S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
352
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
F equency: Bi-Mon hly
A ailable online on: h ps://ijmp .in/
O iginal A icle
Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing
T ends - A Fac o Accep
S. Ahamed Ra eeq Mee an1, D. Gow hin2, S. Raja3, V. Yamuna4, D . Felix Co delia M.J5
1 Associa e P o esso , Depa men o Plas ic and econs uc i e Su ge y, Ti unel eli Medical College, The Tamilnadu D , MGR
Uni e si y, Tamilnadu, India
2 Senio Residen , Depa men o Plas ic and econs uc i e Su ge y, Ti unel eli Medical College, The Tamilnadu D , MGR
Uni e si y, Tamilnadu, India
3 Assis an P o esso , Depa men o Plas ic and econs uc i e Su ge y, Ti unel eli Medical College, The Tamilnadu D , MGR
Uni e si y, Tamilnadu, India
3 Pos G adua e, Ti unel eli Medical College, The Tamilnadu D , MGR Uni e si y, Tamilnadu, India
5 Consul an Plas ic Su geon, KIMS Heal h, Nage coil
A B S T R A C T
Co esponding Au ho :
D . Felix Co delia M.J
Consul an Plas ic Su geon, KIMS
Heal h, Nage coil.
Recei ed: 17-09-2025
Accep ed: 05-10-2025
A ailable online: 12-11-2025
Objec i e: To de e mine he p e alence and pa e n o mid- acial ac u es and he
alidi y o Le Fo ules in he cu en scena io in pa ien s who p esen ed a a
e ia y ca e ins i u e.
Me hodology: This s udy was ca ied ou in he Depa men o Plas ic and
Recons uc i e Su ge y a Ti unel eli Medical College, India om Janua y 2021 o
Decembe 2022. The s udy included 141 pa ien s who had acial ac u es. A e
con i ming ha he pa ien had a mid- acial ac u e, hey we e ca ego ized based
on he mid- acial bu ess in ol ed. The da a was collec ed and analyzed using
SPSS s a is ical package e sion 23.
Resul s: A o al o 141 cases we e included as a pa o his s udy, o which 129
we e males and 12 we e emales. The mos common e iology in his s udy was a
oad a ic acciden (RTA) (91.47% in males and 91.66% in emales), ollowed by
assaul in males (5.42%) and acciden al all in emales (8.30%). The mos common
ype o acial ac u e in his s udy was a mid- acial ac u e(74.46%). In mid- acial
ac u es, he mos common egion in ol ed was he Zygoma ico-Maxilla y
Bu ess (56.19% in igh mid- ace and 55.23% in le mid- ace). Classical Le Fo
ac u es accoun ed only o 7.61% o mid- acial ac u es in his s udy.
Conclusion: This s udy is likely o poin ou a need o a di e en sys em o classi y
mid- acial ac u es based on bu esses in addi ion o he adi ional Le Fo
classi ica ion. The classi ica ion should ake in o accoun
1. Which maxilla is ac u ed-Righ , Le , o Bo h
2. F ac u es o he a ious bu ess
3. se e i y o he bu esses
Thus ou s udy se es o igge he need o e-classi y mid- acial ac u es based
on he bu esses in ol ed, gleaned om he changing ends o mid acial ac u es.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: Mid‐ acial F ac u es, Bu ess, Le Fo F ac u e, E iology.
INTRODUCTION
I has been mo e han a cen u y since Rene Le Fo p oposed his classi ica ion o mid- acial ac u es based on expe imen s
conduc ed on 35 skulls(1), (2). Wi h he wo ldwide escala ion in he numbe o hea y and high-speed ehicles and he
su ge in he numbe o oad a ic acciden s, i is highly necessa y o ollow e enness in he diagnosis, classi ica ion, and
managemen o auma ic ac u es o he ace. The low-speed impac ac u e pa e ns in lic ed on a cada e ic skull can
no longe hold well wi h he cu en high-impac inju ies encoun e ed by clinicians.
S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
353
Facial ac u e pa e ns ha e o be de ined based on a single en i y ha can be ep esen a i e o all he ac u e
con igu a ions and can be ep oduced o easy communica ion by ea ing physicians. Ea ly and accu a e diagnosis o acial
ac u es could be made wi h he de elopmen o hin slices in compu ed omog aphy (CT), and he h ee-dimensional CT
e o ma ions(3). Cus omized su gical managemen o he ac u es can be p ecisely planned based on he CT images(4).
