Le Fort Fractures Research Articles

Patterns of ZMC and Le Fort Fractures under the Impact of the COVID-19 Pandemic-"A Changing Face?"

Background: The aim of this study was to analyze the impact of the COVID-19 pandemic on midfacial fracture patterns/distributions and circumstances in a German craniomaxillofacial trauma center. Methods: This retrospective study compared the midface fracture patterns (excluding nasal fractures) of patients in the pre-COVID (PC) era (February 2019-January 2020) with patients in the intra-COVID (IC) era (February 2020-January 2021). In addition to baseline characteristics, the type of midface fractures, the circumstances leading to midface fractures, and hospital admissions/treatments were analyzed. Results: During the COVID-19 pandemic, a reduction in the total number of midface fractures was observed (PC = 88 vs. IC = 57). No significant differences were found regarding the midfacial fracture localization between both periods. During the pandemic, there was a significant increase in falls, accidents at home, and virus/flu-associated syncopes. At the same time, a significant decrease in sports accidents, interpersonal violence, and alcohol-related accidents leading to midface fractures was recorded. Furthermore, there was a significant increase in accidents during the morning time with a simultaneous reduction in accidents during the nighttime. In addition to that, a significant delay in days from trauma leading to midface fracture until hospital admission and surgical treatment (ORIF) was revealed. Conclusions: Despite the limitations of a monocentric retrospective study, the current findings lead to the conclusion that the COVID-19 pandemic had a significant impact on the patterns and circumstances leading to midface fractures. Analyzing the specific characteristics of patients suffering from midfacial fractures under the influence of the COVID-19 period can represent added value in order to treat facial fractures in future pandemics.

Analyzing Epidemiology and Hospital Course Outcomes of LeFort Fractures in the Largest National Pediatric Trauma Database

Analyzing Epidemiology and Hospital Course Outcomes of LeFort Fractures in the Largest National Pediatric Trauma Database

Surgical management of frontal bone and naso-orbito-ethmoidal fractures: a 7-year multi-center retrospective review

Frontal and naso-orbito-ethmoidal (NOE) fractures are rare but important injuries due to their anatomical complexity and proximity to vital structures. This study aims to describe the patient factors, procedural factors, and postoperative outcomes in the surgical management of these fractures. Retrospective review of patients aged 18 years or older who were surgically treated for these fractures at two Australian tertiary hospitals (2014-2020). Patient factors (demographics, mechanism of injury, fracture pattern, concomitant injuries); procedural factors (operation timing, surgical approach); and postoperative outcomes (complications, revision surgeries) were recorded. 60 cases were included (41 frontal; 29 NOE; 10 combined). Mean age was 37 (frontal) and 39 years (NOE). Most cases were male (87.8%; 75.9%). The most common mechanism was traffic accidents (29.3%; 34.5%). The most common associated facial fractures were Le Fort fractures (46.3%; 89.7%). The most common associated systemic injuries were brain injuries (36.6%; 34.5%). Mean operation timing was 13 days (frontal) and 11 days (NOE). Coronal flap was most commonly used (68.3%; 82.8%). Postoperative complication rates were 39.0% (frontal) and 37.9% (NOE). Three cases required revision surgeries. Further larger longitudinal studies are required to build knowledge and improve patient outcomes.

Management of Maxillofacial Injuries with Palatal Fracture

Maxillofacial injuries, especially palatal fractures, often result from high-energy trauma, posing a challenging treatment. Achieving good occlusion is crucial, particularly when palatal fractures are associated with Le Fort fractures. While tracheostomy has traditionally been the airway management option, submental intubation serves as an alternative. The objective of this report is to illustrate a case of palatal fractures associated with Le Fort fractures in a 12-year-old female following a motorbike accident. She was admitted to dr. Cipto Mangunkusumo Hospital with Le Fort I and II fractures and palatal fractures. The treatment plan included submental intubation, the application of wire and arch bars, and the use of plates and screws. The patient experienced a good recovery without complications. Compared to submental intubation, tracheostomy requires a significantly longer time and often necessitates scar revision. No significant difference was observed in post-operative occlusal stability between intra-arch wire and mini-plate. In conclusion, limited direct comparisons exist between submental intubation, tracheostomy, intra-arch wire, and miniplate for palatal stabilization. Submental intubation is a faster and less complication-prone alternative to tracheostomy in maxillofacial surgical procedures. However, evidence regarding the superiority of intra-arch wire or mini plate for palate stabilization remains inconclusive.

