The maximum incisal opening is noted, and the intraoral examination includes assessment of the maxillary vestibule, zygomaticomaxillary buttresses, and palate.
Evaluation should then proceed along the lateral orbital rims and zygoma, including the zygomatic arch. For detection of mid-face fractures, the examiner should systematically and bimanually palpate the frontal bones, including the supraorbital rims and the nasofrontal suture. The patient’s head and neck are inspected for asymmetry, laceration, ecchymosis, and discharge from the nose or ears. The zygoma, maxilla, palatine bones, and nasal bones, including the entire septum, are separated from the cranial base.Īfter initial resuscitation and stabilization of the trauma patient, a complete head and neck physical examination is performed as part of the secondary survey. The fracture then extends through the zygomaticotemporal suture and inferiorly through the sphenoid bone and pterygomaxillary fissure. The fracture passes through the nasofrontal region along the medial orbit through the superior and inferior orbital fissures and then along the lateral orbital wall through the frontozygomatic suture. With a force directed at the level of the orbit, a Le Fort III fracture can occur and result in craniofacial disjunction. The fractured segment includes the entire maxilla, the nasal bones, the medial third of the orbital rim, the nasal septum, the palatine bones, the dentoalveolar segment, and the inferior portion of the pterygoid plates. The fracture then continues along the zygomaticomaxillary suture inferiorly to the maxillary tuberosity and through the pterygoid plates. The fracture line extends from the nasofrontal suture through the nasal and lacrimal bones to the zygomaticomaxillary suture along the orbital floor. The pyramidally shaped central mid-face is separated from the rest of the facial skeleton and skull base. Le Fort IiĪ Le Fort II fracture results from a somewhat more superior force directed at the nasal bones. 41-2, B ).Īnterior open bite in a patient with a Le Fort I fracture. The maxillary buttress consists of the palate at the level of the maxillary alveolus ( Fig. The frontal buttress consists of the superior orbital rim, and the zygomatic buttress consists of the zygomatic arch and body of the zygoma extending to the inferior orbital rim. The horizontal buttresses are the frontal, zygomatic, maxillary, and mandibular buttresses. The pterygomaxillary buttress includes the pterygoid plates of the sphenoid and maxillary tuberosity and establishes posterior facial height along with the mandibular condyle-ramus unit ( Fig. The zygomaticomaxillary buttress runs from the frontal bone superiorly along the lateral orbital rim, including the zygoma and zygomatic process of the maxilla. The nasomaxillary buttress includes the lateral piriform rim and, superiorly, the frontal process of the maxilla and the maxillary process of the frontal bone. Through its articulations with the rest of the mid-face, the maxilla helps form three of the vertical buttresses of the face. Each maxilla consists of a body and frontal, zygomatic, palatine, and alveolar processes. It has articulations with the frontal, lacrimal, nasal, inferior concha, vomer, sphenoid, ethmoid, palatine, and zygomatic bones. The maxilla is the largest bone involved in these fractures and actually consists of two bones that are fused at the midline and serve to attach the skull base to the lower part of the face. Le Fort fractures involve multiple bones of the mid-face, including the maxilla, nasal bone, lacrimal bone, ethmoid, palatine bone, vomer, sphenoid, and zygoma.
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