Rene Le Fort was a french surgeon who became interested in and therefore studied the different patterns that occur with mid-facial fractures. Interestingly, Dr. Le Fort determined the most common patterns of facial fractures that result from high impact trauma by dropping cadaver heads off of buildings and then dissecting the heads to analyze the broken bones within the face.
Dr. Le Fort found three common “fault lines” where the midfacial bones will break following injury.
Le Fort I: (red dotted line in diagram) This fracture line goes through the maxillary bone at the level of the piriform aperature (the bony edge of the nasal airway). This results in complete mobility of the upper jaw bone. Patients with this fracture will have mobility of the upper jaw, will have malocclusion of the teeth (i.e. the bite is off) and may have some nasal bleeding.
Le Fort II: (blue dotted line in diagram) This fracture occurs through the naso-frontal junction (where the nasal bones join up with the frontal bones) and then continues though the maxillary bone (at the nasal process), into the orbital floor (bony eye socket) and then extends through the remaining anterior portion of the maxillary bone. Patients with this fracture will have mobility of their entire mid-face as well as malocclusion of their bite.
Le Fort III: (green dotted line in diagram) This fracture is also known as a “craniofacial dysjunction” since the entire mid-facial bony skeleton becomes separated from the skull base. In this pattern, the fracture line occurs through the zygomatico-frontal suture, the nasal-frontal junction, the medial wall of the orbit (eye socket), the orbital floor, as well as the zygomatic arches laterally. Patients with this severe injury will commonly have an elongated facial appearance, as well as involvement of the globes (eyeballs).
Most of these fractures result from high impact injuries such as falls (over 20 feet), motor vehicle collisions, and assaults. Because the energy force required to break bones in these patterns is so great, it is common for patients with these fractures to have other associated injuries (i.e. such as injury to the eyeball, broken sinuses, and bleeds within the skull. These patients need to be cared for by a multidisciplinary team, that may include trauma surgeons, neurosurgeons and intensivists, as well as by a plastic and reconstructive surgeon accustomed to caring for injuries of this magnitude.