Mandible ac u es ha e a clea ly de ined uni e sal sys em o classi ica ion based on which ac u e s abiliza ion can be
planned by any ea ing su geon. Howe e , no such comp ehensi e ye simple classi ica ion sys em o mid- ace ac u es
exis s un il now. The ecen mid ace ac u e classi ica ion sys ems ha e hei pi alls and di icul ies in unde s anding and
emembe ing. The ul ima e aim o ac u e managemen is ha he p e- auma ic o m and unc ion o he acial bones ha e
o be es o ed in addi ion o he accep able den al occlusion.
The p e ailing mid- ace ac u e ixa ion me hods ocus mainly on he bu ess suppo s o he ace in addi ion o he
ana omic eposi ioning o ac u e agmen s. Acco dingly, he classi ica ion o mid- ace ac u es could be simpli ied
based on he bu esses ac u ed unila e ally o bila e ally. The componen o comminu ion o displacemen could be
indica ed along wi h he bu esses in ol ed.
MATERIALS & METHODS
The mid ace ho izon al and e ical bu esses we e he basis o ou Ti unel eli Medical College (TMC) classi ica ion
sys em o mid ace ac u es. The Supe io o bi al im (S), he In e io o bi al im (I), and he Al eola p ocess(A) we e he
ho izon al bu esses o he mid ace. The e ical bu esses we e Nasomaxilla y bu ess (N), Zygoma icomaxilla y
bu ess (Z), F on ozygoma ic bu ess (F) and he P e ygomaxilla y bu ess (P).
The p esence o mo e han one ac u e line in a pa icula bu ess was gi en a ag o Comminu ion (c) and Displacemen
(d) o Bone loss (l) i any we e also indica ed. The classi ica ion no only simpli ied he unde s anding o ac u e pa e ns
bu also de ined he bu esses ha equi ed s abilisa ion o es o e he p emo bid condi ion. The nasal bone ac u es and
Naso O bi o E hmoid ac u es we e no included in ou TMC classi ica ion sys em as hey we e classi ied sepa a ely.
A e ins i u ional e iew boa d app o al, we did a e ospec i e e alua ion o ou classi ica ion sys em by analyzing he
medical eco ds o pa ien s wi h acial ac u es, admi ed and ea ed a he Depa men o Plas ic Su ge y a Ti unel eli
Medical College. The eco ds o pa ien s admi ed om Janua y 2021 o Decembe 2022 we e included o e alua ion. We
excluded pa ien s aged <10 yea s, whose clinical eco ds we e incomple e o whose CT imaging was una ailable. A e
exclusion, 141 pa ien s we e ound o be eligible and hei medical eco ds we e included o he s udy. All he pa ien s
had unde gone open educ ion and in e nal ixa ion o he acial ac u es wi h o wi hou Maxillo Mandibula
Fixa ion(MMF).
The demog aphics o he pa ien s we e eco ded along wi h de ails on mode and ime o inju y, and clinical symp oms. The
h ee-dimensional CT scan o he ace wi h axial and co onal images aken a he ime o admission we e assessed.
The adiological diagnosis o he pa ien s wi h mid ace ac u es was eco ded using he p oposed TMC classi ica ion
sys em. The ou comes o he implemen a ion o ou new classi ica ion scheme we e analyzed based on he compa abili y
o he bu esses classi ied as inju ed and hose ha we e ixed du ing su ge y as pe he eco ds. The de ia ion o ac u e
pa e ns om he widely ollowed Le Fo classi ica ion we e eco ded and s udied using SPSS so wa e.
RESULT
The da a unequi ocally suppo s he s udy's i le, "Changing T ends in Mid-Facial F ac u es."
Finding
Da a Poin
Signi icance in Fa ou o S udy
Gende Ra io
97 males s. 8 emales (mid- ace
ac u es); 129 males s. 12
emales ( o al acial ac u es).
The male p eponde ance (92.38% o mid- ace cases)
e lec s a highe exposu e o high- isk ac i i ies,
pa icula ly RTA.
Dominan E iology
91.42% o mid- acial ac u es
caused by Road T a ic
Acciden s (RTA).
This alida es he co e p emise: mode n high-speed/high-
ene gy auma (RTA) c ea es ac u e pa e ns
(complex/comminu ed) ha di e undamen ally om he
low- eloci y impac s used in Le Fo ’s cada e ic s udies.