Le Fort fractures: a review

Rene Le Fort proposed 3 classifications to determine the type of facial fracture based on the main facial lines with the least resistance, these being the places where facial fractures are most located. These fractures occur mainly because of high-velocity impact mechanisms. Le Fort fractures are difficult to manage and at the same time challenging, although it is not a common pathology, it is potentially lethal, and its initial approach and resuscitation are critical in the first hours. As in any other trauma, an initial evaluation must be carried out exhaustively and following the ABC, which mainly includes evaluation of the airway, breathing and circulation. Once a facial fracture is suspected, its extension and location must be determined through images such as x-ray or computed tomography. CT being the gold standard. Once the patient is stabilized, reconstructive surgery will be the indicated approach in most cases, with the main objective being the restoration of occlusion, direct exposure and manual reduction of the fractures, reconstruction of the medial and lateral bone buttresses, restoring the projection of the face and restore the width of the maxillary arch, nose and orbit. In general, some of the most frequently described postoperative complications are hemorrhage, infection, foreign body reaction, malunion, among others; however, these will vary depending on their classification.

Virtual Reality and Mixed Reality-Assisted Endoscopic DCR in Extremely Complex Lacrimal Obstructions.

To report the techniques and outcomes of virtual reality (VR) and mixed reality (MR)-assisted powered endoscopic dacryocystorhinostomy (DCR) in extremely complex lacrimal drainage obstructions. A prospective, non-randomized clinical study was performed in complex syndromic congenital nasolacrimal duct obstruction (CNLDO) and post-traumatic secondary acquired lacrimal duct obstruction (SALDO) in the setting of Le Fort fractures. All patients underwent preoperative planning in VR and intraoperative planning with a step ahead with MR assistance during the surgery. Surgery was supported by mixed reality intraoperative guidance with the use of the prearranged 3D models and real-time-rendered digital models. Parameters assessed include demographics, clinical presentation, complexities of the nasolacrimal duct obstruction, preoperative and intraoperative utility of VR and MR models, surgical techniques, complications, and outcomes. The technique is described as a proof of concept in challenging situations with Apert syndrome and traumatic SALDOs with gross malposition of the sac, and gross nasal and lacrimal anatomical deformities. The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach. Intraoperatively, MR models were present in the surgeon's view without disturbing the endoscopic procedure. Intermittently, the surgeon could pull any of the models virtually present in the operating room, slice them, rotate them, and intricately study the alterations in a stepwise manner, as the surgery proceeds. Virtual reality and mixed reality-assisted powered endoscopic DCR can be an alternate approach reserved for extremely challenging cases of complex syndromic CNLDOs and post-traumatic SALDOs. 4 Laryngoscope, 134:3508-3515, 2024.

Case Report: Management of pediatric Le Fort and mandibular fracture with a modified cap splint

Pediatric facial fractures are rare and make up 5–15% of all facial fractures. The low incidence of facial fractures among children is due to physiological and environmental factors such as greater resilience of the pediatric skeleton, higher bone to tooth ratio, direct parental supervision and limited outdoor activity.1 In children of 5–10 years of age nasal fractures are by far the most frequent (58.6%), followed by mandibular fractures (21.5%). Orbital (9.5%), frontal (5.1%), and midfacial (3.8%) fractures are next in frequency2. Le Fort fractures are very rare in children, and there is a paucity of literature presenting their frequency and characteristics. In the mandible condylar fracture is the most common (38.9%) followed by angle (20.6%), parasymphysis (18.3%), body (15.3%) and symphysis (5.3%).3 Facial fractures are more common in boys, though this varies greatly from 1.1:1 to 8.5:1.4 The majority of facial fractures in children result from falls (7.8–48%) and sports-related injuries (4.4–42%).5 In primary or mixed dentition, the placement of internal fixation hardware is challenging due to the risk of injuring unerupted permanent tooth follicles. The use of resorbable plates and screws offer a potential solution to the growing pediatric facial bone as the standard titanium fixation systems carry the risk of translocation, growth restriction, and dental injury. Dental splinting or suspension wires can also be used in place of direct plating. Fortunately, mild malocclusion at this age has the potential to be improved through bony remodeling, the eruption of permanent dentition, compensation of the mastication mechanism, and posttraumatic orthodontia.6 Accordingly, the goal of treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion with minimal residual functional and esthetic impairment.

