American Board of Surgery Qualifying Exam (ABS QE) Practice Test

For a LeFort III fracture, what is the recommended surgical technique?

1. IMF and wires

2. Suspension wiring to stable frontal bones

3. Reduction, stabilization, and halo

4. Immediate reconstruction

The correct answer is: Suspension wiring to stable frontal bones

In the context of a LeFort III fracture, which involves a separation of the facial skeleton from the cranial base, the recommended surgical technique is suspension wiring to the stable frontal bones. This method is essential because it helps to re-establish the alignment and stability of the midfacial skeleton after the fracture. Suspension wiring provides support for the maxillary and zygomatic bones, allowing for effective stabilization during the healing process. By anchoring the structures to the relatively stable frontal bones, it helps in achieving proper anatomy and function, as well as minimizing complications related to malunion or nonunion of the fracture. Other techniques, while they may have specific therapeutic roles, do not address the unique dislocation and instability characteristic of a LeFort III fracture as effectively as suspension wiring does. For example, intermaxillary fixation (IMF) and wires can help stabilize jaw alignment but may not provide the necessary support for the extensive facial structure displacement that occurs in a LeFort III injury. Immediate reconstruction is not typically feasible in the acute setting due to swelling and other surgical considerations, and reduction and stabilization with a halo are more suited for cranial injuries rather than facial fractures. Thus, suspension wiring is the most appropriate choice for addressing the specific challenges