Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 71-72
Influence of skull base or frontal bone fracture on the result of treatment for Le Fort type maxillofacial fractures: Outcomes of Le Fort IV fractures


Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Ohmura City, Nagasaki, Japan

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Date of Submission16-Oct-2018
Date of Acceptance24-Oct-2018
Date of Web Publication22-Apr-2019
 

How to cite this article:
Fujioka M. Influence of skull base or frontal bone fracture on the result of treatment for Le Fort type maxillofacial fractures: Outcomes of Le Fort IV fractures. J Emerg Trauma Shock 2019;12:71-2

How to cite this URL:
Fujioka M. Influence of skull base or frontal bone fracture on the result of treatment for Le Fort type maxillofacial fractures: Outcomes of Le Fort IV fractures. J Emerg Trauma Shock [serial online] 2019 [cited 2019 Aug 23];12:71-2. Available from: http://www.onlinejets.org/text.asp?2019/12/1/71/256619




Dear Editor,

Le Fort fractures often extend to the skull base and/or frontal bone, which sometimes results in cerebral spinal fluid (CSF) leakage.[1] These more severe fractures were so-called “Le Fort IV fracture.”[2],[3] The purpose of this study was to investigate the clinical features of Le Fort IV fractures.

A retrospective review of 19 patients with Le Fort type fractures who were treated in our Medical Center from 2008 to 2017 was conducted. Nine patients were defined as Le Fort IV fracture (Le Fort IV group), and one with Le Fort III, three with Le Fort II, and six with Le Fort I (Le Fort I–III group). Seven of the 9 Le Fort IV patients developed CSF leakage [Table 1].
Table 1: Cases of Le Fort type fracture

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We investigated several clinical results in both groups.

  1. Associated injury: the most frequent associated injury was another head and neck fractures, followed by extremity fractures, thoracic injuries, and abdominal injuries, which showed a similar tendency in both groups [Figure 1]
  2. Presurgical waiting days and hospitalization periods: the mean period to reduction surgery from injury in patients with Le Fort IV group was 12 ± 4.7 days, and it was 6.0 ± 3.1 days in those with Le Fort I–III. The mean period of hospitalization in patients with Le Fort IV group was 37 ± 11.0 days, and it was 29 ± 10.0 in those with Le Fort I–III. Patients with Le Fort IV fracture required a significantly longer preoperative (P = 0.02) and hospitalization (P < 0.05) period (Wilcoxon signed-rank test). The mean time to discharge from reduction surgery in patients with Le Fort IV fracture was 25 ± 11.0 days, and it was 25 ± 11.5 in those with Le Fort I–III, which showed no significant differences between the two groups (P = 0.35, Wilcoxon signed-rank test)
  3. Prognosis and aftereffects: all patients in the Le Fort IV group survived, however, two in the Le Fort I–III group died. There was no statistically significant difference in mortality between these groups (P > 0.10, Chi-square test).
Figure 1: Differences in associated injuries in Le-Fort IV and I–III fracture groups

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In our patients, 7 of 13 with Le Fort II or III fracture developed cranial base fracture, suggesting that the frequency of Le Fort IV fracture is high contrary to our expectations. The skull base fractures are of marked interest for physicians because it usually results in leakage of CSF and meningitis.[4] Once CSF is confirmed, nonsurgical therapy is instigated in most patients, however, if CSF leakage continues for >1 week, lumbar drainage and/or surgical repair are required.[3],[5]

Our study showed that there was no statistically significant difference in the frequency of mortality or aftereffects between Le Fort IV and Le Fort I–III groups. Only the presurgical waiting and hospitalization periods were longer in the Le Fort IV group because it takes about 1 week to control the CSF leakage. Thus, once successful treatment of liquorrhea is achieved, Le Fort IV fracture can be treated like any other surgical reduction of Le Fort I–III fractures.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Winegar BA, Murillo H, Tantiwongkosi B. Spectrum of critical imaging findings in complex facial skeletal trauma. Radiographics 2013;33:3-19.  Back to cited text no. 1
    
2.
Gupta KC, editor. Classification: Middle third facial skelton. In: When, Why and Where in Oral and Maxillofacial Surgery. New Delhi: Jaypee Brothers Publishers; 2012. p. 185-9.  Back to cited text no. 2
    
3.
Pradip KG, editor. Maxillofacial trauma and management. In: Synopsis of Oral and Maxillofacial Surgery: An Update Overview. New Delhi: Jaypee Brothers Medical Publishers; 2012. p. 164-81.  Back to cited text no. 3
    
4.
Ratilal BO, Costa J, Pappamikail L, Sampaio C. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev 2015;(4):CD004884.  Back to cited text no. 4
    
5.
Hertelendy AJ, Brewer JM, Hancock KC, Sherry SP. Neurologic emargencies; traumatic brain injury. In: Mark WW, editor. American Academy of Orthopaedic Surgeons, American College of Emergency Physicians. Mississauga: Jones and Bartlett Publishers; 2009. p. 395-405.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Masaki Fujioka
Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Ohmura City, Nagasaki
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_105_18

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