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

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.

Comparing the Efficacy of Postoperative Antibiotic Regimens in the Treatment of Maxillofacial Fractures: A Prospective Study.

The present study was designed to investigate the difference in the effectiveness of a 3 day postoperative course and a single perioperative dose of antibiotics on the incidence of postoperative infection in the management of maxillofacial trauma patients. About 183 maxillofacial trauma patients requiring open reduction and internal fixation (ORIF) under general anesthesia were divided based on the type of fracture sustained, i.e., mandibular fractures, Le Fort fractures, and zygomaticomaxillary complex fractures. Patients from each fracture type were randomized into two groups, A and B. All patients were administered amoxicillin/clavulanate 1.2 grams intravenously 8 hours from the time of admission till the patient was taken up for surgery. Once the patients were taken up for surgery, a perioperative dose was administered. No antibiotics beyond this point were given to patients in Group A. Patients in Group B were administered the same antibiotic for 3 postoperative days additionally. Outcomes in terms of purulent discharge from the surgical site, an abscess or any other sign of infection, and wound dehiscence requiring reopening of the surgical site were considered. Patients were reviewed at 1 week, 2 weeks, 1 month, 2 months, and 3 months. No statistically significant difference was found between the two groups across all three fracture types in terms of postoperative outcomes. However, increased numbers of complications were noted in the patients treated with an intra-oral approach in each fracture type irrespective of group. All complications were managed with local measures. A single perioperative dose of antibiotics is effective in minimizing postoperative complications following ORIF of maxillofacial fractures and there is no significant benefit in prolonging the course of antibiotics postoperatively with the need for further studies to be conducted considering comminuted, complex fractures and old fractures. In maxillofacial trauma, fractures frequently communicate with contaminated indigenous flora on the skin surface, oral cavities, or sinus cavities. Surgery is frequently performed using an approach across a contaminated area, even in closed fractures. Postoperative infections can be significantly decreased by using antibiotics in surgical procedures to treat facial fractures.

Changing trends in central midface fracture – A proposal for revised classification and holistic management

BackgroundMidface fractures are one of the common facial fractures encountered in the current era. High energy impact injuries that lead to gross comminution of the midface warranting modification of the standard treatment plan, often cannot be categorized by existing classification systems. The aim of the current paper is to describe the changing trends in midface fracture patterns and propose a modification for the current classification system and describe the holistic approach for management. Materials and methodsA retrospective study was conducted at our center to include all the patients who reported to us for the management of maxillofacial trauma between 2020 and 2022. The details of the cause of facial trauma and pattern of injury, clinical presentation, diagnosis were retrieved from the medical records and the radiographic details including computed tomography details of the fracture pattern were tabulated for evaluation. The Fractures which could not be classified based on the classical Le fort fracture lines were isolated and were classified based on the current classification system and the modifications in the treatment plan and management were recorded. ResultsA total of 673 trauma cases reported between the given time frame. Out of which 205 were midface fractures. 109 patients from the foresaid group had central mid face fracture. 62 fractures of these cases could not be classified based on conventional Le fort classification due to fragmentation, bone loss and combination with other Le fort level injury of the opposite side of the midface and involvement of orbit/ anterior cranial fossa. The modified Le fort classification (Table 1) was used to reclassify these fractures and according to the same 12 cases of Le fort IA, 9 cases of le fort IB, 4 cases of Le fort IIA, 20 cases of Le fort IIB, 4 cases of Le fort IIIA, 9 cases of Le fort IIIB and 4 cases of Le fort IV fracture.The details of the management strategy along with the timing of repair are discussed. ConclusionWith continual rise in the high impact injuries, the pattern of midface fracture presentation is changing. Advanced fixation modalities that are currently available can be applied only when a precise diagnosis and planning can be performed. The current modification of the midface fractures provides a better insight in defining the fracture patterns which will enable the surgeon to plan the midface reconstruction adequately.

