RECONSIDERATION OF THE LE FORT CLASSIFICATION OF MAXILLOFACIAL FRACTURES

1990 ◽  
Vol 83 (Supplement) ◽  
pp. 2S-65
Author(s):  
Kenneth R. Barraza ◽  
Suman K. Das
Author(s):  
Y. Doi ◽  
S. Tomitsuka ◽  
K. Asano ◽  
E. Sakai ◽  
Sasaki T. ◽  
...  

2020 ◽  
Vol 9 (6) ◽  
pp. 527-530
Author(s):  
José Jhenikártery Maia de Oliveira ◽  
Micaella Fernandes Farias ◽  
Flaviana Laís Pereira dos Santos ◽  
Artemisa Fernanda Moura Ferreira ◽  
Lucas Alexandre de Morais Santos

Introdução: Fraturas no complexo zigomático orbital podem resultar em deslocamento ósseo com alteração do volume orbital e distúrbios funcionais. As complicações associadas aos traumas dessa região podem vir a interferir diretamente na qualidade de vida do indivíduo, dessa forma, faz-se necessário a cirurgia de reposicionamento anatômico do osso. Objetivo: Relatar um caso clínico de fratura do complexo zigomático orbital em paciente vítima de acidente desportivo. Relato de caso: Paciente do sexo masculino, leucoderma, vítima de acidente desportivo, compareceu a um serviço de Cirurgia Bucomaxilofacial da cidade de Recife-PE, apresentando alterações anatômicas visíveis na região zigomática do lado esquerdo da face. Ao exame clínico observou-se assimetria facial, edema, equimose periorbital, hemorragia subconjuntival, perda de volume do lado afetado e desconforto relado pelo paciente, sugerindo fratura do complexo zigomático orbital. A Tomografia Computadorizada mostrou perda da projeção anteroposterior do corpo do osso zigomático esquerdo, com fratura no arco zigomático e descontinuidade da sutura esfenozigomática esquerdas. O corte tomográfico coronal evidenciou aprisionamento do conteúdo orbital por fragmentos presentes no assoalho da órbita, e fratura do pilar zigomático-maxilar. Através de acessos cirúrgicos peri-orbitais (superciliar e subtarsal) foi instalada 1 mini-placa com parafusos (1 em cada acesso), nas regiões da sutura fronto-zigomática e da margem infraorbital. Pelo acesso intraoral foi fixada uma placa no pilar zigomático-maxilar. O tratamento cirúrgico buscou acesso ao esqueleto da órbita, redução anatômica e fixação interna estável com mini-placas e parafusos. Considerações finais: Após 10 dias, observou-se o restabelecimento anatômico da projeção anteroposterior do osso zigomático direto, procedendo à melhora estético-funcional. Descritores: Anatomia Regional; Traumatologia; Fraturas Orbitárias. Referências Obimakinde OS, Ogundipe KO, Rabiu TB, Okoje VN. Maxillofacial fractures in a budding teaching hospital: a study of pattern of presentation and care. Pan Afr Med J. 2017;26:218. Ugboko V, Udoye C, Ndukwe K, Amole A, Aregbesola S. Zygomatic complex fractures in a suburban Nigerian population. Dent Traumatol. 2005;21(2):70-5.  Zamboni RA, Wagner JCB, Volkweis MR, Gerhardt EL, Buchmann EM, Bavaresco CS. Epidemiological study of facial fractures at the Oral and Maxillofacial Surgery Service, Santa Casa de Misericordia Hospital Complex, Porto Alegre - RS - Brazil. Rev Col Bras Cir. 2017;44(5):491-97. Ramos JC, Almeida MLD, Alencar YCG, de Sousa Filho LF, Figueiredo CHMC, Almeida MSC. Estudo epidemiológico do trauma bucomaxilofacial em um hospital de referência da Paraíba. Rev Col Bras Cir. 2018;45(6):e1978. Wulkan M, Parreira Junior JG, Botter DA. Epidemiologia do trauma facial. Rev Assoc Med Bras. 2005;51(5):290-95. Knight JS, North JF. The classification of malar fractures: an analysis of displacement as a guide to treatment. Br J Plast Su1961;13:325-39. Mendonça JCG, Crivelli DMB. Tratamento de fratura cominutiva do complexo zigomático orbitário com utilização de fio de aço: relato de caso. Rev Bras Cir Cabeça Pescoço. 2012; 41(2):93-5. Hupp JR, Tucker MR, Ellis E.Cirurgia oral e maxilofacial contemporânea. 6. ed. Rio de Janeiro: Elsevier; 2015. p. 1099-1113. Oliva MA. Acesso subciliar para fraturas do complexozigomático-orbitári. Rev Bras Cir Cabeça Pescoço. 2013;42(2):106-8. Soares LP, Gaião L, Santos MESM, Pozza DH, Oliveira MG. Indicações da Tomografia Computadorizada no Diagnóstico das Fraturas Nasoórbito-etmoidais. Rev de Clin Pesq Odontol. 2004;1(1):29-33. Kurita M, Okazaki M, Ozaki M, Tanaka Y, Tsuji N, Takushima A, et al. Patient satisfaction after open reduction and internal fixation of zygomatic bone fractures. J Craniofac Surg .2010;21(7):45–9. Hammer B. Fraturas orbitárias: Diagnóstico, tratamento cirúrgico, correções secundárias. São Paulo: Santos; 2005. Panarello F, Chaves Júnior AC, Leles JLR, Oliveira MG. Análise dos materiais empregados para a reconstrução das fraturas orbitárias – Revisão de literatura. RBC: Rev Int Cir Traumatol Bucomaxilofacial. 2005;3(9):57-64. Kloss FR, Stigler RG, Brandstätter A, Tuli T, Rasse M, Laimer K, Hächl OL, Gassner R. Complications related to midfacial fractures: operative versus non-surgical treatment. Int J Oral Maxillofac Surg. 2011;40(1):33-7. Liedtke FS, Richinho KP, Pisanelli CH, Araf D. Fraturas do soalho da órbita do tipo ‘’Blow-out”: revisão de literatura. Revicience 2005;5(5):8-11.


