Abstract
Background: In the early 20th century, René Le Fort studied facial fractures resulting from blunt trauma and devised a classification system still in common use today. This classification, however, was based on low-velocity trauma. In modern practice, in a quaternary-level referral hospital, patients are often admitted following high-velocity injuries that mostly result from motor vehicle collisions.Objectives: A retrospective study to define facial bone fractures occurring subsequent to highvelocity trauma.Method: A retrospective study comprising the review of CT scans of 52 patients with highvelocity facial fractures was performed between April 2007 and March 2013. Injuries were classified using the Le Fort classification system. Deviations from the true Le Fort types, which are often depicted in the literature as occurring bilaterally and symmetrically, were documented; these included unilaterality, occurrence of several Le Fort fractures on one side of the face, occurrence of several Le Fort fractures on different levels and on different sides of the face, and occurrence of other fractures in addition to Le Fort fractures.Results: Of the 52 cases, 12 (23%) had Le Fort injuries, with true Le Fort fractures occurring in only 1, and 11 deviating from the classic description. Nine patients had Le Fort fractures and additional fractures. Mandibular and zygomatic bone fractures were found to be common associations with Le Fort injuries, occurring in 58% and 33% of the cases respectively.Conclusion: Fractures occurring in modern practice often deviate from the traditional Le Fort classification. Precise recognition of these deviations and recognition of additional associated fractures is pivotal in their management, assisting the surgeon in determining the treatment plan, such as the surgical approach and the order in which to fix the various fractured components.
Highlights
Around the turn of the 19th into the 20th centuries, René Le Fort, a renowned French surgeon, conducted a series of experiments using human cadavers to study facial bone fractures resulting from blunt trauma
One case had no facial bone fractures, the patients in 2 cases died before the scans could be performed and 3 patients presented with imaging from referring hospitals
Precise recognition of fracture complexes such as Le Fort types, the pattern variants and additional associated fractures is pivotal in their management
Summary
Around the turn of the 19th into the 20th centuries, René Le Fort, a renowned French surgeon, conducted a series of experiments using human cadavers to study facial bone fractures resulting from blunt trauma. The impacts included hitting the midface of a whole or decapitated cadaver with a baseball bat, and hitting the midface region onto a granite tabletop He cut the body segments open and studied the fractures they had sustained. He boiled the skulls to strip off the flesh and expose the underlying fractures He concluded that midface fractures occurred through ‘lines’ of inherent weakness in the facial skeletal structure, producing defined injury patterns.[1] The fracture patterns were predictable and reproducible, depending on the site of impact on the midface. He formulated a classification system still extensively used today: the Le Fort classification. In a quaternary-level referral hospital, patients are often admitted following high-velocity injuries that mostly result from motor vehicle collisions
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