All Lefort fractures involve the pterygoid processes. The type II Lefort fracture line passes vertically through the maxilla from posterior alveolar margin to the medial orbital rim, over the bridge of the nose and down the other side. The midface is separated from the rest of the skull and is typically depressed (see angled image). The presence of a Lefort fracture implies a large force, and imaging of the brain and cervical spine should also be performed. The airway is at risk, particularly with Lefort III fractures, and intensive airway management is required.

Reference: Dähnert W. Radiology Review Manual 5th edition. Lippincott, Williams & Wilkins 2003

Credit: Dr Laughlin Dawes