Changing patterns of mid face fractures in 21century-A need to redefine lines

Abstract

To study the changing patterns of mid face fractures using computed tomography scan. 100 patients with midface fracture requiring open reduction and internal fixation were selected for this study. They underwent 2D and 3D computed tomography scan. The fracture lines were studied radiographically and intraoperatively and compared with the standard Le Fort lines.The study showed that men ranging from age 21-30 years were more likely to suffer midface fracture compared to women M:F =19:5. Road traffic accidents (RTA) happens to be the most common aetiology (78%) followed by assaults and accidental fall. The midface fractures that were encountered were divided into 3 categories after assessing the CT scans as follows- 1. Similar to Le Fort lines-24%; 2. Combination of Le fort lines-12%; 3. Deviation from Le Fort lines-64%.The 64% of patients with deviations were divided into 5 categories- 1. V1: Additional line from the pyriform aperture to the infraorbital rim of the same side. (37.17%); 2. V2: Additional line connecting the Le Fort fracture line to the infraorbital rim. (38.46%); 3. V3: Additional line connecting the pyriform aperture to the orbit's lateral wall without crossing the infraorbital rim on the same side. (12.82%); 4. V4: Additional line involving the fractured segment, running from the infraorbital rim across the canine fossa and finishing on the dentoalveolar segment on the same side. (5.12%); 5. V5: Pterygoid plates not fractured. (6.41%). Every patient with a facial fracture should undergo a complete clinical and radiographic assessment. In order to accurately determine the fracture patterns, it is necessary to review the sectional pictures of the scans coupled with 3D-reconstructed images. Newer classification needs to discussed to describe the deviation caused by high velocity objects. To treat the patient promptly and to establish better communication between the surgeon and radiologist.