Face off

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    Face off

    A 29 y/o M presents to your ED after a head-on MVC at moderate speed.  The patient was driving an older automobile without airbags, and smashed his face hard against the steering wheel.  He has significant facial ecchymoses and swelling, and you note clear fluid continuing to drain from his nose.  What injury will likely be seen on the CT?

    230px-schaedelschraeglefort123

    A Le Fort III fracture, also known as craniofacial dysjunction.  La Fort fractures are common after blunt trauma to the head, especially from auto accidents.  There are three types of La Fort fractures, I (horizontal), II (pyramidal), and III (transverse), labelled as red, blue and green respectively in the diagram above.  All of these fractures mobilize the maxilla due to their involvement of the hard palate.  Type III (and occasionally type II) can extend to the cribiform plate and is therefore associated with CSF rhinorrhea.

    Due to the significant facial trauma, these patients may have airway compromise requiring intubation or possibly cricothyrotomy.  Definitive management is with surgical fixation, and multiple services (Neurosurg, plastics, ENT) may need to be involved in the repair depending on the extent of injury.

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