Midfacial Fractures: A Scoring Method and Validation on 117 Patients

The midfacial region (MR) is located in the middle-third of the face, composed of several bones and surrounded by complex anatomical structures so that MR fractures (MRFs) often involve other parts of the face. A staging system for classifying MRFs is of paramount importance in order to exchange information among trauma centers. Le Fort described three lines of fractures but still there is no scoring method to stage MRFs. In this article, a classification for MRFs is proposed. It is based on Le Fort's three lines and it defines seven facial units. MRFs can be staged as follows: F in situ = a fracture line without fragment mobility (i.e. greensticked); F1 = a fracture involving one MR unit (MRU); F2 = a fracture involving two MRUs; F3 = a fracture involving three MRUs; F4 = a fracture involving four or more MRUs or neighboring anatomical regions (i.e. mandible, orbit and skull). To evaluate the suitability of the proposed classification a retrospective study on a series of 117 MRFs was performed. Age, gender, new stage, clinical diagnosis at admission, type of surgery, and outcome were considered. A good correlation between the proposed classification and the studied variables was detected. In conclusion, the proposed classification is a simple and precise method of staging MRFs. It can summarize MRFs and be used in daily practice. It is our understanding, however, that a multi-centers study should be performed before the effectiveness of the proposed classification can be clearly stated.