A 30-year-old male presents after a road traffic accident with bilateral periorbital ecchymosis ('raccoon eyes'), CSF rhinorrhea, and a step deformity across the nasal bridge. Axial CT shows bilateral medial orbital wall fractures with involvement of the nasoethmoid complex. The Le Fort classification of this fracture pattern is best described as:
- A Le Fort I (low level transverse maxillary fracture)
- B Le Fort II (pyramidal fracture through orbital rims and nasal bridge)
- C Le Fort III (craniofacial dysjunction at the zygomatic arches and orbital walls) ✓
- D Nasoethmoidal orbital (NEO) fracture not classified under Le Fort
Explanation
Le Fort III fracture represents craniofacial dysjunction — the entire midface separates from the cranial base. The fracture line passes through the nasofrontal suture, medial and lateral orbital walls, zygomatic arches, and pterygoid plates. Bilateral periorbital ecchymosis and CSF rhinorrhea indicate involvement at or above the cribriform plate level, consistent with Le Fort III. Le Fort I is a low transverse maxillary fracture (palate separates). Le Fort II (pyramidal) fractures through the nasal bones and infraorbital rims. NEO fractures are distinct but often accompany Le Fort III.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.