![]() 2 reported that 88.2% of the studies analyzed indicated a higher incidence of the middle third of the face lesions happened in males, corroborating with this case report, as well as the study by Regmi et al., 13 which described a ratio of males to females of 4:1. The fact that the middle third of the face is our main focus of attention is because alterations involving or acquired in the region are very noticeable, so there is a clear concern in literature about fractures and sequels in this region. The imaging exam showed a line of fracture going through the right maxillo-zygomatic suture, extending to the right infraorbital margin, perpendicular to the right naso-maxillary suture, inter-nasal suture and left naso-maxillary suture, and proceeding towards the left infraorbital margin and ending at the left maxilla-zygomatic suture, compatible with a high Le Fort I fracture ( Fig. ![]() 1, A), visual acuity and ocular motricity preserved in both eyes, a cut-contusion wound on the upper lip and maxillary mobility when handling, limited opening of the mouth compatible with the condition, and discrete occlusal dystopia. The patient was conscious and lucid, with clinical characteristics of sinking of the middle third of his face, edema and bilateral periorbital ecchymosis ( Fig. The aim of this paper is to describe the clinical management performed on a victim of the middle third of the face atypical type Le Fort I fracture in addition to highlight the main characteristics and analyze the classifications for this pattern of fracture.Ī thirty-three year old man was seen at the Surgery and Maxillofacial Traumatology Service of the Senator Humberto Lucena Emergency and Trauma Hospital - Joao Pessoa (PB), Brazil, victim of physical aggression. 1, 8, 13 The key criterion to reduce these fractures is to evaluate the direction from which the trauma was caused, as well as to fix the plates in parallel directions to the chewing forces. Therapeutic approaches are commonly performed with wide exposition of the fracture lines, anatomical reposition and stable fixation of the segments in all planes using titanium plates and screws. The treatment of Le Fort I fractures aims to restore masticatory function and aesthetic appearance. 6, 11, 12 ) Atypical fractures, with different characteristics from the previously mentioned patterns, can be caused due to impact force, mechanism of the trauma, as well as the facial biomechanics. ![]() However, patterns of facial traumas may vary, so that in some cases it may not be possible to perfectly fit them in the classification originally developed by René Le Fort. 5, 8, 10 Different from the Le Fort I fractures, forces applied to a higher level direction result in Le Fort II and Le Fort III fractures. 4, 7 It is usually caused by horizontal excessive force applied over the three sustaining maxillary pillars. Le Fort I fracture, or horizontal fracture, is defined by a line that commences at the pyriform margin, passes above the dental apexes and canine fossae, involves a portion of the zygomatic buttress and then ends in the inferior portion of the pterygoid process. 3, 7, 8, 9 ) He classified the middle third face traumas into three patterns of fractures, through direct observation of the weak lines/points in the craniofacial skeleton: Le Fort I, Le Fort II and Le Fort III. The classification proposed by René Le Fort is the most used among the several different kinds of classifications of maxillary fractures. 1, 2, 5 Therefore, this helps with diagnosis and treatment through the clinical and radiological aspects. The role of the mechanism of the injury in the development of fractures as well as the comprehension of the distribution of forces over the craniofacial skeleton have been in focus in current research. Men aged 20 to 30 are the most frequently affected. These fractures have a high incidence rate and variable etiological factors such as motorcycle and automobile accidents, physical aggression and falls. The middle third of the face fractures are more vulnerable to impact or strength of the attack due to the facial skull anatomical components and to the absorption of external forces.
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