LE FORT FRACTURES and

NOE FRACTURES
Kirstie Ann B. de Luna
FEU-NRMF Junior Intern
Quezon City General Hospital ENT-HNS Rotation

6 Facial Buttresses
Vertical Buttress
Nasomaxillary
Zygomaticomaxillary
Pterygomaxillary
Vertical mandible

Horizontal Buttress
Frontal Bar
Infra-orbital Rim
Alveolar Ridge/Hard Palate

Lefort Fractures

Clinical
Presentation

Anterior drawer sign

Open bite deformity
Epistaxis
Ecchymosis/ hematoma
Flat face (nasal depression
or disfiguration
Subconjuctival Hemorrhage
Malocclusion
Elongation of face (Dishshaped face)
Airway obstruction
CSF leakage
Step deformity at
infraorbital margin
Anesthesia/paresthesia of
cheek

Diagnostics and
Treatment
WATERS VIEW (Occipitomental
View)
CALDWELL VIEW
(Occipitofromtal View)
LATERAL VIEW
CT SCAN

Treatment

Lefort I
- reduce fracture by aligning dentition
Surgical access via bilateral maxillary
gingival buccal sulcus incision
Intermaxillary fixation using skeletal
screws or arch bars
Once reduced and fixed, titanium miniplates
screwed directly to maxilla to create
stability
If minimally displaced, simple
Intermaxillary fixation alone for 4-6 weeks

 Lefort II

Lefort III

- ICU and CT with 3D

Intermaxillary fixation
reconstruction
Bicoronal approach to
Intermaxillary fixation
facilitate repair of
Interosseous wiring orfrontozygomatic and
plating of intraorbital
zygomatic arch
rims, nasofrontal and
Elective tracheotomy may
lateral maxillary walls
be an option
Antibiotics: Penicillin
(due to involvement of
oral or nasal cavity)

Naso-orbital
Ethmoidal (NOE
Fracture)

ORBITAL ANATOMY

Medial Canthal
Tendon

-inserts to lacrimal bone

-pumping action of the lacrima
sac and ducts, allowing for
propagation of tears through t
nasolacrimal system.
-acts as a suspensory sling fo
the globe, maintaining its
support along with the lateral
canthal tendon.
-ensures close apposition of t
eyelid to the globe

Assessment and
Clinical
Presentation

Severe Orbital Swelling

Swelling with Traumatic

Telecanthus (widening of
intercanthal distance)

Disruption of medial canthal

ligaments

CSF Leakge
Depressed nasal root

Types of NOE
fractures
(Markowitz-Manson)

Type I- central Segment

Type II- comminuted but
canthal tendons attached
Type III- comminuted but
canthal tendons free

Treatment
Re-establishment pf midline
vertical height of nasal root
Bicoronal forehead flap
Mid-face degloving incision
Open-sky procedure