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Le Fort Fractures

Amy L Richter, K Kelly Gallagher
We describe the case of a 77-year-old immunocompetent woman with a history of chronic rhinosinusitis who presented with a pathologic Le Fort I fracture after a forceful sneeze. Imaging revealed diffuse sinus opacification and a Le Fort type I complex fracture involving the maxilla, pterygoid plates, clivus, and right nasal bridge. The patient underwent endoscopic debridement of her sinuses, which revealed mucosal dehiscence and otherwise normal healthy bleeding tissue. Anatomic pathology identified necrotic bone with invasive fungal hyphae...
September 2016: Ear, Nose, & Throat Journal
Tetsuya Yumoto, Tatsushi Matsumura, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike
INTRODUCTION: Cricothyroidotomy is an emergency procedure that can be used to secure the airway in situations in which intubation and ventilation are not possible. PRESENTATION OF CASE: We describe a case of 79-year-old male presenting with facial trauma combined with massive upper airway bleeding and swelling in which cricothyroidotomy was required to open the airway in an elderly male patient taking antiplatelet agents who suffered a simple ground-level fall. DISCUSSION: Although emergency airway management is often required in patients with Le Fort fractures, mandibular condyle fractures exhibit a significant relationship with ground-level falls, which are not usually associated with emergency airway management...
2016: International Journal of Surgery Case Reports
Sagar Dahiya, Prasad Chitra, Vikrant, Narahari Kalyana Srinivas Aravind, Sukhvinder Bindra
Mid palatal fractures are usually present in conjunction with Le Fort I maxillary fractures. Literature on isolated mid palatal fractures as seen in this case is relatively rare. A novel approach for the management of this case was undertaken. A rapid maxillary expander was used to separate palatal segments which healed well. The patient's crossbite and open bite was corrected with elastic use. The protocol of management of malunion of isolated mid palatal fractures is simple with reduced costs, morbidity and higher rates of acceptance...
May 2016: Journal of Clinical and Diagnostic Research: JCDR
Shao-Fu Huang, Lun-Jou Lo, Chun-Li Lin
This study investigates the biomechanical interaction of different mini-plate fixation types (shapes/sizes and patterns) with segmental advancement levels on the Le Fort I osteotomy using the non-linear finite element (FE) approach. Nine models were generated under a standard 1-piece LeFort I osteotomy for advancement with 3, 6 and 9 mm distances and four mini-plates with three fixation patterns including LL, LI, and II patterns placed on the maxillae models by integrating computed tomography images and computer-aided design system...
May 6, 2016: Computer Methods in Biomechanics and Biomedical Engineering
Shinji Kobayashi, Toshihiko Fukawa, Takashi Hirakawa, Toshihiko Satake, Jiro Maegawa
The Le Fort II osteotomy is a relatively rare operation. The posterior wall osteotomy of the maxillary sinus (MS) is often difficult for Le Fort III. We developed the transmaxillary sinus approach (TSA) for the Le Fort II osteotomy that cuts the posterior wall of the MS directly. This report illustrates this easy-to-use procedure for the Le Fort II osteotomy in syndromic craniosynostosis. This procedure was performed in an 18-year-old patient with Apert syndrome and a 15-year-old patient with Pfeiffer syndrome...
February 2016: Plastic and Reconstructive Surgery. Global Open
Gustavo Halak Oliveira-Campos, Leandro Lauriti, Marcos Kazuo Yamamoto, Rubens Camino Júnior, João Gualberto C Luz
PURPOSE: To assess the trends in Le Fort (maxillary) fractures in patients seen at a South American trauma care center based on the characteristics and management of these. MATERIALS AND METHODS: Of all patients with facial fractures seen at a trauma hospital during a six-year period, 50 (6.6 %) presented with Le Fort fractures. Medical charts were reviewed for characteristics presented and management performed. To improve the analyses, computed tomography and intraoperative findings were used...
March 2016: Journal of Maxillofacial and Oral Surgery
João Paulo Bonardi, Fernanda Herrera da Costa, Glaykon Alex Vitti Stabile, Cecilia Luiz Pereira-Stabile
The chemical senses of taste and smell are important to human life, because they play an important role in detecting potential environmental hazards. Humans can identify countless different flavors by the simultaneous perception of taste and smell. Reports of sensory loss after craniocerebral trauma began to appear in the medical literature in the middle 1800s. Dysgeusia associated with head injuries is rare and its reported incidence is 0.4 to 0.5%. This report describes the clinical case of a 32-year-old man with Le Fort I and III fractures treated with surgical reduction and fixation...
