Le Fort II - maxilla, nasal bones and medial aspect of the orbit involved -> freely mobile, pyramidal-shaped portion of the maxilla (pyramidal disjunction).
- fracture line extend from the lower nasal bridge through medial wall of the orbit, crosses the zygomaticomaxillary process.
Le Fort III - craniofacial disjunction -> fracture line runs parallel to the base of the skull which separates the midfacial skeleton from the cranium (involves the ethmoid bone and cribriform plate at the BOS)
- fracture line extends through the upper nasal bridge and most of the orbit across the zygomatic arch.
- mechanical impairment may result from condylar or zygomatic arch # and can prevent jaw opening (even when paralyzed).
- severity can vary
- oedema and ecchymosis -> subconjunctival haemorrhage and loss of vision -> ocular rupture.
- blow out # = when pressure directly applied to eye with fracture of inferior bony structures (enophthalmos, diplopia, impaired eye movement, infraorbital hypoesthesia)
- prime concerns = epistaxis and septal haematoma.