Comparison of the severity of bilateral Le Fort injuries in isolated midface trauma

Abstract

Purpose: The Le Fort classification pattern established in 1901 by the French surgeon Rene Le Fort is commonly used in describing midface fractures. This frequently used classification system is based on predictable patterns of midface fractures initially described for blunt trauma. The purpose of this study was to compare the profile and outcome of patients with isolated bilateral Le Fort I, II, and III fractures.

Patients and methods: All patients presenting to the emergency department (ED) at Legacy Emanuel Hospital (Level I trauma center) in Portland, OR, between December 1990 and December 2003 with isolated bilateral Le Fort I, II, or III fractures with or without concomitant nonfacial injuries were identified retrospectively using the Hospital Trauma Registry. Patients were classified into study groups I (n = 22), II (n = 22), or III (n = 23) corresponding to the Le Fort classification, respectively.

Results: Sixty-seven patients had a diagnosis of isolated bilateral Le Fort I, II, or III fracture. The average Injury Severity Score (ISS) and hospital length of stay were 18.8 +/- 8.9 and 9.5 +/- 11.9 days, respectively. Blood alcohol was detected in 19 patients. Sixty-four injuries (95.5%) were secondary to blunt trauma, and the remaining 3 (4.5%), penetrating injuries. More than half of the patients (n = 35, 52.2%) were admitted to the intensive care unit (ICU), 18 patients (26.8%) were transferred to the hospital trauma ward from the ED, and 14 patients (20.9%) were taken directly to the operating room. Fifteen (22.4%) patients required a tracheostomy secondary to their maxillofacial injuries. A statistically significant difference in the ISS was detected between patients with Le Fort I versus those with II or III injuries ( P < .0001). Patients with Le Fort II or III fractures had a significantly higher probability of ICU admission or immediate operative intervention. Ten patients (43.5%) with Le Fort III injuries required tracheostomy versus 3 patients (13.6%) with Le Fort I, and 2 patients (9.1%) with Le Fort II injuries. This was statistically significant. None of the patients with Le Fort I injuries had a negative outcome (death); however, 1 patient with Le Fort II injuries (4.5%) and 2 with Le Fort III injuries (8.7%) had a negative outcome. No statistically significant differences or emerging trends were observed among the 3 groups for age, gender, length of stay, number of operations, and number of associated injuries.

Conclusions: Patients with higher Le Fort injuries are characterized by an overall greater severity of injuries as measured by the ISS and the more frequent need for a surgical airway. Patients with Le Fort III injuries have a higher chance of requiring neurosurgical intervention or of experiencing vision-threatening ocular trauma. Immediate operative intervention and/or ICU care is more frequently indicated in these patients.