The Le Fort III advancement osteotomy in the child under 7 years of age

This is a longitudinal study of 12 patients with craniofacial synostosis syndromes (Crouzon's, Apert's, Pfeiffer's) who underwent Le Fort III advancement under the age of 7 years (average age 5.1 years, range 4.0 to 6.7 years). The average follow-up was 5.0 years and included clinical, dental, and cephalometric examinations according to a prescribed protocol. The study demonstrated that the procedure could be safely performed in the younger child with an acceptable level of morbidity. There was a remarkable degree of postoperative stability of the maxillary segment. However, although vertical (inferior) growth or movement of the midfacial segment was demonstrated, there was minimal, if any, anterior or horizontal growth. Any occlusal disharmony developing during the period of follow-up could be attributed to anticipated mandibular development and could be corrected by orthognathic surgery. The roles of surgical overcorrection and anterior-pull headgear therapy after release of intermaxillary fixation are also discussed. The Le Fort III osteotomy is justifiably indicated during early childhood for psychological and physiologic reasons.     

A novel insertion in the FGFR2 gene in a patient with Crouzon phenotype and sacrococcygeal tail

BACKGROUND: Mutations in the FGFR2 gene are present in several syndromes with craniosynostosis, such as Pfeiffer's, Apert's, and Crouzon's. CASE: We report a case of craniosynostosis (Crouzon phenotype) with tracheal anomalies and a sacrococcygeal tail. In addition, the patient shows dolichoplagiocephaly, prominent occiput, proptosis, mild facial asymmetry, strabismus, small umbilical hernia, and syndactyly of the second and third toes. CONCLUSIONS: Molecular analysis of the FGFR2 gene in this patient revealed a 12-bp insertion (GAGGAGACCTAG) at nucleotide 824. This is an in-frame mutation that adds four amino acid residues to the immunoglobulin IIIa (IgIIIa) domain of the putative protein. This is the first report of an in-frame insertion in exon 8 of FGFR2 in a child with Crouzon's syndrome, tracheal anomalies, and a tail.     

Le Fort I型截骨术定位平面的应用解剖学研究

目的：研究Le Fort I型截骨术与上颌牙根尖的关系,为临床合理制订截骨平面提供解剖学依据。方法：选择上颌牙槽清晰或出土后仍有牙保留的颅骨,在颅骨梨状孔下缘至上颌结节作一连线作为模拟Le Fort I型术式截骨水平,以上颌牙槽缘为标志,用游标卡尺测量每侧上颌各牙的牙槽缘至上述模拟截骨水平的距离及牙槽缘至各牙根尖端的长度,然后计算出上颌各牙根尖至Le Fort I型术式截骨线的距离。结果：上颌各牙相对的牙槽缘至Le FortI型术式截骨线的距离,从中切牙至第二磨牙逐渐缩小,右侧中切牙为21．09±1．53mm,左侧中切牙为20．96±1．64mm,右侧第二磨牙为14．94±1．52mm,左侧第二磨牙为14．95±1．59mm;上颌各牙根尖至Le Fort I型术式截骨水平的距离,从中切牙至第二磨牙也逐渐缩小,而两侧尖牙牙根尖距离Le Fort I型术式截骨线的距离右侧为4．49±1．74mm,左侧为4．69±2．14mm,第二磨牙牙根尖距离Le Fort I型术式截骨线的距离右侧为4．65±1．63mm,左侧为4．49±1．89,两侧尖牙牙根尖和第二磨牙牙根尖至Le Fort I型术式截骨水平的距离均比较接近。结论：上颌各牙根尖至LeFortI型术式截骨线的距离均在4mm以上,根据前牙中尖牙牙根尖的位置和后牙中第二磨牙牙根尖的位置,Le Fort I型术式截骨线水平在13、23（3｜3）根尖及27、27（7｜7）根尖上方4mm以上,按此平面作截骨水平较为安全,不易损伤牙根。     

Tooth eruption in Reeves' muntjac (Muntiacus reevesi) and its use as a method of age estimation (Mammalia: Cervidae)

The sequence of tooth eruption and replacement in Reeves' muntjac was determined from captive animals of known age. Pronounced sexual dimorphism is shown by the permanent upper canine which in the male is large, tusk-like and is used as a weapon. The upper canine was the first deciduous tooth to be replaced in males, at approximately 21 weeks of age, compared with 53–57 weeks in the female. The permanent mandibular teeth erupted in the order: molars, first and second incisors, premolars, third incisor and canine. The maxillary teeth erupted in the order: first molar, canine (in male), second and third molars, canine (in female), premolars. The full complement of 34 functional permanent teeth was attained by 83–92 weeks of age.     