Does Alcohol Use Influence Hospitalization Outcomes in Adults Suffering Craniomaxillofacial Fractures From Street Fighting?

This retrospective cohort study utilized the National Inpatient Sample (NIS) database for the years 2016-2018. Incidences of street fighting were identified using the corresponding ICD-10 codes. To determine whether alcohol use (measured by blood alcohol content (BAC)) in patients sustaining maxillofacial trauma from hand-to-hand fighting influence hospitalization outcomes. The primary predictor variable was BAC stratified into six categories of increasing magnitude. The primary outcome variable was mean length of hospital stay (days). The secondary outcome variable was total hospital charges (US dollars). Our final sample consisted of 3038 craniomaxillofacial fractures. Each additional year in age added +$545 in hospital charges (P < .01). Non-elective admissions added $14210 in hospital charges (P < .05). Patients admitted in 2018 experienced approximately $7537 more in hospital charges (P < .01). Le Fort fractures (+$61921; P < .01), mandible fractures (+$13227, P < .01), and skull base fractures (+$22170; P < .05) were all independently associated with increased hospital charges. Skull base fractures added +7.6days to the hospital stay (P < .01) and each additional year in patient age added +.1days to the length of the hospital stay (P < .01). BAC levels did not increase length of stay or hospitalization charges. Le Fort fractures, mandible fractures, and skull base fracture each independently increased hospital charges. This reflects the necessary care (ie, ICU) and treatment (ie, ORIF) of such fractures. Older adults and elderly patients are associated with increased length of stay and hospital charges-they are likely to struggle in navigating the healthcare system and face socioeconomic barriers to discharge.

Multidetector computed tomography in evaluation of maxillofacial injuries

Facial injuries occur in significant proportion in trauma patients requiring prompt diagnosis and management. The number of maxillofacial injuries is continuously increasing due to rise in traffic, failure to take preventive measures in the traffic leads to road traffic accidents, which is the main etiological factor in maxillofacial fractures. To study role of multidetector tomography in evaluation of maxillofacial injuries. To describe the advantages of 3D reconstructed images over axial images in the imaging of facial fractures. This cross-sectional study included 100 patients who underwent CT evaluation of facial bones when they presented with evidence of fracture of maxillofacial bones on a 64-slice volume scanner (SIEMENS SOMATOM definition) in Geetanjali Medical College and Hospital, Udaipur during February 2019 to July 2020. RTA comprised of 76.19% cases. Assault and fall from height were 11.42 and 12.38%. The maxilla, the walls of its sinus were the most commonly involved bone with 71.42% next was Naso-orbito-ethmoid 68.57%. Zygomatic bone and mandible fractures were 50 and 38.09%. The type 2 frontal bone fractures were commonly seen 12 (31.5%) followed by Type 3, 10 (26.02%), Type 4 &amp; Type 1 seen in 6 (15.7%) and Type 5 was the least common injury seen 4 (10.52%). The medial wall of the orbit was most commonly involved 49 (35.76%). Le Fort fracture lines were identified in 17 occasions with Le Fort II seen 9 (52.9%). The advantages of 3D images within the assessment of facial trauma might be described especially in mandible and cheekbone. 3D images were better within the identification of Le Fort fracture lines. The coronal reconstructed images are superior in the detection of fractures in the orbit and maxilla. 3D images have a limited role in fractures involving the naso-orbito-ethmoid region and also when there is minimal fracture displacement.