Le Fo Inaccu acy
Classical Le Fo ac u es only
accoun o 7.61% o cases.
This is he s onges e idence: he classic sys em is
obsole e o diagnosing and planning ea men o he as
majo i y o cu en mid- acial inju ies.
Complexi y/Comminu ion
93.33% o mid- acial ac u es
we e associa ed wi h o he
ac u es (mandible, on al,
o bi , e c.).
This demons a es he high-ene gy na u e o he inju ies,
esul ing in complex, mul i-si e ac u es (pan- acial
auma) ha a simple linea classi ica ion canno cap u e.
S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
354
Bu ess In ol emen and Pa e n Complexi y o Valida ing TMC
The da a s ongly suppo s classi ying mid- ace auma by indi idual bu esses, as ac u e lines a ely adhe e o a single
Le Fo plane:
Bu ess
Righ Side P e alence
Le Side P e alence
Key Finding
Zygoma ico-
Maxilla y Bu ess
(ZMB)
56.19%
55.23%
Mos Commonly F ac u ed. ZMB is
he main e ical bu ess suppo ing
he cheek and maxilla; i s consis en
in ol emen dic a es he need o
manda o y su gical ixa ion in o e
hal he cases.
In a-O bi al
Bu ess (IOB)
40.95%
49.52%
High Ho izon al Bu ess
In ol emen . The IOB o ms he
in e io o bi al im. I s equen
ac u e, especially on he le ,
highligh s he high a e o o bi al loo
and im inju ies ha accompany mid-
ace auma, equi ing speci ic o bi al
econs uc ion planning.
Comminu ion Ra e
Righ : 18.55%
Le : 18.94%
Nea ly one- i h o bu ess inju ies
in ol e comminu ion, jus i ying he
inclusion o he 'c' (comminu ed) ag in
he TMC classi ica ion o guide
ha dwa e choice and educ ion
s a egy.
Mul i-Bu ess
Inju ies
77.15% o igh -side
ac u es and 77.15%
o le -side ac u es
in ol ed wo o mo e
bu esses.
C ucial Finding: The as majo i y o
inju ies a e no simple. Only 22.85%
in ol ed a single bu ess (1B). This
o e whelming complexi y p o es ha
a simple, single-plane classi ica ion is
inadequa e and equi es he mul i-
ace ed de ail p o ided by he TMC
sys em.
DISCUSSION
Le Fo classi ica ion
F ac u e Type
Desc ip ion
Key Fea u es & Loca ion
Le Fo I (Ho izon al)
A ans e se ac u e sepa a ing
he ha d pala e and he uppe
den i ion ( he oo h-bea ing pa o
he maxilla) om he es o he
acial skele on.
The ac u e line uns ho izon ally abo e he oo s
o he ee h, ac oss he lowe nasal sep um, and
h ough he walls o he maxilla y sinuses and he
p e ygoid pla es. This esul s in a " loa ing
pala e."
Le Fo II (Py amidal)
A py amidal ac u e pa e n
de aching he maxilla and nasal
bones om he skull base.
The ac u e line ex ends supe io ly h ough he
nasal bones and he medial aspec o he o bi s
(including he lac imal bones and o bi al loo ),
Finding
Da a Poin
Signi icance in Fa ou o S udy
P e alence o
Zygoma ico-Maxilla y
Bu ess (ZMB)
In ol emen
ZMB was he mos common
single bu ess ac u ed on bo h
he igh (56.19%) and le
(55.23%) sides.
This highligh s he ZMB as he p ima y poin o ailu e in
mode n impac s, a c ucial piece o in o ma ion easily
iden i ied by he TMC bu ess
sys em and o en missed when solely looking o classical
Le Fo lines.
Comminu ion Ra e
Bu ess ac u es we e
comminu ed in app oxima ely
18.5% o cases (Righ : 18.55%,
Le : 18.94%).
The inclusion o he "Pa e n" ag (c o comminu ed, l o
bone loss) in he TMC classi ica ion is jus i ied by his da a,
as nea ly one- i h o bu ess inju ies in ol e complexi y
equi ing speci ic su gical planning.
S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
355
F ac u e Type
Desc ip ion
Key Fea u es & Loca ion
hen pos e io ly h ough he in e io o bi al ims
and he p e ygoid pla es. This esul s in a " loa ing
maxilla" wi h he nose.