2021 ◽  
pp. 817-820
Author(s):  
Jiten D. Parmar ◽  
Lachlan M. Carter

Maxillary fractures can be classified according to fracture pattern as described by the Le Fort classification. These are usually high-energy injuries and there are often other facial injuries associated with these fractures that need to be identified and managed in addition to the treatment of the fracture itself. Fracture treatment is by reduction and stabilization, usually with internal fixation. Complications of the injury and treatment are discussed in this chapter


2021 ◽  
Vol 11 (14) ◽  
pp. 6293
Author(s):  
Maria Amodeo ◽  
Vincenzo Abbate ◽  
Pasquale Arpaia ◽  
Renato Cuocolo ◽  
Giovanni Dell’Aversana Orabona ◽  
...  

An original maxillofacial fracture detection system (MFDS), based on convolutional neural networks and transfer learning, is proposed to detect traumatic fractures in patients. A convolutional neural network pre-trained on non-medical images was re-trained and fine-tuned using computed tomography (CT) scans to produce a model for the classification of future CTs as either “fracture” or “noFracture”. The model was trained on a total of 148 CTs (120 patients labeled with “fracture” and 28 patients labeled with “noFracture”). The validation dataset, used for statistical analysis, was characterized by 30 patients (5 with “noFracture” and 25 with “fracture”). An additional 30 CT scans, comprising 25 “fracture” and 5 “noFracture” images, were used as the test dataset for final testing. Tests were carried out both by considering the single slices and by grouping the slices for patients. A patient was categorized as fractured if two consecutive slices were classified with a fracture probability higher than 0.99. The patients’ results show that the model accuracy in classifying the maxillofacial fractures is 80%. Even if the MFDS model cannot replace the radiologist’s work, it can provide valuable assistive support, reducing the risk of human error, preventing patient harm by minimizing diagnostic delays, and reducing the incongruous burden of hospitalization.


2020 ◽  
Vol 9 (6) ◽  
pp. 546-549
Author(s):  
Maria Eloise de Sá Simon ◽  
Gustavo Antonio Correa Momesso ◽  
William Phillip Pereira da Silva ◽  
Leonardo Alan Delanora ◽  
Leonardo Alan Delanora ◽  
...  