Precautions for Pneumo-Orbital in Cases of Maxillofacial Trauma: Data Mining for Artificial Inteligence of Air Localization on CT-Scan

&lt;span lang="EN-US"&gt;Along with rapid mobility, the incidence of traffic accidents is increasing. Maxillofacial trauma often accompanies traffic accidents. Facial bone fractures need serious concern, considering that the face contains several important organs and an important aesthetic aspect daily. Pneumo-orbital, in which air is found in the orbital cavity, is a threat to vision. The development of diagnostic modalities for maxillofacial trauma is developed continuously for determining the accuracy and improving rapid diagnosis. A radiologist is greatly facilitated by the presence of a CT scan that is able to detect certain abnormalities through artificial intelligence (AI) features. The data of this study are preliminary data showing the incidence of pneumo-orbital that was often missed in maxillofacial trauma cases. The maxillofacial trauma cases (classified as Le Fort fractures) were collected from January 2022 to July 2022 consecutively and determined into Le Fort fractures with pneumo-orbital and without pneumo-orbital. From 19 cases, 13 cases (68%) were accompanied by pneumo-orbital, while 6 cases (32%) were not. Multiple pneumo-orbitals with relatively visible sizes are detected easily on CT scan but a single and relatively small pneumo-orbital has potentially not to be seen on CT scan. It is concluded that CT scan nowadays is not only used to see anatomical abnormalities, but also equipped with AI-based features; such as the intracranial bleeding volume calculation and calcium score estimation on cardiac CT. It is possible that a CT scan can also detect the presence of air particles. Thus, the sensitivity of pneumo-orbital detection can be increased.&lt;/span&gt;

Risk Factors for Acute Postoperative Complications Following Operative Management of Le Fort Fractures-A NSQIP Study.

Le Fort fractures comprise a pattern of complex midfacial fractures that arise secondarily to craniofacial trauma. Although management of these fractures has been detailed within the literature, there is a paucity of research examining postoperative outcomes after surgical repair. The primary aim of this study is to assess patient outcomes after operative management of Le Fort fractures, and examine factors influencing the risk for developing postoperative complications, through utilization of the ACS-NSQIP database. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for cases recorded between 2012 and 2019 with International Classification of Disease (ICD)-9 and ICD-10 codes corresponding to Le Fort fractures. Patient demographics, clinical variables, and postoperative variables were recorded. Logistic regression analysis was conducted to identify independent risk factors for postoperative complications. Identification of cases with appropriate ICD codes, and exclusion of those with missing data, yielded 562 patients for analysis. There were no cases of minor complications and 14 cases of severe complications (3 cases of wound dehiscence, 3 cases of transfusion requirement, 1 case of failure to wean from the ventilator for more than 48 h, 1 pulmonary embolism, and 8 cases of reoperation), corresponding to an overall complication rate of 2.49%. Logistic regression analysis revealed steroid use as an independent predictor of severe postoperative complications (OR =13.73, 95% CI: 1.08-128.02, P =0.02). The present study is the first to conduct a risk factor analysis of patients with Le Fort fractures using the ACS-NSQIP national database. The overall postoperative complication rate was 2.49%, with 14 cases of complications recorded in 8 years. Although this may suggest that surgical management of Le Fort fractures is generally well-tolerated, it should be noted that this problem is frequently associated with other severe injuries of the head and neck that may influence patient prognosis. Given this, further analysis would benefit from a larger patient cohort and longer postoperative data as the ACS-NSQIP database only records outcomes within 30 days.

Age-Related Outcomes in Le Fort Fractures.

This study aims to provide patient characteristics and short-term clinical outcomes of Le Fort fractures. Using the National Surgical Quality Improvement Program database from 2016 to 2019, cases involving Le Fort fractures on initial encounters were reviewed. 130 cases from 3293 facial fractures were identified. 70 cases were diagnosed with type I, 41 with type II, and 19 with type III. The male-to-female ratio was 4.9:1. Compared to geriatric patients (>65years old), Le Fort fractures were more common among patients between the ages of 18 and 65 (P < .003). 5.4% of patients had in-hospital complications, including sepsis, superficial-deep incisional surgical site infection, and wound disruption. Two patients (1.5%) were readmitted, while three (2.3%) underwent reoperation. Type I fractures in adult males are the most common presentation. Overall complication rates for surgical repairs are low.

