A patient involved in a road traffic accident presents with epistaxis, bilateral periorbital haematoma ('raccoon eyes'), and inability to occlude the teeth (malocclusion). CT face shows a horizontal fracture through the pterygoid plates bilaterally. This fracture pattern is classified as:
- A Le Fort I fracture
- B Le Fort III fracture ✓
- C Le Fort II fracture
- D Naso-orbito-ethmoid (NOE) fracture
Correct answer: B. Le Fort III fracture
Explanation
Le Fort III fracture (craniofacial disjunction) involves separation of the entire midface from the cranial base. The fracture line passes through the frontozygomatic suture, zygomatic arch, orbital walls, and pterygoid plates bilaterally. Clinically: 'dish face' deformity, bilateral periorbital ecchymosis, malocclusion, and mobility of the entire midface. Le Fort I is a low horizontal fracture through the maxilla only; Le Fort II is a pyramidal fracture. All Le Fort fractures pass through the pterygoid plates.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.