What is a simple way to remember Le Fort fractures?

Le Fort Fracture Classification: Memory Aid

The Le Fort classification describes three progressive levels of midface fractures, all involving the pterygoid plates, with increasing severity from I to III—think of them as horizontal lines across the face that get progressively higher.

Visual Memory System

Le Fort I: "Floating Palate" or "Mustache Fracture"

• Runs horizontally above the teeth, below the nose—imagine a mustache line across the maxilla 1
• Separates the hard palate and alveolar process from the rest of the midface 1
• Involves the maxillary sinus and pterygoid plates 1
• Lowest severity with average ISS of 18.8, rarely requires tracheostomy (13.6% of cases) 2

Le Fort II: "Pyramidal Fracture"

• Forms a pyramid shape—starts at the nasal bridge, extends through the medial orbital walls, crosses under the orbits (infraorbital rims), and extends back to the pterygoid plates 3, 1
• Involves nasal bones, maxillary sinus, and orbital floors 1
• Can disrupt the infraorbital nerve (V2), causing anesthesia of upper teeth, gingiva, upper lip, and lateral nose 3
• Moderate severity—only 9.1% require tracheostomy 2

Le Fort III: "Craniofacial Disjunction"

• Complete separation of the midface from the skull base—the fracture line runs through BOTH orbital rims (lateral and medial), across the zygomatic arches, and through the skull base 1
• Highest severity: 43.5% require tracheostomy, 8.7% mortality rate 2
• Frequently associated with cervical spine injuries, intracranial trauma, and vision-threatening ocular injuries 2, 4

Simple Memory Mnemonic

"1-2-3, Low to High, Mustache-Pyramid-Floating Face"

• Le Fort I = 1 horizontal line (mustache level)
• Le Fort II = 2 sides of a pyramid (nasal bridge to cheeks)
• Le Fort III = 3 complete separations (entire face from skull)

Critical Clinical Distinctions

Severity Progression

• Statistically significant difference in Injury Severity Score between Le Fort I versus II or III (P < 0.0001) 2
• Le Fort II and III patients have significantly higher probability of ICU admission and immediate operative intervention 2
• All Le Fort fractures involve the pterygoid plates—this is the unifying feature 1

Screening Requirements

• Screen ALL Le Fort II and III fractures for blunt cerebrovascular injury (BCVI) 1
• Recent evidence suggests screening even Le Fort I fractures for BCVI 1
• 68% of facial fracture patients have associated head injury 3
• 7% have concomitant cervical spine injury 3

Imaging Approach

MDCT maxillofacial is the first-line imaging modality for all Le Fort fractures 3, 1

• Provides superb osseous and soft-tissue delineation with thin-section acquisitions 3
• 3-D reconstructions are critical for preoperative surgical planning 3
• CT contrast is NOT useful for detecting facial injury 3
• MRI only indicated for cranial nerve deficits not explained by CT or suspected CSF leak 3

Common Pitfalls

• Do not miss associated injuries: Le Fort fractures result from high-velocity mechanisms and are rarely isolated 2, 4
• Le Fort III fractures can cause airway obstruction requiring urgent intubation or tracheostomy 4, 5
• Pure Le Fort patterns are uncommon—most patients have combination or asymmetric fractures 2
• Always assess for vision-threatening ocular trauma, especially in Le Fort III 2