From the Guidelines
Surgical repair of a LeFort II fracture is indicated when there is significant displacement of the midface fracture, resulting in functional or aesthetic impairment, as evidenced by symptoms such as malocclusion, facial asymmetry, or nasal airway obstruction, as suggested by the study published in the Journal of the American College of Radiology in 2022 1. The indications for LeFort II fracture repair include:
- Malocclusion (improper bite alignment)
- Facial asymmetry
- Nasal airway obstruction
- Diplopia (double vision)
- Enophthalmos (sunken eyes)
- CSF rhinorrhea (cerebrospinal fluid leakage from the nose)
- Midface instability or mobility These symptoms are often the result of blunt or penetrating facial trauma from motor vehicle accidents, assaults, falls, or gunshot wounds, which can lead to complex fracture patterns involving the zygoma, naso-orbital-ethmoid region, and maxilla, as described in the study 1. The treatment approach typically involves open reduction and internal fixation (ORIF) using titanium plates and screws to restore proper anatomical alignment and facial projection, with preoperative CT imaging essential for surgical planning, as is common practice in the management of midface injuries 1. Postoperatively, patients require a soft diet for 4-6 weeks, regular follow-up appointments, and possibly physical therapy for TMJ dysfunction, highlighting the importance of comprehensive care in the management of LeFort II fractures. Early intervention is crucial as these fractures involve the maxilla, nasal bones, and orbital floor, potentially affecting vision, breathing, and mastication if left untreated, as noted in the study published in 2022 1.
From the Research
Indications for Lefort 2 Fracture Repair
The primary goal of Lefort 2 fracture repair is to restore the functional and aesthetic integrity of the midface. Some key indications for repair include:
- Restoration of occlusion and reduction of fractures 2
- Repositioning and fixation of fractures to achieve stable anatomical relationships 3
- Management of airway obstruction, which can be caused by hemorrhage into the upper airway or midface instability 4
- Improvement of aesthetic appearance, particularly in relation to nasal contour and shape 2
- Prevention of post-operative complaints and potential need for secondary rhinoplasty 2
Surgical Considerations
Surgical repair of Lefort 2 fractures often involves open reduction and internal fixation (ORIF), which may be combined with other procedures such as rhinoplasty using diced cartilage fascia graft 2. The choice of surgical approach and technique depends on the individual case and the specific needs of the patient. Understanding the biomechanics of midface fractures and the principles of repair sequencing is crucial for successful outcomes 3.