An analysis of 12 years of craniomaxillofacial surgery in Toronto

Over 12 years, 1092 patients underwent 2019 craniomaxillofacial procedures in Toronto. Overall mortality was 0.64 percent, and that directly related to surgery was 0.18 percent. Major complications developed in 14.3 percent of patients, but not all had permanent sequelae. Infection was the greatest problem, occurring in 5.3 percent of the major operations. The annual incidence of complications dropped to 5.4 percent as our experience increased. Certain types of deformity, particularly those in patients with orbital hypertelorism, Treacher-Collins syndrome, or Crouzon's or Apert's syndrome, require more than one operation to achieve maximum correction. Our procedures have undergone many changes, the main one being a reduced operating time.     

The Le Fort III osteotomy: to distract or not to distract?

Treatment of the craniofacial dysostoses (e.g., Crouzon, Apert, Pfeiffer, Saethre-Chotzen syndromes) is critically dependent on the successful advancement of the midface with a Le Fort III procedure. The purpose of this retrospective clinical outcome study was to evaluate a new technique for distracting the Le Fort III procedure and to compare its results in growing children with those of the standard Le Fort III osteotomy. The records of 22 children were reviewed; 10 patients (mean age, 6.5 years) underwent a standard Le Fort III procedure, and 12 patients (mean age, 7.5 years) underwent a Le Fort III distraction procedure. The distraction group included two separate techniques, bilateral buried distraction (n = 2) and halo distraction (n = 10). Preoperative and 2- to 3-month postoperative cephalograms were analyzed. The average horizontal advancement achieved in the standard Le Fort III group was 6 mm, compared with 19 mm of advancement in the distraction group (p 相似文献   

Masculinization of the eruption pattern of permanent mandibular canines in opposite sex twin girls

The aim of this study is to explore the effect of prenatal androgenization on the clinical eruption of permanent teeth expressing dimorphism and bimaturism. The eruption curves of permanent teeth (except third molars), including those that make up the canine complex (permanent canines, lower first premolars), are compared among opposite sex twins (OS twins) relative to single‐born boys and girls. The comparisons are made with regard to three phases of eruption (pierced mucosa, half‐ erupted, and completely erupted) from a cross‐sectional sample of dental casts, using Kaplan–Meier survival and Cox regression analyzes. The casts were collected from 2159 school children from the US Collaborative Perinatal Project, including 39 pairs of OS‐twins, of which 12 pairs (30.8%) were Euro‐Americans and 27 pairs (69.2%) were of African‐American ancestry. The eruption patterns of the incisors, upper first molars, and lower canines were found to be significantly masculinized (delayed) among OS twin girls. The differences in most other teeth were either not significant, or the number of observations of active eruption phases were too few, such as in the upper first molars and incisors, to yield strong evidence and meaningful results. The masculinization of the tooth eruption pattern in OS twin girls is intriguing because of the lower canine responses during puberty, as well as canine primordial formation during early fetal androgenization of their co‐twin during the 8th to 14th gestational weeks. The present results offer a challenge for future research exploring tooth eruption mechanisms, and may also highlight some cases of delayed or ectopic canines, which are biased toward females. Am J Phys Anthropol 151:566–572, 2013. © 2013 Wiley Periodicals, Inc.     

