RT Book, Section A1 Stark, Christopher L. A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181038063 T1 Lefort Facial Fractures T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessmedicine.mhmedical.com/content.aspx?aid=1181038063 RD 2024/10/14 AB All LeFort facial fractures involve the maxilla. Clinically, the patient has facial injuries, swelling, and ecchymosis. LeFort I fractures are those involving an area under the nasal fossa. LeFort II fractures involve a pyramidal area including the maxilla, nasal bones, and medial orbits. LeFort III fractures, sometimes described as craniofacial dissociation, involve the maxilla, zygoma, nasal and ethmoid bones, and the bones of the base of the skull. LeFort IV fractures have been described as a LeFort III fracture that also involves the frontal bone. Patients may have different LeFort fractures on each side of their face. Airway compromise may be associated with LeFort II and III fractures. Physical examination is sometimes helpful in distinguishing the four. The examiner places fingers on the bridge of the nose and tries to move the central maxillary incisors with the other hand. If only the maxilla moves, a LeFort I is present; movement of the upper jaw and nose indicates a LeFort II; and movement of the entire midface and zygoma indicates a LeFort III. Because of the extent of LeFort II and III fractures, they may be associated with cribriform plate fractures and CSF rhinorrhea. The force required to sustain a LeFort II or III fracture is considerable, and associated brain or cervical spine injuries or other facial fractures are common.