The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
7. Areas of Strength
Thickened Bones
Higher ratio of cortical:cancellous
Analogus to architectural concepts of support
Sicher & Tandler in 1928
www.indiandentalacademy.com
12. FRACTURES NOT INVOVING OCCLUSION
A. CENTRAL REGION
Fractures of the nasal bones and / or nasal
septum
- lateral nasal injuries
- anterior nasal injuries
Fractures of the frontal process of the maxilla
Fractures of (1) and (2) which extend into the
ethmoid bone ( nasoethmoid)
Fractures of types (1), (2) and (3) which
extend into the frontal bone (fronto- orbitonasal dislocation)
www.indiandentalacademy.com
13. B. LATERAL REGION
Fractures involving the zygomatic bone,
Zygomatic arch and
maxilla
(zygomatic complex) excluding the dento-
alveolar component
www.indiandentalacademy.com
15. Rowe & William’s (1985)
FRACTURES NOT INVOVING THE
DENTOALVEOLAR COMPONENT
FRACTURES INVOLVING THE
DENTOALVEOLAR COMPONENT
www.indiandentalacademy.com
16. Classification
Alphonse Guerin ( 1888)
Rene LeFort (1901)
Experimental cadaveric
studies
# along the lines of weakness
Assault from frontal / lateral
impact
Avoided areas of strength
LeFort I
LeFort II
LeFort III
www.indiandentalacademy.com
17. Le Fort I
Guerin #,Floating #
Fracture extends
transversely above
level of teeth
Traumatic force
directed
to the lower maxillary
region
B/L or U/L
U/L: auxillary # :
midline of the palate
www.indiandentalacademy.com
19. Le Fort II:
Pyramidal #
Begins above level
of teeth
a violent force to the
central region of the
mid
Central portion
mobilized
independently
Pa Skull- Pyramidal
shaped.
www.indiandentalacademy.com
20. MAXILLOFACIAL INJURIES
MIDFACE FRACTURES
Le-Fort II Fracture
( Pyramidal # / Subzygomatic # )
Nasal bone
Frontal bone
Orbit
Lacrimal bone
Infraorbital foramen
Maxillary antrum
ZM suture
www.indiandentalacademy.com
21. Le Fort III:
Craniofacial Dysjunction
Fracture extends through
zygomatic arch
Entire midface separated &
suspended solely by soft
www.indiandentalacademy.com
tissues
22. MAXILLOFACIAL INJURIES
MIDFACE FRACTURES
Le-Fort III Fracture
( High transverse/Suprazygomatic/Craniofacial disarticulation)
Fronto-nasal suture
Ethmoid cribriform plate
Frontal process maxilla
Medial wall orbit
Optic foramen
Inferior orbital fissure
Pterygoid lamella
Lateral wall of orbit Z-F
suture
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD
23. These fractures may occur unilaterally or
may be associated independently with a
fracture of the zygomatic complex
There may be midline separation of the
maxilla and / or extension of the fracture
pattern into the frontal or temporal bones
www.indiandentalacademy.com
24. Factors influencing displacement
Degree of force
Direction of force
Resistance to the force offered by the facial
bones
Point of application of force
Cross sectional area of object
Attached muscles
www.indiandentalacademy.com
26. Local clinical examination
gently clean up the face
Inspection
Palpation
Diagnostic Imaging
Extra oral examination
Lacerations or injury over head
Check for edema, ecchymosis (periorbital,
conjunctival, scleral) and soft tissue
lacerations
Any obvious bony deformities, haemorrhage,
epistaxis or otorrhoea, rhinorrhoea
occular involvement
www.indiandentalacademy.com
27. Palpation
It should begin at the back of the neck and
cranium, Upper face,the zygomatic arch ,bone
and orbit
Ares of tenderness, deformities noted
Step deformity,subcutaneous emphysema
Mobility of maxilla
Eyelids separated and vision tested, check for
diplopia, light reflex
Check for Paraesthesia
www.indiandentalacademy.com
30. Intra oral examination
Derangement of occlusion, gagging of
occlusion, lacerations, ecchymosis
Palpation
Areas of tenderness, bony irregularities,
crepitus mobility of teeth noted
Examination of teeth
Pharynx evaluated for laceration & bleeding
www.indiandentalacademy.com
31. Clinical Features
LeFort - I
Swelling of the upper lip
Ecchymosis present in the buccal sulcus
beneath each zygomatic arch
Patient keeping the
mouth slightly open
Occlusion derranged
Midline split of the palate
Subluxation of teeth
www.indiandentalacademy.com
32. The impacted Le Fort I fracture (Telescoping
fracture) –difficult to diagnose – ‘grating
sound’
Percussion ‘cracked pot’ sound
Haemorrhage in the maxillary sinuses
www.indiandentalacademy.com
33. LeFort - II / III
Swelling : gross; (moon face) eyelids
conjunctiva
Ecchymosis : bilateral circum-orbital
(panda face/raccoon face)
: subconjunctival
Chemosis
Infra orbital step
(Le Fort II)
Nasal deformity
www.indiandentalacademy.com
34. Retropositioning of maxilla : Deranged
occlusion : post gagging : V. D
Mobility of midface
Hematoma on palate
Dish face
Loss of function:
Diplopia? Anosmia
Nares filled with clotted blood
Emphysema, Epiphora,
CSF Rhinorrhea,Hooding of eye
www.indiandentalacademy.com
35. LeFort - II
No alteration of pupillary level
Haematoma in the upper buccal sulcus
Step deformity : infra orbital margins
Limitation of orbital movement with diplopia
and enopthalmos
Anaesthesia or Paraesthesia of the cheek
Gagging of occlusion and retro-positioning of
the maxilla
On manipulation: movement being detected at
the infra orbital margins and nasal bridge
www.indiandentalacademy.com
36. LeFort - III
Lenghtening of the face
Alteration of the occular level
unilateral or bilateral hooding
of the eye
# of the zygomatic arch :
flattening of the zygomatic complex
Tenderness and deformity over the zygomatic arch
Tenderness and separation at the F-Zsuture
Mobility of the whole facial skeleton as a single
block
Gagging of occlusion in the molar area
Disruption of the cribriform plate :CSF rhinnorhoea
www.indiandentalacademy.com