O terço médio da face é funcional e esteticamente importante. De acordo com a classificação Le Fort, existem três níveis mais fracos desta região da face quando traumatizados a partir de uma direção frontal, sendo que os acidentes motociclísticos, atualmente, correspondem a causa de aproximadamente 29% destes traumas. O presente trabalho tem como objetivo relatar um caso clínico de tratamento cirúrgico de fraturas do tipo Le Fort I e Le Fort II em um paciente de 29 anos de idade, sexo masculino, vítima de acidente motociclístico, atendido no Hospital de Emergência e Trauma Senador Humberto Lucena (João Pessoa – PB). Ao exame físico observou-se mobilidade de maxila, degrau palpável em pilar zigomático e pilar canino, alteração oclusal com leve mordida aberta e degrau em rebordo infraorbitário direito, entretanto o paciente não apresentava nenhuma alteração ocular. Foi solicitada tomografia computadorizada como exame complementar para confirmação do diagnóstico e planejamento cirúrgico, o qual se deu como fratura Le Fort I e Le Fort II no lado direito. O paciente foi submetido à cirurgia sob anestesia geral para fixação dos pilares zigomático e canino através do acesso vestibular maxilar e rebordo infraorbitário através do acesso subciliar. Inicialmente foi feito o bloqueio maxilo – mandibular para a utilização da oclusão como ponto de referência, seguido da redução das fraturas e fixação com placas e parafusos do sistema 2.0. Sob acompanhamento pós – operatório o paciente apresentou retorno da oclusão dentro dos padrões de normalidade, recuperou a projeção da região zigomática fraturada e então recebeu alta. Descritores: Fraturas Ósseas; Fixação de Fratura; Traumatismos Faciais. Referências Organização das Nações Unidas no Brasil. Traumas matam mais que malária, tuberculose e AIDS, alerta OMS. Disponível em: <http://www.onu.org.br/traumas-matam-mais-que-malaria-tuberculose-e-aids-alerta-oms/>. Acesso em: 22 julho 2019 Ansari MH. Maxillofacial fractures in Hamedan province, Iran: a retrospective study (1987-2001). J Craniomaxillofac Surg. 2004;32(1):28-34.  Kostakis G, Stathopoulos P, Dais P, Gkinis G, Igoumenakis D, Mezitis M, Rallis G. An epidemiologic analysis of 1,142 maxillofacial fractures and concomitant injuries. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5 Suppl):S69-73.  Li Z, Li ZB. Characteristic changes of pediatric maxillofacial fractures in China during the past 20 years. J Oral Maxillofac Surg 2008;66:2239-42. Fonseca RJ. Trauma Bucomaxilofacial 4. ed. Rio de Janeiro : Elsevier; 2015. Wulkan M, Parreira Junior JG, Botter DA. Epidemiologia do trauma facial. Rev Assoc Med Bras. 2005;51(5):290-95. Scherer M, Sullivan WG, Smith DJ Jr, Phillips LG, Robson MC. An analysis of 1,423 facial fractures in 788 patients at an urban trauma center. J Trauma. 1989;29(3):388-90.  Cohen RS, Pacios AR. Facial and cranio-facial trauma: epidemiology, experience and treatment. F Med. 1995;111(suppl):111-16. de Birolini D, Utiyama E, Steinman E. Cirurgia de Emergência. São Paulo: Atheneu; 1997. Tessier P. The classic reprint: experimental study of fractures of the upper jaw. 3. René Le Fort, M.D., Lille, France. Plast Reconstr Surg. 1972;50(6):600-7.  Buehler JA, Tannyhill RJ 3rd. Complications in the treatment of midfacial fractures. Oral Maxillofac Surg Clin North Am. 2003;15(2):195-212. Manson PN, Clark N, Robertson B, Slezak S, Wheatly M, Vander Kolk C, Iliff N. Subunit principles in midface fractures: the importance of sagittal buttresses, soft-tissue reductions, and sequencing treatment of segmental fractures. Plast Reconstr Surg. 1999;103(4):1287-306; Carr RM, Mathog RH. Early and delayed repair of orbitozygomatic complex fractures. J Oral Maxillofac Surg. 1997;55(3):253-8; 258-9. 


2016 ◽  
Author(s):  
Richard A. Hopper ◽  
Graham G Walmsley ◽  
Michael S Hu ◽  
H Peter Lorenz

The human face is vulnerable to injury most frequently as the target of interpersonal violence or when inadequately restrained within a motor vehicle collision. Injuries to both the soft tissues and skeleton of the face are common reasons of emergency department admissions and consultations. Isolated maxillofacial trauma is rarely life threatening or an immediate cause of death unless associated with airway compromise; however, approximately 20% of all patients with facial soft tissue, dentoalveolar, or facial fracture trauma have associated injury to additional body systems. In particular, motor vehicle crash victims, personal assault, occupational injuries, and motorcycle crash victims may have associated injuries to additional body systems. This review covers the assessment and management of maxillofacial fractures, initial evaluation, comprehensive survey, treatment of soft tissue injuries, and treatment of maxillofacial fractures. Figures show a patient with a combination of blunt and penetrating trauma to the central face; fractured mandible; fractured zygoma; infraorbital fracture; broken nose; soft tissue injuries involving the facial nerve distal to the vertical line, likely too small for primary repair; injuries to the parotid duct repaired by passing a catheter through the Stensen duct and through the area of laceration and then repairing the parotid duct over the catheter; mandibular fracture; Le Fort I, Le Fort II, and Le Fort III fractures; findings in patients with Le Fort III maxillary fractures immediately after injury, before obliterative edema develops; and preoperative and postoperative right-sided orbitozygomatic fracture. This review contains 12 highly rendered figures, and 29 references Key words: Jaw injuries; Face injuries; Maxillofacial injuries; Le Fort level; Facial fractures; Orbital fractures; Maxillary fractures; 