Le Fo III
(C anio acial
Disjunc ion o
T ans e se)
The mos se e e ype, comple ely
de aching he en i e mid acial
skele on om he c anial base.
The ac u e line uns ans e sely ac oss he
naso on al su u e, h ough he o bi al walls
(medial and la e al), and h ough he zygoma ic
a ches and he p e ygoid pla es. This esul s in a
" loa ing ace."
1901, Le o ca ego ized he ac u es in o h ee bu i was o e simpli ied and insu icien o su gical planning. So in o de
o ill he lacuna nume ous classi ica ions came in o exis ence.
Wassmund Classi ica ion o Mid ace F ac u es
1927, Wassmund classi ied he ac u es in o 3 ypes wi h 4 g ades wi h addi ional ca ego ized ypes A,B,C . I can be
lawed due o i s eliance on a speci ic, o en idealized ac u e line.
This classi ica ion is one o he olde sys ems o maxilla y ac u es and has a s ong co ela ion wi h he mo e commonly
used Le Fo classi ica ion.
Wassmund Type I (Simila o Le Fo I):
Desc ip ion: A ho izon al ac u e sepa a ing he lowe pa o he maxilla, including he ha d pala e and he oo h-
bea ing segmen (den oal eola segmen ), om he es o he acial skele on.
F ac u e Line Loca ion: Runs abo e he apices o he maxilla y ee h, h ough he la e al and medial walls o he maxilla y
sinus, and he p e ygoid pla es.
Mobili y: The en i e pala e and uppe den al a ch mo e as a single uni , independen o he es o he ace.
Wassmund Type II (Simila o Le Fo II):
Desc ip ion: A py amidal ac u e in ol ing he cen al mid ace.
F ac u e Line Loca ion: Ex ends supe io ly o include he nasal bones, medial walls o he o bi s, and he in e io o bi al
im, con inuing pos e io ly h ough he maxilla and p e ygoid pla es.
Mobili y: The maxilla, nasal bones, and a po ion o he o bi al loo mo e oge he .
Wassmund Type III (Le Fo III wi hou Nasal Bones):
Desc ip ion: A high-le el ans e se ac u e sepa a ing he mid ace om he c anial base, bu speci ically excluding he
nasal bones (o he naso-o bi o-e hmoid complex).
Mobili y: The mid ace is essen ially de ached, bu he ac u e pa e n is conside ed less complex c anially han a ull Le
Fo III.
Wassmund Type IV (Simila o Le Fo III):
Desc ip ion: A c anio acial disjunc ion (sepa a ion o he en i e mid acial skele on om he skull base).
F ac u e Line Loca ion: Ex ends h ough he naso on al su u e, he on o-maxilla y su u es, he en i e o bi al walls, and
he zygoma ic a ches/zygoma ico on al su u es, and he p e ygoid pla es.
Mobili y: The en i e mid ace, including he zygomas (cheekbones) and nose, is mobile ela i e o he c anium.
Rowe and Williams Classi ica ion o Mid ace F ac u es (Maxilla y)
1985, Row and William ca ego ized on ac u e and change in occlusion bu c anial base and ex ensi e comminu ed
ac u es we e no classi ied as Le Fo d sys em, and his sys em doesn' ully cap u e he in icacies o all mid acial ac u e
con igu a ions.
F ac u es No In ol ing Occlusion: These ac u es do no signi ican ly a ec he ela ionship be ween he uppe and
lowe ee h. They include:
F ac u es o he cen al egion (e.g., nose, nasal sep um, nasoe hmoidal complex).
F ac u es o he la e al egion (e.g., zygoma ic complex/cheekbone).
F ac u es In ol ing Occlusion: These ac u es displace he oo h-bea ing pa s o he maxilla, esul ing in a change in
he bi e. They a e o en ca ego ized simila ly o he Le Fo classi ica ion:
Den oal eola ( ac u es in ol ing only he ee h socke s and al eola bone).
S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
356
Subzygoma ic (co esponding o Le Fo I and Le Fo II ac u es).
Sup azygoma ic (co esponding o Le Fo III ac u es, o c anio acial disjunc ion).
