Le Fort Fractures

Excerpt

In 1901, René Le Fort, a French military surgeon, performed a series of experiments on 35 cadavers to determine the most common patterns of midfacial skeletal injuries that result from blunt trauma. Despite being an army physician, he eschewed the study of penetrating facial trauma, particularly gunshot wounds, as he termed them "veritable explosions in the face" and deemed them to be "without surgical interest." Apocryphally, he is often reported to have dropped cannonballs onto severed heads to deliver the blunt force necessary for his studies; however, the literature contradicts this colorful story.

A combination of blows with a wooden club and a metal rod, stomping on the face, crushing with a vise, and "hurling" heads at the edge of a table was employed by his aides, after which the skulls were boiled to facilitate removal of the soft tissue for subsequent osseous examination. Despite the lack of consistency in the experimental protocol to force, orientation, and mechanism of injury, Le Fort's work described many patterns in which fractures most commonly occur along the “lines of least resistance” (linea minoris resistentiae) that he identified (see Images. Facial Great Lines of Weakness, Profile View and Facial Great Lines of Weakness, Front View). These patterns are now classified into 3 types based on their orientation: horizontal (type I), pyramidal (type II), and transverse (type III). All of these injuries separate the upper jaw from the skull and, by definition, involve fractures of the pterygoid plates of the sphenoid bone. The severe pattern fractures (pyramidal and transverse) occur more superiorly than the horizontal fracture, separating more of the facial skeleton from the neurocranium. These fractures are typically the result of greater forces applied to the central and upper midface.