July 2016: Journal of Oral and Maxillofacial Surgery
Yuuki Uchida, Nobuyuki Mitsukawa, Shinsuke Akita, Takane Suzuki, Chisato Mori, Kaneshige Satoh
UNLABELLED: Carotid-cavernous sinus fistula (CCF) is a rare complication occurring after the Le Fort osteotomy. We aimed to elucidate the cause of CCF in the Le Fort osteotomy. METHODS: Eleven fresh cadavers were used. After craniotomy, a Le Fort III bipartition osteotomy was then performed. On the left side, both the lateral wall of the maxilla and the pterygomaxillary junction (PMJ) were divided, in addition to the conventional osteotomy line. On the right side, those parts were kept intact...
April 2016: Journal of Cranio-maxillo-facial Surgery
Francesco Carinci, Ilaria Zollino, Laura Arduin, Giorgio Brunelli, Francesco Pagliaro, Roberto Cenzi
The midfacial region (MR) is located in the middle-third of the face, composed of several bones and surrounded by complex anatomical structures so that MR fractures (MRFs) often involve other parts of the face. A staging system for classifying MRFs is of paramount importance in order to exchange information among trauma centers. Le Fort described three lines of fractures but still there is no scoring method to stage MRFs. In this article, a classification for MRFs is proposed. It is based on Le Fort's three lines and it defines seven facial units...
August 2008: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
M T Kiani, G Tajik, M Ajami, H Fazli, M J Kharazifard, A Mesgarzadeh
The Le Fort I osteotomy is performed under general anaesthesia and specific haemodynamic conditions, i.e. hypotensive general anaesthesia. This study assessed the incidence of the trigeminocardiac reflex (TCR) during the different stages of the Le Fort I osteotomy. Forty-seven patients requiring a Le Fort I osteotomy were included. General anaesthesia was induced. In terms of haemodynamic changes, each patient's oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), and electrocardiogram (ECG) were monitored by SADAAT Monitoring System and recorded during the different stages of osteotomy: before the induction of anaesthesia, before osteotomy cuts, after finishing the right pterygoid plate osteotomy, after finishing the left pterygoid plate osteotomy, and after performing down-fracture of the maxilla...
May 2016: International Journal of Oral and Maxillofacial Surgery
Qiqin Zhan, Xiaojun Chen
This paper proposes an interactive method of model clipping for computer-assisted surgical planning. The model is separated by a data filter that is defined by the implicit function of the clipping path. Being interactive to surgeons, the clipping path that is composed of the plane widgets can be manually repositioned along the desirable presurgical path, which means that surgeons can produce any accurate shape of the clipped model. The implicit function is acquired through a recursive algorithm based on the Boolean combinations (including Boolean union and Boolean intersection) of a series of plane widgets' implicit functions...
2016: PloS One
J J Conforte, C P Alves, M del P R Sánchez, D Ponzoni
This study assessed the impact of oral and maxillofacial trauma and surgical treatment on the quality of life of patients. The study included 66 patients (age range 18-65 years) with facial fractures; 33 required surgical treatment and 33 required conservative (non-surgical) treatment. Quality of life was evaluated by applying the Oral Health Impact Profile questionnaire (OHIP-14) immediately after diagnosis of the trauma (T1), 30 days after surgery or trauma (T2), and 90 days after surgery or trauma (T3). For the control group (conservative treatment), there was a change in quality of life at T1 and T2...
May 2016: International Journal of Oral and Maxillofacial Surgery
Jordan N Halsey, Ian C Hoppe, Andrew A Marano, Anthony M Kordahi, Edward S Lee, Mark S Granick
OVERVIEW: Cervical spine injury may present with pediatric patients having sustained fractures of the craniofacial skeleton. Management considerations of the cervical spine often take priority to the fractures of the facial skeleton. The goal of this study was to examine this subset of patients with a focus on initial presentation and need for intervention. METHODS: A retrospective review from 2000 to 2012 of all facial fractures in patients ≤ 18 years at a level 1 trauma center was performed...
January 2016: Journal of Craniofacial Surgery
J Breeze, C Verea Linares, P Stockton
Pterygomaxillary dysjunction with an osteotome is commonly used to mobilise the maxilla during Le Fort I osteotomy, despite the risk of serious complications. Different instruments and positions have been tried, including dysjunction through the tuberosity. Down fracture by digital pressure alone has also been advocated, but to our knowledge has not been widely adopted. We have therefore reviewed published papers to see if there is any clinical or anatomical evidence for the use of osteotomes to mobilise the maxilla vertically during a Le Fort I osteotomy for either pterygomaxillary dysjunction or dysjunction through the tuberosity...
