LeFort I fracture There are three types of LeFort fractures: Le Fort I fractures (horizontal) may result from a force

of injury directed low on the maxillary alveolar rim in a downward direction. It is also nown as a !uerin fracture or "floatin# palate"$ and usually involves the inferior nasal aperture. The fracture extends from the nasal septum to the lateral pyriform rims$ travels horizontally a%ove the teeth apices$ crosses %elow the zy#omaticomaxillary junction$ and traverses the ptery#omaxillary junction to interrupt the ptery#oid plates.

LeFort II fracture Le Fort II fractures (pyramidal) may result from a %low to the lower or mid maxilla and usually involve the inferior or%ital rim. &uch a fracture has a pyramidal shape and extends from the nasal %rid#e at or %elow the nasofrontal suture throu#h the frontal processes of the maxilla$ inferolaterally throu#h the lacrimal %ones and inferior or%ital floor and rim throu#h or near the inferior or%ital foramen$ and inferiorly throu#h the anterior wall of the maxillary sinus' it then travels under the zy#oma$ across the ptery#omaxillary fissure$ and throu#h the ptery#oid plates.

LeFort III fracture Le Fort III fractures (transverse) are otherwise nown as craniofacial dissociation and involve the zy#omatic arch. These may follow impact to the nasal %rid#e or upper maxilla. These fractures start at the nasofrontal and frontomaxillary sutures and extend posteriorly alon# the medial wall of the or%it throu#h the nasolacrimal #roove and ethmoid %ones. The thic er sphenoid %one posteriorly usually prevents continuation of the fracture into the optic canal. Instead$ the fracture continues alon# the floor of the or%it alon# the inferior or%ital fissure and continues superolaterally throu#h the lateral or%ital wall$ throu#h the zy#omaticofrontal junction and the zy#omatic arch. Intranasally$ a %ranch of the fracture extends throu#h the %ase of the perpendicular plate of the ethmoid$ throu#h the vomer$ and throu#h the interface of the ptery#oid plates to the %ase of the sphenoid. This type of fracture predisposes the patient to (&F rhinorrhea more commonly than the other types.

[edit] Signs and Symptoms

Lefort I ) &li#ht swellin# of the upper lip$ ecchymosis is present in the %uccal sulcus %eneath each zy#omatic arch$ malocclusion$ mo%ility of teeth. Impacted type of fractures may %e almost immo%ile and it is only %y #raspin# the maxillary teeth and applyin# little firm pressure that a characteristic #rate can %e felt which is dia#nostic of the fracture. *ercussion of upper teeth results in crac ed pot sound. !uerin"s si#n is present characterised %y ecchymosis in the re#ion of #reater palatine vessels. Lefort II and Lefort III(common)) #ross edema of soft tissue over the middle third of the face$%ilateral circumor%ital ecchymosis$%ilateral su%conjunctival haemorrha#e$epistaxis$(&Frhinorrhoea$dish face deformity$diplopia$enophthalmos$crac ed pot sound. Lefort II) step deformity at infraor%ital mar#in$mo%ile mid face$anesthesia or paresthesia of chee . Lefort III) tenderness and separation at frontozy#omatic suture$len#thenin# of face$depression of occular levels$ enophthalmos$ hoodin# of eyes$ tiltin# of occlusal plane with #a##in# on one side.