Blindness as a complication of Le Fort I osteotomy for maxillary distraction

High Le Fort I osteotomy and maxillary distraction has become an accepted method for the treatment of maxillary retrusion in children and teenagers with cleft lip and palate or craniofacial anomalies. This procedure effectively corrects the dentofacial deformity in these patients. No major surgical morbidity has been reported. During the past 4 years, 94 cleft patients with maxillary hypoplasia received Le Fort I osteotomy and distraction osteogenesis at the authors' center. Two of them developed blindness after this operation. The first case was a girl with bilateral cleft lip and palate with median facial dysplasia. She received high Le Fort I osteotomy at age 12 years 4 months to correct maxillary retrusion. Right eye swelling and ecchymosis was found after surgery. The patient complained of vision loss in that eye 2 days later. Computed tomography showed subarachnoid hemorrhage and skull base hematoma. There were no atypical fractures in the orbit, pterygoid plates, sphenoid bone, and skull base. Angiogram revealed left ophthalmic and basilar artery aneurysm. The second case was a 12-year-old boy with left cleft lip and palate. He received Le Fort I osteotomy to correct maxillary retrusion. During surgery, abnormal pupil dilatation was found after the osteotomy and down-fracture of maxilla. Emergent computed tomography found no hemorrhage or atypical fractures. Examination revealed complete left optic neuropathy and partial right abducens nerve palsy with mydriasis. Magnetic resonance imaging, magnetic resonance angiography, and repeated computed tomography revealed no sign of orbital injury, vascular problem, or abnormal fractures. The cause of blindness was unknown. In both cases, a steroid was used. Maxillary distraction was continued. Recovery of meaningful visual sense did not occur after 3 and 2 years' follow-up, respectively. A review of the literature revealed five other patients who suffered from visual loss after Le Fort I osteotomy. Inadvertent skull base fractures were identified in two cases, but a cause for the blindness was not known in the others. Induced hypotension and indirect trauma may be responsible for the optic nerve injury. In none of the cases was meaningful visual sense recovered, although high-dose steroids were given. In conclusion, a total of seven cases developed blindness after Le Fort I osteotomy. Once blindness develops, the prognosis is poor. High Le Fort I osteotomy should be performed with extreme care, and perhaps the informed consent should include visual loss as a complication of the procedure.     

Dental fast track: Prenatal enamel growth,incisor eruption,and weaning in human infants

Correlation between the timing of permanent first molar eruption and weaning age in extant primates has provided a way to infer a life history event in fossil species, but recent debate has questioned whether the same link is present in human infants. Deciduous incisors erupt at an age when breast milk can be supplemented with additional foods (mixed feeding), and weaning is typically complete before permanent first molars erupt. Here, I use histological methods to calculate the prenatal rate by which enamel increases in thickness and height on human deciduous incisors, canines, and molars (n = 125). Growth trajectories for each tooth type are related to the trimesters and assessed against the eruption sequence and final crown height. Analyses show that central incisors initiate early in the second trimester with significantly faster secretion rates relative to canines and second molars, which initiate closer to birth. Even though initial extension rates were correlated with crown height and scaled with positive allometry within each tooth class, the relatively short incisors still increased in height at a significantly faster rate than the taller canines and molars. The incisor prenatal “fast track” produces a greater proportion of the crown before birth than all other tooth types. This growth mechanism likely facilitates early incisor eruption at a time when the mixed feeding of infants can be initiated as part of the weaning process. Findings provide a basis from which to explore new links between developmental trends along the tooth row and mixed feeding age in other primates. Am J Phys Anthropol 156:407–421, 2015. © 2014 Wiley Periodicals, Inc.     

Dual midfacial distraction osteogenesis: Le Fort III minus I and Le Fort I for syndromic craniosynostosis

Midfacial hypoplasia has been corrected by Le Fort III or monobloc forward advancement in one stage in syndromic craniosynostosis, but recently developed distraction osteogenesis has been in use. Whereas the amount of forward mobilization in Le Fort III conventional osteotomy is determined by the preplanned fabricated interdental splint, that in Le Fort III distraction is determined by the positions of the inferior orbital rim, malar complex, and nose. Therefore, the forward mobilization of the upper part of the midface may sometimes be insufficient when one focuses on the final occlusion, and the occlusion might not be satisfied when the forward mobilization is sufficient. Correction of the midfacial hypoplasia should be considered differently in the upper and lower portions of the midface. The upper portion contains the inferior orbit and nose, and the lower portion contains the occlusal structure of the maxillary dentoalveolar portion with the mandible. Separating the midface into two portions and conducting the distraction osteogenesis in both portions separately in different amounts and vectors of distraction is described in this article. Although distraction of the upper portion of the midface can be conducted in one direction with an internal device, distraction of the lower portion of the midface is preferred for conduction by a controllable device because of the need to obtain the preferred occlusion. To obtain better functional and aesthetic results in midfacial distraction in adults and adolescents with syndromic craniosynostosis, dual Le Fort III minus I and Le Fort I midfacial distraction osteogenesis was performed in four cases (in two patients with Crouzon syndrome and in two patients with Apert syndrome). Two females and two males are described (age range, 13 to 26 years). An internal device was used for the upper portion of the midface and an external device was used for the lower portion. The amount of distraction ranged from 14 to 21 mm in the upper portion of the midface and from 11 to 18 mm in the lower portion. No particular complications were noticed over a follow-up period of 10 to 38 months (average follow-up, 19.8 months).     

