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 I, edentulous patients - ORIF

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1 Principles top

Le Fort I enlarge

Edentulous Le Fort I fractures are rare. If they occur, the fracture is usually linear.

It is not possible to establish a definite occlusal relationship.

These fractures are usually treated by using bone plates after osseous reduction.

More information regarding choice of implants can be found here.

Teaching video

AO Teaching video on fixation of a complex midface fracture

2 Approach top

Principles enlarge

For this procedure, standard approaches to the maxilla are used. However, if present, lacerations can be used to directly access fracture site for fracture managment.

3 Reduction top

Fracture reduction

In case of a displaced maxillary complex, the fracture must be reduced first. This can be done manually or by use of reduction forceps.

Le Fort I enlarge

Reduction instruments

Rowe disimpaction forceps

The Rowe disimpaction forces are side specific. They allow the application of great amounts of force to disimpact and reposition the maxilla and midface.

Note: Special attention has to be given to the patient individual fracture pattern so that the use of these instruments does not result in significant shearing at the skull base or orbit. Otherwise, severe complications such as blindness can occur.

Le Fort I enlarge

Special attention has to be paid regarding the correct placement of the Rowe disimpaction forceps so that the upper anterior dentition is not harmed.

The maxillary fracture is completely mobilized and an attempt should be made to make the fragment as passive as possible. This may require an up-down and side-to-side movement of the forceps.

Le Fort I enlarge

Bone hooks

According to regional preferences and various schools of teaching, different bone hooks are used for fracture reduction.

  • Reduction hook (Stromeyer hook)

The Stromeyer hook (Georg Friederich Louis Stromeyer, Hannover, Germany, 1804-1876) is very versatile for transoral reduction of Le Fort fractures.

In selected cases the Stromeyer hook can also be used for manipulating the Le Fort complex by hooking the tip of the instrument inside the piriform aperture and pulling downwards and anteriorly. This technique is called downfracture procedure in Le Fort osteotomies.

Confirm proper reduction

Confirm proper reduction by assessing bone alignment at the piriform aperture (nasomaxillary buttress) and the zygomaticomaxillary buttress.

4 Fixation top

Le Fort I enlarge


A minimum of two plates are necessary. Four L-plates are shown in the illustration.

Posttraumatic care

Hardware removal may be required in the future to facilitate the wearing of a denture or placement of dental implants.

v1.0 2009-12-03