Maxillary Fractures
Maxillary fractures are breaks of the upper jaw and central midface. They are classically organised by the Le Fort levels — horizontal patterns of midface separation described from early cadaveric experiments — although real injuries are often comminuted and do not fall neatly into a single level. Because the midface supports the dental arch, the nasal airway, and the floor of the orbits, these fractures carry occlusal, airway, and ocular implications.
Definition
A maxillary fracture is a disruption of the maxilla and associated central midfacial skeleton, often described using the Le Fort I (low transverse), Le Fort II (pyramidal), and Le Fort III (craniofacial disjunction) patterns, frequently in combination or with comminution.
Scope
This topic covers midface anatomy and buttresses, the Le Fort classification and its limits, associated structures (orbit, nose, palate), and the principles by which midface fractures are assessed. It is a reference and educational entry and does not provide operative or individualized treatment instructions.
Key concepts
- Midface buttress anatomy
- Le Fort I, II, and III patterns
- Craniofacial disjunction
- Associated orbital and nasal injury
- Palatal (sagittal) fractures
- Occlusion and midface height/projection
- Comminution and mixed fracture patterns
Mechanisms
The midface transmits masticatory load through vertical and horizontal bony buttresses; fractures tend to follow these structural lines of weakness, which is the anatomical basis for the Le Fort patterns observed when graded force is applied to cadaver specimens [lefort-1901]. High-energy injury commonly produces mixed or comminuted patterns and concurrent orbital, nasal, or skull-base involvement, so a single Le Fort label often understates the true injury [boffano-2015].
Clinical relevance
Maxillary fractures matter clinically because the midface anchors the upper teeth, frames the nasal airway, and forms part of the orbital floor, so injuries can affect the bite, breathing, vision, and facial projection. This entry describes how midface injuries are categorised and studied; it is not a basis for diagnosing or treating an individual injury.
Epidemiology
Midface fractures are common within facial-trauma series and frequently coexist with mandibular, orbital, and nasal injuries; road-traffic collisions and assaults are recurrent mechanisms, with a male predominance reported across multicentre data [boffano-2015].
Evidence & guidelines
Cross-sectional imaging, particularly computed tomography, is central to characterising the often complex three-dimensional anatomy of midface fractures, and intraoperative cone-beam CT has been studied as a way to confirm reduction [stuck-2012]. Classification and assessment principles are codified in standard reference texts [miloro-2022].
History
In 1901 René Le Fort published experiments in which he applied force to cadaver skulls and described three predominant horizontal lines of midface separation, now known as the Le Fort I, II, and III patterns; this framework continues to organise discussion of maxillary fractures even though modern high-energy injuries are frequently comminuted [lefort-1901] [miloro-2022].
Key figures
- René Le Fort
Related topics
Seminal works
- lefort-1901
- boffano-2015
Frequently asked questions
- What are the Le Fort fracture patterns?
- They are three classic horizontal patterns of midface separation described by René Le Fort: Le Fort I (a low transverse fracture above the teeth), Le Fort II (a pyramidal fracture involving the nasal region), and Le Fort III (craniofacial disjunction). Real fractures are often combinations or comminuted.
- Why can a midface fracture affect the eyes?
- The maxilla and adjacent bones form part of the orbital floor and walls, so higher midface fractures can involve the orbit and have ocular implications in addition to affecting the bite and nasal airway.