Association of relatively delayed emergence of mandibular molars with molar reduction and molar position

Among 234 children examined annually from age three to 20 years at the Burlington Growth Centre, there was statistically significant cooccurrence of early and late emergence sequences of the permanent first and second molars relative to the central incisors and second premolars in the same jaw and in both jaws. Alternatively, mandibular molar delay was not accompanied by corresponding maxillary molar delay, and the mandibular molars emerged later than the maxillary molars. This was strongly associated with Angle Class II malocclusion, indicating a relationship between relative time of emergence and relative position of opposing molars. Delay of the mandibular molar relative to the successional teeth or maxillary molars was associated with increased frequency of four cusped first and second molars and agenesis of third molars, indicating a tendency for co-occurrence of delay in timing of molar emergence with reduction in structure of the molars. These relationships were evident even though emergences were affected by early loss of a deciduous second molar which increased M1I1 and M2P2 sequences by earlier emergence of M1 and delayed emergence of P2.     

Platyrrhine dental eruption sequences

To determine dental eruption sequences of extant platyrrhines, 367 mandibles and maxillae of informative juvenile specimens from all 16 genera were scored for presence of permanent teeth including three intermediate eruption stages following Harvati (Am J Phys Anthropol 112 (2000) 69-85). The timing of molar eruption relative to that of the anterior dentition is variable in platyrrhines. Aotus is precocious, with all molars erupting in succession before replacement of any deciduous teeth, while Cebus is delayed in M2-3 eruption relative to I1-2. Callitrichines have a distinct tendency toward delayed canine and premolar development. Platyrrhine eruption sequences presented here show some evidence of conformity to Schultz's Rule, with relatively early replacement of deciduous dentition in "slower"-growing animals. The relationship of dental eruption sequences to degree of folivory, body mass, brain mass, and dietary quality is also examined. The early eruption of molars relative to anterior teeth in Pithecia, Chiropotes, and Cacajao, in comparison to genera such as Ateles, Lagothrix, and Alouatta, showing relatively later eruption of the molars, appears to be consistent with current phylogenetic hypotheses. Schultz (Am J Phys Anthropol 19 (1935) 489-581) postulated early relative molar eruption as the primitive dental eruption schedule for primates. The extremely early molar eruption of Aotus versus Callicebus (where both incisors erupt before M2 and M3, with M3 usually last) may lend support to the status of Aotus as a basal taxon. The early relative molar eruption of the fossil platyrrhine species Branisella boliviana is also consistent with this hypothesis (Takai et al.: Am J Phys Anthropol 111 (2000) 263-281).     

Maxillonasal dysplasia (Binder's syndrome).

Eleven patients with Binder's syndrome (nasomaxillary hypoplasia) have been treated by the Toronto Craniofacial Team from 1972 to 1977. The treatment has consisted of onlay bone and cartilage grafts to the nose and perialar region for young children, or when the occlusion is normal. However, cases with severe malocclusion were treated by a Le Fort I and/or Le Fort II osteotomy when the children were older. When the malocclusion was less severe, interceptive orthodontics have been useful. The nose can be significantly lengthened and enlarged through a frontal craniotomy incision connected with an upper buccal sulcus incision, without any incision on the face.     

Evolutionary Implications of Dental Eruption in Dasypus (Xenarthra)

Late eruption of the permanent dentition was recently proposed as a shared anatomical feature of endemic African mammals (Afrotheria), with anecdotal reports indicating that it is also present in dasypodids (armadillos). In order to clarify this question, and address the possiblity that late eruption is shared by afrotherians and dasypodids, we quantified the eruption of permanent teeth in Dasypus, focusing on growth series of D. hybridus and D. novemcinctus. This genus is the only known xenarthran that retains two functional generations of teeth. Its adult dentition typically consists of eight upper and eight lower ever-growing (or euhypsodont) molariforms, with no premaxillary teeth. All but the posterior-most tooth are replaced, consistent with the identification of a single molar locus in each series. Comparison of dental replacement and skull metrics reveals that most specimens reach adult size with none or few erupted permanent teeth. This pattern of growth occurring prior to the full eruption of the dentition is similar to that observed in most afrotherians. The condition observed in Dasypus and many afrotherians differs from that of most other mammals, in which the permanent dentition erupts during (not after) growth, and is complete at or near the attainment of sexual maturity and adult body size. The suture closure sequence of basicranial and postcranial epiphyses does not correlate well with dental eruption. The basal phylogenetic position of the taxon within dasypodids suggests that diphyodonty and late dental replacement represent the condition of early xenarthrans. Additionally, the inferred reduction in the number of molars to a single locus and the multiplication of premolars represent rare features for any living mammal, but may represent apomorphic characters for Dasypus.     

