A patient involved in a road traffic accident presents with facial swelling, bilateral periorbital oedema ('raccoon eyes'), and cerebrospinal fluid rhinorrhoea. CT face shows a fracture through the anterior skull base. This injury pattern is most consistent with which Le Fort fracture level?

• A Le Fort I — horizontal fracture through the maxilla above the teeth
• B Le Fort II — pyramidal fracture involving the nasal bones, orbital floor, and zygomaticomaxillary suture
• C Isolated zygomatic arch fracture with no orbital involvement
• D Le Fort III — craniofacial dysjunction with separation of all facial bones from the skull base ✓

Explanation

Le Fort III (craniofacial dysjunction) is the most severe Le Fort fracture — the fracture line passes through the orbits, zygomatic arches, and pterygoid plates, effectively separating the entire facial skeleton from the cranial base. CSF rhinorrhoea occurs because the fracture disrupts the cribriform plate/anterior skull base, creating a communication between the subarachnoid space and the nasal cavity. Bilateral periorbital ecchymosis ('raccoon eyes') results from orbital wall fractures with tracking of blood to the periorbita. Le Fort I involves only the maxillary alveolus; Le Fort II is pyramidal without complete craniofacial separation.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.