2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Senzwesihle C. Magagula ◽  
Timothy Hardcastle

Background: In the early 20th century, René Le Fort studied facial fractures resulting from blunt trauma and devised a classification system still in common use today. This classification, however, was based on low-velocity trauma. In modern practice, in a quaternary-level referral hospital, patients are often admitted following high-velocity injuries that mostly result from motor vehicle collisions.Objectives: A retrospective study to define facial bone fractures occurring subsequent to highvelocity trauma.Method: A retrospective study comprising the review of CT scans of 52 patients with highvelocity facial fractures was performed between April 2007 and March 2013. Injuries were classified using the Le Fort classification system. Deviations from the true Le Fort types, which are often depicted in the literature as occurring bilaterally and symmetrically, were documented; these included unilaterality, occurrence of several Le Fort fractures on one side of the face, occurrence of several Le Fort fractures on different levels and on different sides of the face, and occurrence of other fractures in addition to Le Fort fractures.Results: Of the 52 cases, 12 (23%) had Le Fort injuries, with true Le Fort fractures occurring in only 1, and 11 deviating from the classic description. Nine patients had Le Fort fractures and additional fractures. Mandibular and zygomatic bone fractures were found to be common associations with Le Fort injuries, occurring in 58% and 33% of the cases respectively.Conclusion: Fractures occurring in modern practice often deviate from the traditional Le Fort classification. Precise recognition of these deviations and recognition of additional associated fractures is pivotal in their management, assisting the surgeon in determining the treatment plan, such as the surgical approach and the order in which to fix the various fractured components.


2020 ◽  
Author(s):  
Orawan Chansanti ◽  
Yaninee Anusitviwat ◽  
Atthawit Mongkornwong

Abstract Background: Maxillofacial injury was usually found in low to middle countries moreover it commonly associated with brain injury, the major etiological factors are traffic collision, violence, and fall from hight. The incidence and etiology was important to developed treatment moreover to improve patient care in the future. The aim of this study was to analyze the incidence of the pattern of maxillofacial fracture in a patient with a traumatic head injury and to measure the incidence of the cause of injury, age, and gender distribution Methods: This is a retrospective study in Songhklanagarind hospital. We evaluate all patients who presented with a concomitant maxillofacial and traumatic head injury in Songklanagarind hospital between 2007 and 2016. Results: 859 patients consisting of 73.3% male and 22.7% female. The mean age was 39.5 years.The severity of the traumatic head injury was mild traumatic head injury 70.15%. Moreover the alcohol consumption was significantly related to a mild and severe traumatic head injury (P < 0.05). The most frequent was maxilla bone. 33.9% of patients were undergone the operation. Conclusion: In this retrospective study, the maxilla bone fracture was the most frequent site involved. The patients with mild traumatic head injury are related to the coronoid process of mandible, Le Fort fracture type II and type III, moderate traumatic head injury is only related to the coronoid process of mandible and severe traumatic head injury are related to Le Fort fracture type II and III. Keyword: traumatic head injury, maxillofacial fracture


2020 ◽  
Vol 18 ◽  
pp. 100060
Author(s):  
Alessandro Stecco ◽  
Francesca Boccafoschi ◽  
Zeno Falaschi ◽  
Giulio Mazzucca ◽  
Andrea Carisio ◽  
...  

1966 ◽  
Vol 24 ◽  
pp. 21-23
Author(s):  
Y. Fujita

We have investigated the spectrograms (dispersion: 8Å/mm) in the photographic infrared region fromλ7500 toλ9000 of some carbon stars obtained by the coudé spectrograph of the 74-inch reflector attached to the Okayama Astrophysical Observatory. The names of the stars investigated are listed in Table 1.


Sign in / Sign up

Export Citation Format

Share Document