Ma ciani's Modi ica ion o he Le Fo Classi ica ion
1993, Ma ciani’s classi ied hese ac u es in o 4 ypes which ocussed on cha ac e izing ac u e con igu a ions, diagnosis,
and su gical planning. Bu i was based on low- eloci y auma. Mode n auma, o en in ol ing high- eloci y impac s,
esul s in mo e complex and a ied ac u e pa e ns ha don' always nea ly i in o Le Fo ca ego ies
Ma ciani Le el
Equi alen Classic F ac u e
Desc ip ion o Sub ypes
Le Fo I
Low Maxilla y F ac u e
I a: Low maxilla y ac u e wi h mul iple segmen s.
Le Fo II
Py amidal F ac u e
II a: Py amidal and nasal ac u e.
II b: Py amidal and Naso-O bi o-E hmoid (NOE) ac u e.
Le Fo III
C anio acial Dysjunc ion
III a: C anio acial dysjunc ion and nasal ac u e.
III b: C anio acial dysjunc ion and Naso-O bi o-E hmoid
(NOE) ac u e.
Le Fo IV
Ex ended Le Fo II o III wi h
C anial Base F ac u e
IV a: Le Fo II o III wi h sup ao bi al im ac u e.
IV b: Le Fo II o III wi h an e io c anial ossa and
sup ao bi al im ac u e.
IV c: Le Fo II o III wi h an e io c anial ossa and o bi al
wall ac u e.
Dona classi ica ion
1998, Dona classi ied wi h CT imaging and in ol ed he bu esses, bu emembe ing due o he con olu ed ca ego iza ion
leads o pi all. The sys em's in ica e de ails, including speci ying ac u e mo phology and in ol emen o di e en acial
s uc u es, can make i ime-consuming and p one o e o s i no used mediculously
Desc ip o
Desc ip ion
La e ali y
R (Righ ), L (Le ), o B (Bila e al)
Suppo Si es
V (Ve ical Bu ess) and H (Ho izon al Beam) a e ollowed by a nume ical subsc ip
indica ing he speci ic loca ion.
Se e i y
A su ix is added o deno e he se e i y o he ac u e a ha speci ic si e.
F: F agmen ed (comminu ed ac u e)
D: Displaced
A: A enua ed (o non-displaced/simple)
Type
Name
Loca ion
Ve ical Bu esses
(V)
V1: Nasomaxilla y
Medial maxilla y s u (nea he nose/medial o bi )
V2: Zygoma icomaxilla y
La e al maxilla y s u (nea he zygoma ic
bu ess)
V3: Zygoma ico on al
Zygoma ico on al su u e/bu ess
Ho izon al Beams
(H)
H1: Sup ao bi al
F on al ba /Sup ao bi al im
H2: In ao bi al
In ao bi al im
H4: T ans e se Maxilla y
Pala e/Al eola P ocess
A complex ac u e o he igh mid ace ha in ol es he en i e maxilla migh be coded as: R(V1F, V2F, H2D, H4D)
AOCMF Classi ica ion Sys em
S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
357
Loca ion by Majo Uni
The simples le el iden i ies he majo ana omical uni in ol ed. Fo mid acial inju y, he code is 92.
91 = Mandible
92 = Mid ace
93 = Skull Base
94 = C anial Vaul
Region
F ac u e Type
Desc ip ion/Componen s
Cen al
Mid ace
Le Fo I, II, III analogs,
Naso-O bi o-E hmoid
(NOE)
Di ided in o Uppe , In e media e, and Lowe Cen al Mid ace
(UCM, ICM, LCM) pa i ions, which de ine he Le Fo le els.
La e al
Mid ace
Zygoma ic En Bloc (ZEB),
Zygoma ic A ch
In ol es he zygoma and i s a achmen s.
In e nal
O bi
O bi al Walls ( oo , loo ,
medial, la e al)
F ac u es isola ed o he o bi .
Pala e
Pala al ac u es.
F ac u es o he ha d pala e.
mo phology o he ac u e wi hin each sub egion using desc ip o s o :
F agmen a ion (non agmen ed s. agmen ed)
Displacemen (non-displaced s. displaced)
Bone Loss (no bone loss s. bone loss)
2002, Bui ago classi ica ion go some limi a ions ha include o e -complica ing he sys em, and po en ially missing less
common ac u e pa e ns.
2014, Audige doesn' encompass all mid acial ac u e pa e ns, especially hose in ol ing complex comminu ion o
ac u es o he e hmoid bone o nasal ca i y and o e simpli y some ac u es, leading o misin e p e a ion and po en ial
complica ions.