Development and size of the teeth of Macaca mulatta.

A cross-sectional sample of 151 skulls from Macaca mulatta of known age and similar rearing in U.S. Primate Centers was analyzed to determine age-related "norms" of stages of development and size of teeth. The stages of development from the follicle of a deciduous incisor in the fetus to completion of the root with apex closed of the permanent third molar were related to age. The age range observed for eruption of each tooth was noted and related to its stage of development. The crown of each erupted tooth was found to be completely developed, but growth of its root continued for a longer, indeterminate period. When a deciduous tooth was exfoliated, the crown of the permanent successor was found to be completed and root growth had begun. Measurements of both mesiodistal and faciolingual diameters and of crown length of the teeth in situ and of total length and root length on roentgenograms were examined for sexual dimorphism. The faciolingual diameter of the deciduous mandibular second incisor and of both second molars showed the greatest sexual dimorphism among both diameters of all deciduous teeth. The mesiodistal and faciolingual diameters of the mandibular premolars were found to be the best dimensions in discriminant functions for identifying sex in the absence of permanent canines.     

华南人颅骨上、下颌臼齿磨耗与年龄变化的关系

本文以华南人103例17—73岁男性颅骨的709个臼齿为材料,研究了上下颌臼齿磨耗度与年龄的关系。将磨耗度分为九级,统计分析结果表明,华南人臼齿的磨耗度与年龄关系是密切相关的,这种相关关系,能够作为估计华南人颅骨年龄的标准。第一臼齿与第二臼齿的磨耗平均年龄比率是M1∶M2=6∶6.9;磨耗度与年龄的相关系数M1为0.91,M2为0.90,均为高度相关。并得出磨耗度的平均年龄及95％置信区间(见表3)。华南人下颌臼齿的磨耗比上颌臼齿的磨耗稍大(61.5％)。     

Schultz's unruly rule: dental developmental sequences and schedules in small-bodied, folivorous lemurs

Schultz's rule (as reconstructed by Smith) states that there is a relationship between the pattern (or relative order) of eruption of molar versus secondary (replacement) teeth and the overall pace (or absolute timing) of growth and maturation. Species with 'fast' life histories (rapid dental development, rapid growth, early sexual maturation, short life spans) are said to exhibit relatively early eruption of the molars and late eruption of the secondary replacement teeth (premolars, canines, incisors), whereas species with 'slow' life histories are said to exhibit relatively late eruption of the molars and early eruption of the secondary dentition. In a recent review, B.H. Smith noted that primates with tooth combs might violate this rule because tooth combs tend to erupt early, regardless of the pace of life history. We show that exceptions to Schultz's rule among lemurs are not limited to the relative timing of eruption of the tooth comb. Rather, among lemurs, some species with extremely accelerated dental development exhibit a pattern of eruption of molars and of secondary teeth in direct opposition to the expectations of Schultz's rule. We focus particularly on the pattern (order) and pace (absolute timing) of dental development and eruption in Avahi and Lepilemur - two relatively small, nocturnal folivores with rapid dental development. These taxa differ markedly in their eruption sequences (the premolars erupt after M2 and M3 in Lepilemur but not Avahi ). We offer an explanation for the failure of Schultz's rule to predict these differences. Schultz's rule presumes that eruption timing is dependent on the size of the jaw and that, therefore, molar crown formation and eruption will be delayed in species with slow-growing jaws. We show that a variety of processes (including developmental imbrication) allows the crowns of permanent teeth to form and to erupt into jaws that might appear to be too small to accommodate them.     

Patterns of dental wear in the Lengua Indians of Paraguay

Wear patterns were examined on dental casts of 202 living Lengua Indians from the Chaco area of Paraguay. Consideration was given to the development of the molar helicoidal plane, age-related changes in occlusal attrition, coalescence of dentine exposures, interproximal attrition, and erupted crown height. This study lends support to Osborn's theory of the helicoidal plane development by showing that attrition enhances rather than modifies posteruption molar occlusal planes. The rate of interproximal attrition was found to slow down with the eruption and functional initiation of the third molars. Sinuous and cavo-convex interproximal contact areas that are generated with age, however, appeared to be less abrasion resistant than straight surfaces, hence leading to an increase in interproximal attrition rates with advanced age. Maximum crown height reduction occurred between the ages of 20 and 40 years in central incisors, canines, and first molars. Kruskal-Wallis tests and log linera models failed to demonstrate significant sexually dimorphic or antimeric differences in wear patterns of Lengua teeth.     

