The most common disturbance in a treated Le Fort injury is reduced midfacial height and projection rather than the facial elongation and retrusion seen in an untreated Le Fort fracture. To prevent the forces of mastication from disrupting the repair, emphasis must be put on placing the plates in the same direction as the forces of mastication. Le Fort I fractures may be accessed by a gingivobuccal sulcus incision, and fixed by reestablishing the midfacial buttresses using 1.5 to 2.0 mm L and J plates. The structural support between the areas of the buttress and maxillary alveolus must also be restored to provide for proper soft tissue contour. The goals of the treatment of Le Fort I fractures are to restore midfacial height and projection and to reestablish pre-traumatic occlusal relationships. Therefore, the absence of a lateral pyriform fracture rules out a Le Fort I fracture. Īmong Le Fort fractures, only the Le Fort I fracture involves the lateral aspect of the pyriform aperture. These findings indicate that approximately one third of pterygoid plate fractures do not result from Le Fort pattern injuries and that the craniofacial surgeon should have a broad differential for causes of pterygoid plate fractures when reviewing trauma imaging. Common causes included sphenotemporal buttress fractures in 26 patients (33.3%), temporal bone fractures in 18 patients (23.1%), zygomaticomaxillary complex fractures in 17 patients (21.8%), and displaced mandible fractures in 14 patients (17.9%). Pterygoid plate fractures in 78 patients (37.3%) were unrelated to Le Fort fractures. A retrospective review of CT scans obtained on craniofacial trauma patients over a 5-year period revealed 209 patients with pterygoid plate fractures. However, the fracture of the pterygoid plate is not limited to Le Fort fractures. Conversely, if the CT scan does not reveal pterygoid fractures, the Le Fort fractures can be excluded. If a computed tomography (CT) reveals bilateral pterygoid fractures, a Le Fort fracture should be suspected. Pterygoid fractures are found in all three classes of Le Fort fractures, and are the key to establishing the diagnosis. The most consistent and uniting feature of a Le Fort fracture is the presence of bilateral pterygoid fractures. Bones fractured in a Le Fort I fracture include the lower nasal septum, the inferior portion of the pyriform apertures, the canine fossae, both zygomaticomaxillary buttresses, the posterior maxillary walls, and the pterygoid plates.
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