Unilateral Le Fort I, II and Ill-type fractures

       It is possible for a unilateral fracture of the mid-facial skeleton to occur, which may be of the Le Fort I, II or III variety. The physical signs are similar to those already described but they are, of course, only present on one side.

Many combinations of fracture patterns may be present. For example, there may be a fractured zygomatic complex associated with a Le Fort I fracture, or a Le Fort I fracture with unilateral Le Fort II fracture, or Le Fort III, II and I fractures with midline palatal split and fracture of one or both zygomatic complexes. If the clinical features of each individual fracture are understood, it should be possible to determine what combination has occurred in an individual patient.

6. MATERIALS FOR SELF-CONTROL:

A. Tasks for self-control: 1. Anatomy and physiology of face skeleton. 2.Anatomy of maxilla. 3. Anatomy of masseter muscles. 4. Types of fracture of maxilla.5. Clinical features of fracture of maxilla. 6. Basic method of examination of patient with fracture. 7. Additional method of examination of patient with fracture of maхilla. 8. Treatment of fracture of upper jaw. 9. Indications for surgical treatment of upper jaw’s fracture.

B. Tasks for self-control: 1. Patient, 32 years old, was conveyed to the maxillofacial section of the hospital with a trauma got during work in a mine. Objectively: lengthening of middle third of the face, considerable haematomas and edema, increasing in the area of nose root and both eye-lids. An upper jaw is displaced downward and back, freely mobile together with the nasal bones, zygomatic bones and eyeballs. When palpating the deformation, pain and pathological mobility are determined, in the area of root of nose, external edges of orbits, wing-shaped appendices of basic bone. There is insignificant nasal bleeding with the admixture of neurolymph. (Answer: upper jaw fracture according to Le Fort III (upper)).

2.A driver, 35 years old, after a car crash was conveyed to the maxillofacial section of the hospital. He did not lose awareness. Objectively: an asymmetric face due to edema of cheek soft tissues and lacerated wound 2×3 sm. Mouth is half-open. An upper jaw is mobile and displaced downward, to the left and backward. What apparatus is to be applied for treatment? (Answer: Zbarzha’s apparatus).

3.A patient, 30 years old, was serveyed to the maxillofacial section of the hospital with a trauma. Objectively: patient has head-ache, dizziness, nausea, nasal, ear and mouth bleeding, extended face, symptom of glasses in each side, absent frontal teeth, normal bite and mouth opening. What can be diagnosed for this patient? (Answer: upper jaw fracture according to Le Fort III).

C. Materials for test control. Test tasks with the single right answer (a=II): 1. At what type of upper jaw fractures does the breaking off of alveolar appendix from the base of the pear-shaped opening occur? A. According to Le Fort I (lower type). B. According to Le Fort II (middle type). C. According to Le Fort III (upper type). D. According to Vasmund I. E. According to Vasmund II. (Correct answer: А).

2. At what type of upper jaw fracture one can see the such line of maxillary bones fracture: from nasal bones and bottom of eye socket, down to zygoma sutures and wing appendix of basic bone: A. According to Le Fort I (lower type). B. According to Le Fort II (middle type). C. According to Le Fort III (upper type). D. According to Vasmund I. E. According to Vasmund II. (Correct answer: B).

3. At what type of upper jaw fracture does a separation of facial bones from brain skeleton in transversal direction through the base of nasal bones, external edge of the eye socket, zygoma arc and wing appendix of basic bone take place?: A. According to Le Fort I (lower type). B. According to Le Fort II (middle type). C. According to Le Fort III (upper type). D. According to Vasmund I. E. According to Vasmund II. (Correct answer: C).

D. Educational tasks of 3th levels (atypical tasks): A patient, 30 years, brought to the maxillofacial department because of an injury. Objective: patient has headache, dizziness, nausea, bleeding from the nose, ears and mouth, elongated face, real symptom of «glasses» on both sides, front teeth are absent, bite and opening of the mouth are not desorder. That can be diagnosed in this patient? (Correct answer: fracture of maxilla at Le Fort III.).

2. Patient applied to ophthalmology department with complainings of double vision, bleeding in the sclera of the eyes, dizziness and nausea. On examination the ophthalmologist determined the bruising in the area of the circular muscles of the eye, the allocation of a colorless liquid from the nose. What additional studies need to assign to a patient. (Correct answer: an X-ray in a survey projection).

3. After car-accident patient was taken to the maxillofacial department, condition moderate hardness. Objective: the face has mongoloid appearance, multiple abrasions on his face, nose is swollen, real symptom of «glasses» on both sides. At the opening of the mouth move upper teeth displase to the lower teeth, at closing the mouth teeth are in occlusion. Mucose membrane in the upper jaw redness with hematomas. What diagnosis can be assumed? (Correct answer: basal skull fracture).