Craniofacial Dissociation
Car accidents can cause a wide variety of facial injuries. A Le Fort Fracture Type III is a member of the Le Fort Fracture group that ranges widely in type and severity.
What is a Le Fort Fracture Type III?
A Le Fort Fracture Type III has also been called a “craniofacial dissociation” because of the nature of the injury. It can involve fractures to the following bones:
- The pterygoid plate (involved in ALL Le Fort fractures)
- The nasal bridge
- The maxilla
- The zygomatic arch
- The lateral orbit
- The orbital floor
If more than one of these bones are broken, it can cause the front of the skull to detach from the facial structures, explaining the second name.
What Causes this Fracture?
A Le Fort Fracture III is caused by blunt force trauma to either the upper nasal bridge or the upper cheek area. When a car comes to a sudden stop, the driver or passenger’s head continues to move forward due to momentum. It can impact the steering wheel or dashboard across the upper nasal bridge or cheek area. The associated force and location determine which bones are broken on impact.
What are the Treatment Options?
A Le Fort Fracture III can involve a slight fracture to one of the bones or a series of complicated bone fractures to all of the bones described above. This fracture group almost always requires surgery; however, the associated swelling can make it difficult to operate. The surgeon would prefer to wait for the swelling to dissipate but if the patient is struggling, the surgery can be performed emergently.
Wide Variety of Complications
A Le Fort Fracture III can have multiple complications that can cause problems for the patient.
Eyesight: Damage to the orbital socket can make it difficult for the patient to move one or both eyes. This can create a double vision that makes it challenging for the patient to see.
Airway Compromise: A deviated septum can make it difficult for the patient to breathe. If the deviated septum occludes one pathway while the other is obstructed with blood, this can compromise the patient’s airway.
What Structures are at Risk?
A Le Fort Fracture III will cause serious damage to the nose and orbital socket. This places multiple other structures at risk:
- Infraorbital nerve- Damage to the orbital floor can sever this nerve. The patient will lose sensation along the upper cheek just below the eye.
- Extraocular muscles- Damage to the lateral orbital wall and orbital floor can entrap the muscles that power certain movements of the eye. This could require emergent surgery to fix.
- Nasal septum- A broken nasal bridge can cause the septum to deviate and make it difficult for the patient to breathe. This may require surgery to fix.
What is on the Differential Diagnosis?
The Le Fort Fracture Type III is defined by a specific set of broken bones. Other fractures and facial trauma injuries are also on the differential including:
In this region, intracranial injuries must also be considered:
- Epidural hematoma
- Subdural hematoma
- Cerebral contusion
- Intracranial hemorrhage
Detailed physical exams and imaging scans will determine the extent of the patient’s injuries.
What is the Prognosis of this Injury?
The prognosis of a Le Fort Fracture Type III will depend on the extent and location of the facial fractures. The surgeon can almost always put the bones back together using wires, screws, and plates; however, the functionality of the face will be prioritized over the aesthetics. If there are other associated structures that are damaged, they may require rehab to fix. Nerve damage is considered permanent.
What are the Indications for Surgery?
Any Le Fort Fracture III is going to require surgery to fix because the bones are almost always displaced. Surgery is needed to approximate the bones to facilitate the healing process. Furthermore, surgery will be required to reconstruct the face for aesthetic reasons. It is ideal to wait for the swelling to reduce prior to surgery; however, if the patient’s status is deteriorating surgery will be performed on an emergent basis.
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Facial Fracture Lawyers Sacramento
I’m Ed Smith, a Sacramento Bone Fracture Lawyer. If you or someone close to you has suffered injury in a car accident due to no fault of their own, please give me a call anytime at (916) 921-6400 for free, friendly advice. Or, call toll free at (800) 404-5400.
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