- Basal skull fractures: when a skull fracture involves one/more of the following bones: Temporal (the most common bone involved), occipital, sphenoid or ethmoid.
C/F of basal skull fracture–
Symptoms: CSF rhinorrhea, anosmia, bleeding from nose &/or ears, haematympanum, deafness, facial nerve palsy;
Signs: Battle’s sign (Mastoid ecchymosis– bruising over the mastoid process), Racoon eyes/Panda eyes (Periorbital ecchymosis– bruising of the periorbital region).
- Le Forte Fractures: three types- Le Forte I, II & III.
Pure Le Forte Fractures are rare, they are usually associated with other midface fractures. If a fracture is unilateral only then it is “hemi” Le Forte (not described by Rene Le Fort).
Le Forte I– Horizontal maxillary fracture, the fracture line extends from the piriform aperture(anterior nasal aperture) through the lateral maxillary & lateral nasal walls crossing the zygomatico-maxillay junction to the posterior region & often includes a segment of pterygoid plates. It may be Simple(linear) or Complex(comminuted).
Le Forte II– Pyramidal maxillary fracture, it extends from the pterygoid region on one side, underneath the zygomaticomaxillary buttress up over the medial portion of the infraorbital rim, behind the lacrimal bone & along the medial wall of the orbit towards the dorsum of the nose where it crosses & continues to the opposite side in the same pattern. It also involves zygoma & pterygoid plates.
Le Forte III– Craniofacial dysjunction, the entire mass of facial bones is separated from the cranial base. The fracture line starts at the frontozygomatic suture along the lateral aspect of the internal orbit along the sphenozygomatic suture line to the inferior orbital fissure, extends medially across the floor of the orbit up the medial wall of the orbit towards the dorsum of the nose where it crosses & continues to the opposite side in the same pattern.
In other words, the fracture extends from the nasofrontal suture continuing posteriorly through medial wall of the orbit to infferior orbital floor, then to lateral orbital wall through zygomatico-frontal junction & zygomatic arch.