LeFort Fractures: Classifications and Radiographic Evaluation


Transfacial fracture of the midface, involving the maxillary bone and surrounding structures in either a horizontal, pyramidal, or transverse direction.


It involves the pterygomaxillary suture and the nasal septum. Classified according to the experiments by anatomist Rene LeFort. 

Classifications 

LeFort I (Horizontal Fracture) – extends above the apices of the maxillary dentition across the nasal septum and maxillary sinuses. Posteriorly it extends through the pyramidal process of the palatine bone and the pterygoid processes of the sphenoid bone. It also may involve the fracture of the palate. 

LeFort II (Pyramidal Fracture) – extends from the nasofrontal region down through the medial orbital wall, crossing the inferior orbital rim and zygomatic buttresses. Posteriorly similar to a LeFort I fracture. 

LeFort III (Complete Craniofacial Disjunction) – fracture lines extend through the nasofrontal junctions, zygomaticofrontal articulations, zygomaticomaxillary suture, temporozygomatic suture, pterygomaxillary junction, medial and lateral orbital walls, and superior articulation of the nasal septum. Rarely is there a pure category of fracture; usually there’s a mixed combination.



Radiographic Evaluation

Maxillofacial CT with axial, coronal, and sagittal cuts. There are four key areas to evaluate. 

• Pterygoid plates, strong indication of LeFort fracture. 
• Lateral margin of nasal fossa, suggestive of LeFort I fracture. 
• Inferior orbital rim, suggestive of LeFort II. 
• Zygomatic arch, suggestive of LeFort III.


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