![]() The opening inside the mouth is then closed using stitches that will slowly dissolve. The upper jaw is then securely fixed to its new position using a combination of plates and screws. Through this opening, the upper jaw will be accessed, separated and repositioned by bringing it forward. ![]() The opening is about 5 inches long and the resulting scar will be completely hidden inside the mouth. An opening is made inside of the mouth close to where the upper lip meets the gums. Once you are asleep, the anesthesiologist will put a small tube inside your nose which will provide oxygen during the surgery. Positioning your teeth in preparation for surgery can take some time however it is a required step that helps make your surgery successful. The orthodontist will straighten and position your teeth in preparation for surgery. This therapy can take several months to perform and it is an important part of your treatment plan. Although plain films such as PA and Water's views can demonstrate sinus bleeding and fracture lines, modern assessment requires imaging with CT scan.The Process of a Le Fort I Procedure Pre-Surgeryīefore surgery, you will likely undergo orthodontic therapy in the form of braces.Midface segment mobility exam: Stabilize forehead with one hand, grasp anterior alveolar arch/upper teeth with the other, and pull forward can be immobile with severe impaction.Intranasal exam for bleeding or cerebral spinal fluid (CSF) rhinorrhoea.Intraoral exam to assess bite for dental occlusion abnormality (often anterior open bite) and intraoral bruising.Soft tissue assessment for Battle's sign (bruising over mastoid).Palpation of orbital rim for step deformities.Soft-tissue examination for lacerations and eyelid malposition.Canthal assessment to evaluate for telecanthus.Globe position with exophthalmometry and vertical position assessment.Facial sensation/infraorbital nerve evaluation.Pupil exam for signs of an afferent pupillary defect, sphincter tear, ruptured globe, or traumatic mydriasis.Extraocular motility exam and the presence of pain or diplopia with movement.Visual acuity for signs of ocular injury such as traumatic optic neuropathy, ruptured globe, retinal edema, or retinal tear.unsurprisingly type III fractures have the highest rate of CSF leakĪ computerized tomography (CT) scan of the facial bones is often required to fully assess the extent of the injury.because of the involvement of the zygomatic arch, there is a risk of the temporalis muscle impingement.transverse fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch / zygomaticofrontal suture.Le Fort type III (floating face (transverse)).uppermost fracture line can pass through the nasofrontal junction or the frontal process of the maxilla. ![]() fracture arch passes through the posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bones.pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex.Le Fort type II (floating maxilla (pyramidal)).fracture line passes through the alveolar ridge, lateral nose and inferior wall of the maxillary sinus.horizontal maxillary fracture, separating the teeth from the upper face. ![]() Le Fort type I (floating palate ( horizontal)).The commonly used classification is as follows: The Le Fort classification system attempts to distinguish according to the plane of injury In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bone dorsally. Fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base.
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