Executive Editor: Edward Ellis III, Kazuo Shimozato General Editor: Daniel Buchbinder

Authors: Carl-Peter Cornelius, Nils Gellrich, Søren Hillerup, Kenji Kusumoto, Warren Schubert

Midface - Le Fort II

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Glossary

General considerations

This is a very rare isolated fracture pattern. More often it occurs in combination with other midface fractures (Le Fort I and Le Fort III).

Observation
Main indication Skill Equipment
Non- or minimally mobile Le Fort II fractures with unaffected occlusion in compliant patients with good dentition. Basic surgical experience, no specialized skills Basic equipment only

Further Indications:

  • Nondisplaced stable fractures with premorbid occlusion in compliant patients
  • Edentulous patient with minimal fracture displacement
  • General condition of the patient not allowing for surgical intervention
Closed treatment
Main indication Skill Equipment
Non- or minimally displaced fractures in a compliant patient amenable to MMF. Basic surgical experience, no specialized skills Basic equipment only

Fractures with minor malocclusion readily correctable with maxillary manipulation, and not grossly mobile after repositioning may be treated closed. However, closed reduction is more commonly used in conjunction with other stabilization techniques (skeletal suspension, external fixators, etc.).

Further indications

  • Premorbid or unstable medical condition preventing general anesthetic
  • Conditions making open reduction and internal fixation difficult
  • Patient refusal of operative treatment (eg, for religious/cultural or financial reasons)
  • Unavailability of plates and screws

Special consideration: MMF may be contraindicated in patients with psychiatric disorders, seizure disorders, and alcoholics.

Open reduction internal fixation
Main indication Skill Equipment
Displaced Le Fort II fractures resulting in malocclusion or facial deformity. Some specialized surgical experience Simple surgical and imaging resources

Ideally, any displaced Le Fort II fracture should be treated by open reduction and internal fixation.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2009-12-03