From the Guidelines
Management of Lefort type 1 fractures should prioritize open reduction and internal fixation (ORIF) within 7-14 days of injury, allowing time for swelling to subside, as this approach has been shown to provide optimal outcomes in terms of morbidity, mortality, and quality of life. When managing Lefort type 1 fractures, it is essential to consider the fracture patterns and associated injuries, as described in the study by Parsons et al 1.
Key Considerations
- Initial management focuses on securing the airway, controlling bleeding, and addressing associated injuries.
- Definitive treatment typically involves ORIF, which includes exposure of the fracture sites through intraoral and/or extraoral approaches, followed by reduction and fixation using titanium miniplates and screws.
- Post-operatively, patients require a soft diet for 4-6 weeks, regular oral hygiene with chlorhexidine mouthwash (0.12%, twice daily), and prophylactic antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days).
- Pain management typically includes acetaminophen (1000 mg every 6 hours) and/or ibuprofen (400-600 mg every 6-8 hours) as needed.
Follow-up and Monitoring
- Follow-up should occur at 1 week, 2 weeks, 1 month, and 3 months post-surgery to monitor healing and occlusion.
- Intermaxillary fixation may be required for 2-3 weeks in cases with occlusal disturbances. This approach is necessary because Lefort I fractures involve a horizontal fracture of the maxilla above the dental roots, separating the alveolar process, hard palate, and lower maxilla from the rest of the facial skeleton, requiring precise anatomical reduction to restore proper occlusion and facial aesthetics, as noted in the study by Parsons et al 1.
From the Research
Management of Le Fort Fractures Type 1
- The management of Le Fort fractures type 1 involves various approaches, including open reduction and internal fixation (ORIF), skeletal suspension, and intermaxillary fixation (IMF) screws 2.
- A study published in 2014 found that a 1-day course of antibiotics postoperatively is as effective in preventing infective complications as a 5-day regimen in midfacial fractures, including Le Fort fractures 3.
- Another study from 1985 emphasized the importance of immediate extended open reduction and bone grafting in achieving superior aesthetic results in midface fractures, including Le Fort fractures 4.
- A technical note published in 2024 presented a novel technique for managing isolated Le Fort I fractures using IMF screws, offering a minimally invasive alternative to ORIF 2.
- The management of Le Fort I fractures should take into account the potential for cosmetic and functional deficits if treated inappropriately, and a review of the literature highlights the importance of proper management 5.
Characteristics and Cost of Le Fort Fractures
- A review of 519 cases from a nationwide sample found that the mean costs of treating Le Fort I, II, and III fractures were $25,836, $28,415, and $47,333, respectively 6.
- The study also found that increased cost was independently associated with younger age, male gender, African-American ethnicity, Le Fort II and III patterns, motor vehicle accident etiology, mechanical ventilation requirement, tracheostomy, ORIF, transfer to an outside facility, and increased length of stay 6.
- The prevalence of head injuries and the need for respiratory support substantially increased with Le Fort complexity, and hospital costs were predominantly driven by fracture complexity and the need for necessary procedures 6.