April 2016: British Journal of Oral & Maxillofacial Surgery
Sagar Dahiya, Prasad Chitra, Sadam Srinivas Rao, Sukhvinder Bindra
Transverse maxillary hypoplasia or maxillary constriction in conjunction with unilateral or bilateral posterior cross bites is a common finding in cleft palate patients. These situations are also commonly encountered in adults who have not had recourse to orthodontic treatment in childhood. In adults, after ossification of the mid palatal suture is complete, the accepted means of correcting transverse skeletal discrepancies is by Surgically Assisted Rapid Maxillary Expansion (SARME). The disadvantage of this technique in the Indian scenario is reduced patient acceptance and increased treatment costs...
October 2015: Journal of Clinical and Diagnostic Research: JCDR
Momoko Mishima, Tetsuya Yumoto, Hiroaki Hashimoto, Takao Yasuhara, Atsuyoshi Iida, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Fumio Otsuka, Yoshihito Ujike
INTRODUCTION: Superior ophthalmic vein thrombosis is a rare entity, but is associated with significant morbidities. We describe a case in which superior ophthalmic vein thrombosis occurred shortly after severe facial trauma. CASE PRESENTATION: A 77-year-old Japanese man was transferred to our tertiary hospital after a motor vehicle accident. Le Fort III facial bone fractures and a minor cerebral contusion were detected. Follow-up computed tomography scans detected dilatation of his left superior ophthalmic vein on day 3 and thrombosis on day 12; however, no causative carotid cavernous fistula was observed...
2015: Journal of Medical Case Reports
Himani Dadwal, S Shanmugasundaram, V B Krishnakumar Raja
PURPOSE: To determine the rate of complications and occurrence of pterygoid plate fractures comparing two techniques of Le Fort I osteotomy i.e., Classic Pterygomaxillary Dysjunction technique and Trimble technique and to know whether the dimensions of pterygomaxillary junction [determined preoperatively by computed tomography (CT) scan] have any influence on pterygomaxillary separation achieved during surgery. MATERIALS AND METHODS: The study group consisted of eight South Indian patients with maxillary excess...
September 2015: Journal of Maxillofacial and Oral Surgery
N B van Bakelen, K M Vermeulen, G J Buijs, J Jansma, J G A M de Visscher, Th J M Hoppenreijs, J E Bergsma, B Stegenga, R R M Bos
BACKGROUND: Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs. AIM: The aim of the present study was to compare the cost-effectiveness between a biodegradable and a titanium system in Maxillofacial surgery. MATERIALS AND METHODS: This multicenter RCT was performed in the Netherlands from December 2006 to July 2009. Included were 230 patients who underwent a bilateral sagittal split osteotomy (BSSO), a Le Fort-I osteotomy, or a bi-maxillary osteotomy and those treated for fractures of the mandible, maxilla, or zygoma...
2015: PloS One
Ravi K Garg, Nila H Alsheik, Ahmed M Afifi, Lindell R Gentry
Pterygoid plate fractures are often described in the setting of Le Fort fractures. The goal of this study was to define other craniofacial fracture patterns causing injury to the pterygoid plates. A retrospective review of computed tomography (CT) scans obtained on craniofacial trauma patients over a 5-year period revealed 209 patients with pterygoid plate fractures. Pterygoid plate fractures in 78 patients (37.3%) were unrelated to Le Fort fractures. Common causes included sphenotemporal buttress fractures in 26 patients (33...
September 2015: Journal of Craniofacial Surgery
Renier Barreto Arrais Ykeda, Carlos Roberto Ballin, Rafael Souza Moraes, Ronnie Barreto Arrais Ykeda, Alana Farias Miksza
INTRODUCTION:  Epidemiological studies that focus on facial injuries are of great interest for the knowledge of occurrence and severity of presentation. AIM:  To study the epidemiological profile of 277 patients who suffered facial fractures at the Hospital do Trabalhador (HT), with an emphasis on variables such as sex, age, cause, and anatomical sites of fractures, comparing the clinical findings with other studies. METHOD:  Retrospective nonrandomized chart review of 277 patients who were treated at HT by the ENT service during the full year 2010, victims of facial fractures...
October 2012: International Archives of Otorhinolaryngology
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