J Le fort procedures
1. Introduction
a) The usual preoperative diagnosis for patients with maxillary fractures is facial trauma. Le Fort fractures are frequently associated with other skull fractures, zygoma fractures, and possible intracranial fractures and thus with cerebrospinal fluid rhinorrhea.
b) The fractures are divided into Le Fort I, II, and III. The Le Fort I fracture is a horizontal fracture of the maxilla extending from the floor of the nose and hard palate through the nasal septum and through the pterygoid plates posteriorly. The palate, maxillary alveolar bone, lower pterygoid plate, and part of the palatine bone are all mobilized. The Le Fort II fracture is a triangular fracture running from the bridge of the nose through the medial and inferior wall of the orbit beneath the zygoma and through the lateral wall of the maxilla and the pterygoid plates. The Le Fort III fracture totally separates the midfacial skeleton from the cranial base, traversing the root of the nose, the ethmoid bone, the eye orbits, and the sphenopalatine fossa.
2. Preoperative assessment and patient preparation
The airway is a priority. If the airway cannot be managed, emergency intubation becomes necessary. Avoid blind nasal intubation in patients with cerebrospinal fluid rhinorrhea, periorbital edema, “raccoon’s eyes” bruising, or other evidence of nasopharyngeal trauma.