Hypocone reduction and Carabelli's traits in contemporary Jordanians and the association between Carabelli's trait and the dimensions of the maxillary first permanent molar

The objective of this study is to determine the prevalence of expression and bilateralism of two dental morphological traits in contemporary Jordanians: The hypocone reduction trait on the maxillary second permanent molar and Carabelli's trait on maxillary permanent first and second molars. Furthermore, inter-trait correlation and the relationship of Carabelli's traits with upper first molar dimensions were investigated. Three hundred subjects of school children at their 10th grade and of an average age of 15.5 +/- 0.4 years were involved. Alginate impressions for the maxillary arch were taken, dental casts were reproduced. The selected accurate casts were of 132 male- and 155 female-students. The frequencies of hypocone reduction trait on the maxillary second molar and Carabelli's trait on the maxillary molars were examined. Buccolingual and mesiodistal diameters of the maxillary first molar were measured and recorded. Paired Sample t test and Nonparametric Correlation analysis were used for data analysis. Hypocone reduction trait on the maxillary second molar was found in 29.8% of the examined students. Positive forms of Carabelli's trait on first and second molars were observed in 65.0% and 3.8%, respectively. Nonparametric correlation analysis revealed positive association between Carabelli's trait on first molar and hypocone reduction trait on the maxillary second molar. The presence of Carabelli's trait on first molar was strongly associated with the increase of buccolingual, but not the mesiodistal, diameter. Bilateralism was found highly significant in the tested traits and both genders (p < 0.001). This finding might be a sign of relatively low environmental stresses in the living Jordanian population and/or great ability of its individuals to buffer the adverse effects of such stresses.     

Long-term physical impairment and functional outcomes after complex facial fractures

To develop an understanding of the expected functional outcomes after facial trauma, a retrospective cohort study of patients with complex facial fractures was conducted. A cohort of adults aged 18 to 55 years who were admitted to the R. Adams Cowley Shock Trauma Center between July of 1986 and July of 1994 for treatment of a Le Fort midface fracture (resulting from blunt force) was retrospectively identified.Outcomes of interest included measures of general health status and psychosocial well being in addition to self-reported somatic symptoms. General health status was ascertained using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). The Body Satisfaction Scale was used to define patient concerns about altered body image and shape. To determine whether complex maxillofacial trauma and facial fractures contributed to altered social interactions, the Social Avoidance and Distress scale was used. In addition, information about a patient, his or her injury, and its treatment were ascertained from the medical records.Using the methods described above, 265 patients with Le Fort fractures were identified. These individuals were matched to a similar group of 242 general injury patients. A total of 190 of the Le Fort patients (72 percent of those eligible for the study) and 144 (60 percent) general injury patients were successfully located, and long-term interview data were acquired.Le Fort fracture patients as a group had similar health status outcomes when compared with the group of general injury patients. However, when outcomes were examined by the complexity of the Le Fort fracture, the authors found that study subjects with severe, comminuted Le Fort injuries (group D) had significantly lower SF-36 scores (worse outcomes) for the two dimensions related to role limitations: role limitations due to physical problems and role limitations due to emotional problems (p < 0.05). SF-36 scores for all other dimensions except physical function were also lower for comminuted versus less complex Le Fort fractures, although differences were not statistically significant.Specifically, there was a direct relationship between severity of facial injury and patients reporting work disability. Of group C and D Le Fort patients (severely comminuted fractures) only 55 and 58 percent, respectively, had returned to work at the time of follow-up interview. These figures are significantly lower than the back-to-work percentage of patients with less severe facial injury (70 percent).When study participants were asked if they were experiencing specific somatic symptoms at the time of the interview that they had not experienced before the injury, a significantly larger percent of the Le Fort fracture patients (compared with the general injury patients) responded in the affirmative. Differences between the Le Fort fracture and general injury groups were statistically significant (p < 0.05) for all 11 symptoms.The percentage of patients reporting complaints increased with increasing complexity of facial fracture in the areas of visual problems, alterations in smell, difficulty with mastication, difficulty with breathing, and epiphora, and these differences reached statistical significance.Patients sustaining comminuted Le Fort facial fractures report poorer health outcomes than patients with less severe facial injury and substantially worse outcomes than population norms. It is also this severely injured population that reports the greatest percentage of injury-related disability, preventing employment at long-term follow-up. The long-term goal of centralized tertiary trauma treatment centers must be to return the patient to a productive, active lifestyle.