volshteyn to evaluate you for treatment, please ask the emergency room physician to call Dr. Volshteyn at (732)641-3550 and select the emergency option to reach Dr. Volshteyn directly on his cell phone to discuss your case.

More information on facial fractures