Definition
Maxilla fractures and central midfacial fractures are divided into the Le-Fort-I-Fracture with the fracture lying above the floor of the nose and maxillary sinus and the Le-Fort-II-Fracture with the fracture going through the maxillary sinus and the inferior wall of the orbit with and without inclusion of the bony part of the nose. Le-Fort-III-Fracture refers to the so-called centrolateral fracture, where the whole of the facial skull has been avulsed. Combinations of these fractures as well as multiple fractures are possible.

Therapy Goals
Restoration and conservation of the bone structure
Restoration of the facial form
Restoration of the masticatory, speech and swallowing function
Restoration of the respiration
Restoration of the paranasal sinus function
Restoration of the form and function of the nose
Restoration of the form and function of the orbit
Conservation and restoration of the function of the motoric and sensory nerves
Conservation of the teeth
Pain intervention
Infection prevention

Therapy Indications
Clinical and/ or radiological evidence of a maxilla fracture
Malocclusion
Articulation disturbance
Dysfunction (masticatory, speech and swallowing function, respiration)
Disturbance of the jaw relation (e.g. pseudoprogenia)
Sensory disturbance
Continuity defect
Xenolith
Associated soft tissue injuries
Cerebrospinal liquorrhoea
Periorbital echymosis
Emphysema
Subconjunctival haemorrhage
Ocular dysfunction, motility disturbance (e.g. double images)
Nasofrontal complex disturbance
Bleeding

Examinations
Inspection
Palpation
Vitality test
Aesthesiometry
Functional test of the facial nerve
X-ray in 2 levels
Special x-ray pictures
Computer tomography
Casting and modeling of maxilla and mandible for the control of the original occlusion, if indicated for making splints
Additional ophtalmological and/ or otorhinolaryngologic examinations

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Therapy
Conservative Therapy
A conservative therapy is indicated in uncomplicated fractures that are not dislocated, where fracture stabilization can be reached with conservative techniques and without surgical intervention. Also, in cases with medical and/ or anaesthesiological contraindications to a surgical fracture treatment. The conservative therapy can include:
Surveillance over a period in fractures without dislocation and mobility
Maxilla-mandible-fixation
Decongesting measures
Diet (soft food)

Surgical Therapy
Surgical treatment is always required in cases with dislocated fractures and fragment mobility. It can include the following measures:
Repositioning
Maxilla-mandible-fixation
Osteosynthesis
Suspension (zygomatic arch, craniofacial)

Additional Measures
If indicated, antibiotic therapy
Analgesic therapy
Drainage of contaminated wounds

Recommendation
The majority of central midfacial fractures require in hospital treatment. Outpatient treatments are indicated only in exceptional cases. For injuries that reach into other fields of specialization the respective specialists need to be involved in the treatment planning and the treatment.

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