The Prevalence of maxillary fractures in trauma patients referred to Shahid Rajaei Hospital in Shiraz from 2011 to 2021

Introduction: Maxillofacial fractures are one of the most common fractures in the body due to trauma. Maxillary fractures, especially Lefort fractures, are common fractures. The aim of this study is to evaluate the prevalence and etiology of Lefort fractures in patients referred to Shahid Rajaei Hospital during 2011 to 2021.&#x0D; Materials and Method: In this cross-sectional study, 2700 patients who referred to the maxillofacial surgery department of Shahid Rajaei Hospital in Shiraz between 2011 to 2021 due to trauma and fractures of the jaw and face were examined. 903 cases were related to patients with upper jaw fracture and were included in the study. The demographic information of the patients, including age, sex, cause of trauma, and also the type of fracture, were extracted from their records. The etiology of maxilla fracture was divided into three groups: vehicle accidents, violence and interpersonal conflict, and accidents during work and sports. Finally, in order to analyze the data, it was done through statistical tests.&#x0D; Results: 65% of patients were male and 35% were female. The average age of people was 38.5 years. Lefort I fracture was reported in 25% of patients, Lefort II fracture in 31% and Lefort III fracture in 11% of patients. 46% of patients had fractured maxilla due to vehicle accidents, 26% of patients due to interpersonal violence, and 27% of patients due to accidents during work and sports.&#x0D; Conclusion: The prevalence of Lefort fracture in men is significantly higher than in women. In our society, injuries caused by road accidents, especially car accidents, are the most common causes of Lefort fractures. The most common type of Lefort fracture is Lefort II fracture. Of course, the cause of injury has an important effect on the pattern of injury.

Application of Orthognathic Surgery Principles and Techniques in the Management of Craniomaxillofacial Trauma.

Posttraumatic secondary deformities of facial skeleton may occur because of nonmanagement or ill management of primary injuries, whereas some unexpectedly occur even after dedicated management attempts. Orthognathic surgery (OGS) principles and techniques can be used as an efficient tool to correct posttraumatic craniomaxillofacial deformities or skeletal developmental deformities during trauma management. The aims of this study were to describe the different types of posttraumatic secondary deformity and address how to use the principles of orthognathic techniques to correct them. Patients with orthognathic surgical osteotomies during primary or secondary management of facial trauma (referred to as trauma-OGS) during the period of 2010 to 2018 were retrospectively reviewed. Variables pertaining to patients and surgery were collected, including trauma diagnosis, etiology, duration between trauma/primary surgery and secondary presentation, suggested reason for secondary deformity, intervention undertaken to address, and the surgical outcome. Twenty-seven patients were eligible and extensively reviewed. Etiological categorization of trauma-OGS could be done into posttraumatic deformities (18) and developmental deformities (9). The former group was further categorized as OGS done as primary procedure (8) that included immobile Le Fort fractures and delayed initial treatment, and OGS done as secondary procedure (10) that included complex fractures and condylar fractures. The developmental deformity group was categorized into OGS done simultaneously during trauma management (5) or done as a secondary procedure after trauma management (4). Application of principles and techniques of OGS in indicated primary or secondary management of facial trauma patients should always be considered. The categorization of scenarios presented in this article relating facial trauma and OGS may further help to understand the application.