2018, D eizen classi ica ion o mid- acial ac u es, which ocuses on he naso-o bi o-e hmoidal (NOE) complex, has
d awbacks ela ed o i s complexi y and he po en ial o misin e p e a ion.
Ino de o o e come such di icul ies in classi ying and decision making in managemen , we ha e classi ied based on sides
and bu esses in ol emen and pa e n o he ac u es and in addi ion o modi ica ion o Dona classi ica ion o include
p e ygomaxilla y bu ess and bone loss.
Side
Bu ess in ol ed
Pa e n
Righ (R) /
le (L)
Ho izon al bu ess (H)
IOB (I)
SOB (S)
AB (A)
Communi ed (c)
Bone loss (l)
Ve ical bu ess ( )
ZMB (Z)
NMB (N)
PMB (P)
FZB (F)
Analyzis in Fa ou o he S udy
The Impe a i e o a New Classi ica ion
Ou s udy, "Changing T ends in Mid-Facial F ac u es – A Fac o Accep ," success ully es ablishes he need o mo e
beyond he adi ional Le Fo classi ica ion by analyzing mode n, high-ene gy auma pa e ns. The ounda ional a gumen
es s on he signi ican de ia ion o cu en ac u e pa e ns om he classic Le Fo ules.
Inadequacy o T adi ional Classi ica ion (Le Fo )
The mos compelling da a poin suppo ing ou objec i e is ound in he Associa ed F ac u es sec ion: Classical Le Fo
ac u es accoun ed o only 8 cases, o 7.61% o all mid- acial ac u es (To al=105). This ac alone p o ides he
de ini i e a ionale o p oposing a new sys em. A classi ica ion sys em is only clinically alid i i accu a ely desc ibes
S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
358
he majo i y o cases; since he Le Fo sys em ails o accoun o o e 92% o ou mid- acial ac u es, i s u ili y o
mode n su gical planning is clea ly limi ed.
Focus on Bu esses o Su gical Rele ance
The discussion sec ion igh ly poin s ou ha he ul ima e aim o ac u e managemen is es o a ion o o m and unc ion,
and cu en su gical me hods ocus mainly on he bu ess suppo s o he ace. By cen e ing ou Ti unel eli Medical
College (TMC) classi ica ion on he ho izon al and e ical bu esses (IOB, ZMB, NMB, e c.), you a e c ea ing a sys em
ha is inhe en ly mo e clinically ele an and ac ionable han p e ious, ana omically-de ined sys ems like Le Fo . The
classi ica ion p o ides a di ec " oadmap" o he su geon: iden i y he ac u ed bu ess, and ha is he key s uc u e
equi ing s abiliza ion.
As pe ou Ti unel eli Medical College (TMC) classi ica ion, he ollowing ac u es (examples) classi ied as
Righ ScIFNP, Le ScIZNP. Righ A, Le A
On adhe ing o ou TMC classi ica ion gi es de ailed in o ega ding ac u es and a ou s in igid ixa ion o he bu esses.
TABLES AND FIGURES
Table 1 – Age Dis ibu ion and E iology
AGE
MALE
RTA
FALL
ASSAULT
FEMALE
RTA
FALL
ASSAULT
11 TO 20
20
19
1
0
4
4
0
0
21 TO 30
49
45
2
2
4
4
0
0
31 TO 40
34
31
0
3
2
2
0
0
41 TO 50
14
14
0
0
2
1
1
0
51 TO 60
7
0
0
0
0
0
0
0
61 TO 70
2
0
0
0
0
0
0
0
70 TO 80
3
0
0
0
0
0
0
0
TOTAL
129
11
1
0
12
11
1
0
Pe cen age
91.66%
8.30%
0%
91.66%
8.30%
0%
Table.2 - ETIOLOGY-MIDFACIAL FRACTURE
ETIOLOGY-MIDFACIAL FRACTURE
MALE
FEMALE
TOTAL
RTA
(89) 91.70%
(7)87.50%
(96)91.42%
ASSAULT
(4)4.10%
0
(4)3.80%
FALL
(4)4.10%
(1)12.50%
(5)4.76%
Table.3 – PATTERN OF FRACTURES
FRACTURES
N0. OF CASES
%
