Therapeutic approach to atypical Le Fort I fracture

Abstract

Objective: Describe the clinical management of an atypical Le Fort I fracture case. Case presentation: A 33-year-old patient was brought to the Surgical and Maxillofacial Traumatology Service of Humberto Lucena Senatorial Emergency and Trauma Hospital in Joao Pessoa (PB), Brazil, after undergoing physical aggression. The patient was conscious and lucid. Clinical examination revealed sinking of the middle third of the face with edema and bilateral periorbital ecchymosis. Visual acuity and ocular motricity were preserved in both eyes. A cut-contusion injury on the upper lip, maxillary mobility when handled and discrete occlusal dystopia were also observed. Imaging examination identified a high bilateral Le Fort I fracture. The therapeutic approach chosen was fracture reduction and fixation with plates and screws. After a period of two months, the patient is healing well without any apparent functional or aesthetic alteration. Conclusions: Atypical Le Fort I fractures are not frequent; however, a number of etiologies besides the impact force may bring about them. Treatment should be based on the one for classical Le Fort I fractures with adjustments to the surgical access approach.

Keywords

• skull fractures
• fracture fixation
• traumatology.