Time to Propose a New Classification for Midface Fractures on Changing Trends - A Fact to Accept

Objective: To determine the prevalence and pattern of mid-facial fractures and the validity of Le Fort rules in the current scenario in patients who presented at a tertiary care institute.

Methodology: This study was carried out in the Department of Plastic and Reconstructive Surgery at Tirunelveli Medical College, India from January 2021 to December 2022. The study included 141 patients who had facial fractures. After confirming that the patient had a mid-facial fracture, they were categorized based on the mid-facial buttress involved. The data was collected and analyzed using SPSS statistical package version 23.

Results: A total of 141 cases were included as a part of this study, of which 129 were males and 12 were females. The most common etiology in this study was a road traffic accident (RTA) (91.47% in males and 91.66% in females), followed by assault in males (5.42%) and accidental fall in females (8.30%). The most common type of facial fracture in this study was a mid-facial fracture(74.46%). In mid-facial fractures, the most common region involved was the Zygomatico-Maxillary Buttress (56.19% in right mid-face and 55.23% in left mid-face). Classical Le Fort fractures accounted only for 7.61% of mid-facial fractures in this study.

Conclusion: This study is likely to point out a need for a different system to classify mid-facial fractures based on buttresses in addition to the traditional Le Fort classification. The classification should take into account

1. Which maxilla is fractured-Right, Left, or Both
2. Fractures of the various buttress
3. severity of the buttresses

Thus our study serves to trigger the need to re-classify mid-facial fractures based on the buttresses involved, gleaned from the changing trends of midfacial fractures.