A Rare Occurrence of Bilateral Lefort III with a known case of Myocardial Infarction

Background: Patients with LeFort III fractures are at an elevated risk of needing emergency airway management because of midface instability and oropharyngeal airway obstruction. Lefort fracture includes fracture of the nasofrontal junction, bilateral area of the frontozygomatic suture, and probable fracture of the zygomatic arch. This fracture is also referred to as cranial facial disjunction. The Novel treatment for bilateral Lefort III is surgical management and medical management. It may be present in anyone who meets with an accident. Here we present the case of a 41-year adult man who came to the emergency department with complaints of head injury, absence of consciousness, nasal bleed drop by drop, swelling in the face, tooth avulsion, and prickling sensation over the lower right side of the face. The patient was kept in emergency ICU for observation and monitoring for one day, then referred to neurosurgery ICU where he was administered intravenous pan 40mg, Inj emset 2ml, Inj pause 1gm, Inj levopril 1gm, Inj ceftriaxone 1gm, Inj optineurin with 500ml ns, Tab zeredol 20 mg, Tab limce 500mg. The Patient was taken to the ophthalmology operation theater for suturing. Open reduction and internal fixation this surgical procedure is done on my patient. The patient's prognosis was good.

Epidemiology and management of Lefort fractures at the Sylvanus Olympio University Hospital of Lomé (Togo)

IntroductionLefort fractures are lesions of the facial mass following violent trauma. They can be life-threatening and functionally dangerous in the short or long term. This study aimed to report the management of this type of fracture in our context. MethodologyThis was a descriptive cross-sectional study with retrospective data collection from January 1, 2011, to December 31, 2020, in the Department of Otolaryngology and Cervico-Maxillofacial Surgery at the Sylvanus Olympio University Hospital of Lomé. ResultsThe annual frequency was 15.2 cases. The average age of the patients was 34.43 ± 11.98 years with extremes of 15 and 70 years and a sex ratio of 9.13. The majority of patients were workers in the informal sector (44.08%). The etiologies were dominated by road traffic accidents (91.45%) and 28.29% of the patients were emergency cases on admission. Imaging showed 51.06% Lefort II fractures. Treatment was surgical in 99.34%, with screw plates (89.40%). Functional sequelae were reported in 5.92% of patients. ConclusionLefort fractures are common in young adult males after road traffic accidents. Their treatment is delicate and often leaves serious after-effects. Active measures for the prevention of these road traffic accidents are therefore necessary.

What are the Risk Factors for Mortality Among Patients Who Suffer Le Fort III Fractures?

Le Fort III fractures are the most severe subtype of the Le Fort fractures and are associated with adverse clinical outcomes. The purpose of this study was to identify risk factors for mortality among patients who suffer Le Fort III fractures. A retrospective cohort study was completed using the 2016-2018 National Inpatient Sample. Patients with isolated Le Fort III fractures were selected. Patients who incurred bone fractures or organ injuries outside the head and neck were excluded. There were multiple, heterogenous predictor variables. The primary outcome variable was mortality. Relative risk was used to determine independent risk factors of mortality. Statistical significance was deemed for P values less than .05. The final sample consisted of 559 patients (mean age, 45.9years) who suffered a Le Fort III fracture, of whom 15 patients (2.68%) died. Most patients were male (82.7%) middle-aged adults (42.9%) of White race (66.5%) within the lowest income quartile (31.7%) that lived in large metro areas (54.9%). Relative to males, females were nearly 62 times more likely to die (P<.01). Relative to privately insured subjects, uninsured subjects were 23 times (P<.05) more likely to die. Relative to weekday admissions, weekend admissions increased the risk of mortality by 8 times (P<.05). Cranial vault fractures (odds ratio, 7.24; P<.05) and upper cervical fractures (odds ratio, 63.27; P<.05) were risk factors for mortality. Relative to males, females were at an increased risk for mortality (relative risk [RR] 7.14, 95% confidence interval [CI] 2.60, 19.61). Skull base fracture (RR 2.99, 95 CI 1.04, 8.63), cranial vault fracture (RR 3.04, 95 CI 1.07, 8.65), subdural hemorrhage (RR 2.98, 95 CI 1.10, 8.05), subarachnoid hemorrhage (RR 6.73, 95 CI 2.34, 19.35), and injury of blood vessels at neck level (RR 13.24, 95 CI 2.46, 71.16) were each risk factors for mortality. Intracranial injury was not a risk factor for mortality. Instead, cranial vault fractures and skull base fractures increased the risk for mortality. In addition, uninsured patients and female patients were each at an increased risk for mortality.