32yo M presents after fall from scafold approximately 4 stories onto sidewalk. +LOC. +Headache. +Abdominal and Back Pain.

T98 HR 110 RR 20 PO2 98% NRB BP 110/70

GEN:airway intactHEENT: instability of

midface, significant edema, numbness of right cheek, subconjunctival hemorrhage b/l

Neuro: GCS 10

Open Arrows: inf orbit fx

Closed Arrow: no fx to ant/lat nasal margin=no lefort I fx

Star:Inferior orbit fx

Arrow: B/l pterygoid fxs

AirwayMay Require early intubation

Trauma AssessmentHigh Mechanism=risk for associated injuries

Optho C/SAdmission

Open Reduction and Internal FixationObservation for Other Trauma Injuries

Physical ExamNose moves with tugging motion

Fracture Line Pyradmidal shapeNasal bridge->maxilla frontal process-

>lacrimal bones/inf orbital floor->ant wall maxillary sinus->pterygoid plates

Exclusionsanterolateral margins of the nasal fossa=Type I

excludedinfraorbital rims are intact=Type 2 excluded

Ct Axial View Pyramidal Fracture

Right LeFort ILeft LeFort II

Rhea JT, Novelline RA: How to simplify the CT diagnosis of Le Fort fractures. AJR 2005;184:1700-1705

Moe, K. Maxillary and LeFort Fractures. Medscape

http://radiopaedia.org/articles/le-fort-fracture-classification

Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter 257 Maxillofacial Trauma

Akoglu, E. Heading the ball: a case of Le Fort II fracture in football match. BMJ, 2011.