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Le Fort II Fracture — MFDS Part 1 MCQ

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HardAnatomy (Head & Neck)Le Fort II FractureMFDS Part 1

Following blunt central midface trauma, examination demonstrates mobility of a pyramidal segment containing the nasal bridge and maxillary dentition, with bilateral infraorbital paraesthesia. The lateral orbital rims and zygomatic arches remain attached to the cranial skeleton, and CT confirms bilateral pterygoid plate fractures. Which fracture trajectory best accounts for these findings?

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Correct answer: E — Nasofrontal junction, medial orbital wall, orbital floor and infraorbital rim, anterior maxilla, then pterygoid plates

Option E describes the classic Le Fort II pyramidal fracture. It begins around the nasofrontal or nasomaxillary region, passes through the medial orbital walls, orbital floors and infraorbital rims, continues through the anterior maxilla, and extends posteriorly to the pterygoid plates. Mobility of the nasal bridge with the maxillary dentition and infraorbital nerve disturbance supports this level. Option B describes a lower, horizontal Le Fort I pattern. Option C extends laterally through the zygomaticofrontal sutures and zygomatic arches, indicating Le Fort III craniofacial disjunction. Option A is a zygomaticomaxillary complex fracture. Option D resembles a naso-orbito-ethmoid injury and, by sparing the pterygoid plates, cannot constitute a Le Fort fracture.

Reference: Ikeda AK, Burke AB. LeFort Fractures. Seminars in Plastic Surgery. 2021;35(4):250–255. https://pubmed.ncbi.nlm.nih.gov/34819806/