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Age: 75

Sex: Male

Indication: Fall

Save ("V")

Case #13


Findings

  • Bilateral acute Le Fort type I fractures with fractures of the pterygoid plates, nasal septum, and anterior, posterior, and medial walls of both maxillary sinuses.
  • Additional right Le Fort type II fracture with a nasal arch fracture extending into the nasofrontal suture and medial and inferior orbital wall fractures. The medial orbital wall fracture involves the nasolacrimal canal and the orbital floor fracture extends into the infraorbital foramen. No evidence of extraocular muscle entrapment
  • Acute bilateral nasal bone fractures with overriding fracture fragments
  • Mild anteromedial and anteroinferior right retrobulbar, extraconal stranding without proptosis
  • Right greater than left maxillary and right ethmoid hemosinus
  • Extensive right greater than left facial swelling with subcutaneous emphysema. Partially imaged frontal scalp hematoma/laceration


Diagnosis

  • Bilateral Le Fort I, right Le Fort II fractures

Sample Report

Bilateral acute Le Fort type I  and right Le Fort type II fractures. On the right, the medial orbital wall fracture involves the nasolacrimal canal and the orbital floor fracture extends into the infraorbital foramen. No evidence of extraocular muscle entrapment.

Acute bilateral nasal bone fractures with overriding fracture fragments.

Mild anteromedial and anteroinferior right retrobulbar, extraconal stranding without proptosis. Globes are intact.

Right greater than left maxillary and right ethmoid hemosinus.

Extensive right greater than left facial swelling with subcutaneous emphysema. Partially imaged frontal scalp hematoma/laceration.


Discussion

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Images

Red arrows: horizontal fracture through the maxilla bilateral, consistent with Le Fort type I fractures. Yellow arrow: fracture involving the right medial orbital wall extending to the nasal arch and nasofrontal suture, consistent with additional right Le Fort type II fracture. LeFort Fracture Classification Complex facial fracture classification, including Le Fort I, II, and III. Full size image at: bit.ly/leforts Abrupt angulation of the nasal septum anteriorly (red arrow) concerning for acute fracture. Mild extraconal fat stranding in the anteromedial and anteroinferior right orbit (red arrows).



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