ORIF targets piriform rim and zygomaticomaxillary buttress
Restores vertical height and projects occlusal plane correctly
Horizontal buttresses contribute to facial width and projection
Titanium miniplates provide rigid fixation for buttress reconstruction
Antibiotic evidence
Open fractures communicating with oral cavity or sinuses benefit from perioperative antibiotics
No high-quality RCT data for prolonged antibiotic courses
Perioperative coverage for oral flora sufficient for uncomplicated repair
Complications and long-term outcomes
Malocclusion: most common late complication if repair delayed or suboptimal
Infraorbital hypoesthesia: 10-16%, may take months to resolve
Oroantral fistula: communication between oral cavity and maxillary sinus
Hardware infection: rare; titanium plates have low infection rate
Devitalized teeth: especially with alveolar involvement
Nonunion/malunion: risk increases with delayed repair
Patient Discharge Instructions
copy discharge instructions
Discharge instructions for Le Fort I Fracture
You have been diagnosed with a Le Fort I fracture: a break in the upper jaw (maxilla) caused by significant facial trauma
Your fracture was/will be treated with surgery to realign the bones and restore your bite
Jaw wiring and diet
Your jaw may be wired or banded shut with arch bars or MMF screws
Carry wire cutters with you at all times if jaw is wired
Cut wires immediately if you vomit or cannot breathe, then call 911
Strict liquid diet for 4-6 weeks: soups, protein shakes, smoothies, juices
No solid food until cleared by your surgeon
No straws if told to avoid suction
Drink plenty of fluids to avoid dehydration
Wound and oral hygiene
Rinse mouth gently with chlorhexidine 0.12% rinse twice daily
Warm salt water rinses after every meal (1/2 tsp salt in 240 mL warm water)
No vigorous rinsing or spitting for 48 hours after surgery
Keep incision sites clean and dry as directed
Activity restrictions
No contact sports or strenuous activity for 6-8 weeks
No blowing nose forcefully (risk of air entering sinus)
Sleep with head elevated on 2-3 pillows to reduce swelling
No driving while taking opioid pain medications
Medications
Take prescribed pain medications as directed
Complete any prescribed antibiotic course
Antiemetic medication prescribed: take if nauseated
Do not take aspirin or ibuprofen unless specifically approved by your surgeon
Return to Emergency Department immediately for
Difficulty breathing, choking, or airway distress
Uncontrolled bleeding from nose or mouth
Vomiting with jaws wired shut — cut wires and call 911
Worsening facial swelling or severe increasing pain
Fever above 38.5 C (101.3 F)
New numbness, tingling, or visual changes
Change in bite or jaw alignment after surgery
Pus or foul odor from wound or mouth
Follow-up appointments
Oral and maxillofacial surgery or plastic surgery: 1 week post-discharge
Follow-up schedule: 2 weeks, 4 weeks, 6 weeks, then 3 and 6 months
Full bony healing expected by 6-8 weeks
Numbness in upper lip or cheek may take several months to resolve
References
Guidelines and key sources
ACR Appropriateness Criteria for facial trauma imaging
Expert Panel on Neurological Imaging, Parsons MS et al. ACR Appropriateness Criteria Imaging of Facial Trauma Following Primary Survey. J Am Coll Radiol. 2022
CT face rated "usually appropriate" for suspected midface fracture
Available at: https://doi.org/10.1016/j.jacr.2022.02.013
CT diagnosis of Le Fort fractures
Hopper RA, Salemy S, Sze RW. Diagnosis of Midface Fractures With CT: What the Surgeon Needs to Know. Radiographics. 2006. PMID: 16702454
Rhea JT, Novelline RA. How to Simplify the CT Diagnosis of Le Fort Fractures. AJR. 2005. PMID: 15855142
Epidemiology and outcomes
Lee KC, Chuang SK, Eisig SB. The Characteristics and Cost of Le Fort Fractures: A Review of 519 Cases. J Oral Maxillofac Surg. 2019. PMID: 30853420
Bagheri SC et al. Comparison of Severity of Bilateral Le Fort Injuries in Isolated Midface Trauma. J Oral Maxillofac Surg. 2005. PMID: 16094579
Khandelwal G et al. Are Le Fort Fracture Lines Relevant in Modern Trauma? Eur J Trauma Emerg Surg. 2026. PMID: 41697362
Surgical management and outcomes
Manson PN et al. Midface Fractures: Advantages of Immediate Extended Open Reduction and Bone Grafting. Plast Reconstr Surg. 1985. PMID: 3892561
Gruss JS, Mackinnon SE. Complex Maxillary Fractures: Role of Buttress Reconstruction. Plast Reconstr Surg. 1986. PMID: 3523557
Wood Matabele KL et al. Risk Factors for Acute Postoperative Complications Following Operative Management of Le Fort Fractures: a NSQIP Study. J Craniofac Surg. 2023. PMID: 36991535
Pediatric maxillary fractures
Moffitt JK et al. The Epidemiology and Management of Pediatric Maxillary Fractures. J Craniofac Surg. 2021. PMID: 32941219
Physical examination accuracy
Rozema R et al. Diagnostic Accuracy of Physical Examination Findings for Midfacial and Mandibular Fractures. Injury. 2021. PMID: 34103150
Complications of midfacial fractures
Kloss FR et al. Complications Related to Midfacial Fractures: Operative Versus Non-Surgical Treatment. Int J Oral Maxillofac Surg. 2011. PMID: 20870393
Cohn JE et al. An Update on Maxillary Fractures: A Heterogenous Group. J Craniofac Surg. 2020. PMID: 32890151
Pterygoid plate fractures
Garg RK et al. Pterygoid Plate Fractures: Not Limited to Le Fort Fractures. J Craniofac Surg. 2015. PMID: 26147022
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.