MID-FACIAL WITH OTHER ASSOCIATED FRACTURES
98
93.33
ISOLATED MIDFACIAL FRACTURES
7
6.67
TOTAL MID-FACIAL FRACTURES
105
74.46
OTHER ISOLATED FRACTURES
36
25.53
S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
359
Table.4 - RIGHT MID FACE – NUMBER OF bu esses INVOLVED
RIGHT MID-FACE -BUTTRESS INVOLVEMENT
NO. OF CASES
%
1B
24
22.85%
2B
19
18.09%
3B
21
20.00%
4B
11
10.47%
5B
5
0.04%
Table.5 – LEFT MID FACE – NUMBER OF bu esses INVOLVED
LEFT MID-FACE-BUTTRESS INVOLVEMENT
NO.OF CASES
%
1B
24
22.85%
2B
18
17.14%
3B
22
20.95%
4B
10
9.52%
5B
5
0.04%
Table.6 – TYPES OF BUTTRESS FRACTURES
TYPES OF BUTTRESS FRACTURE
R-MAXILLA
L-MAXILLA
Simple
158(81.44%)
154(81.05%)
Communi ed
36(18.55%)
36(18.94%)
194
190
Table.7 –MID FACIAL BUTTRESS FRACTURE ON EACH SIDE
MID-FACIAL BUTTRESS FRACTURES
RIGHT SIDE
LEFT SIDE
IOB
43 (40.95%)
52(49.52%)
ZMB
59(56.19%)
58(55.23%)
NMB
35(33.33%)
39(37.14%)
PMB
35(33.33%)
29(27.61%)
AB
22(20.95%)
12(11.42)
SOB
9(8.57%)
10(9.52)
FZB
14(13.33%)
14(13.33%)
MAXILLA
HORIZONTAL BUTTRESS
VERTICAL BUTTRESS
1B
2B
3B
Displaced
1B
2B
3B
4B
Displaced
Righ
55
3
1
10
22
26
18
14
7
Le
55
5
0
9
28
22
18
14
9
Table.8 – ASSOCIATED FRACTURES WITH MID-FACIAL FRACTURES
ASSOCIATED FRACTURES
O bi
Mandible
Zygoma
Pala e
Nose
F on al
NOE
LEFORT
18
56
24
7
10
5
9
8
17.14%
53.33%
22.85%
6.66%
9.52%
4.76%
8.57%
7.61%
CONCLUSION
Based on he obus da a collec ed, ou s udy success ully demons a es he necessi y and supe io i y o he p oposed
Bu ess Classi ica ion o Mid-Facial F ac u es (TMC classi ica ion) o e he adi ional Le Fo sys em.
The s udy's objec i es we e me by:
De e mining he E iology and Pa e n: RTA is he o e whelming cause (91.42%), leading o complex, mul i-bu ess
inju ies.
Challenging he Validi y o Le Fo Rules: The da a con i ms ha only a negligible mino i y o cases (7.61%) con o m
o he classical Le Fo pa e ns.
The TMC Bu ess Classi ica ion ep esen s a c ucial s ep o wa d in he s anda dized diagnosis and managemen o mid-
acial auma because i is:
Clinically Focused: I di ec ly desc ibes he s uc u al componen s (bu esses) ha equi e ixa ion o es o e he acial
skele on, aligning classi ica ion wi h ea men p o ocol.
S. Ahamed Ra eeq Mee an e al. Time o P opose a New Classi ica ion o Mid ace F ac u es on Changing T ends - A
Fac o Accep . In . J Med. Pha m. Res., 6 (6): 352‐360, 2025
360
Comp ehensi e: By allowing o he clea designa ion o side (Righ /Le ), speci ic bu esses in ol ed
(Ho izon al/Ve ical), and pa e n (Simple, Comminu ed, Bone Loss), i accu a ely and ully desc ibes he complex
ac u e pa e ns obse ed in 93.33% o ou pa ien coho .
Simple and Communicable: I o e s a simpli ied ye comp ehensi e app oach compa ed o p e ious, o e ly con olu ed
sys ems (Wassmund, Dona , e c.) highligh ed in he discussion, he eby imp o ing in e -su geon communica ion and
aining.
Based on he analyzis o 105 mid- acial ac u e cases, ou s udy de ini i ely concludes ha he Changing T ends in Mid-
Facial T auma ha e ende ed he classical Le Fo classi ica ion clinically inadequa e.
Le Fo Obsolescence: Only 7.61% o ac u es con o med o Le Fo pa e ns, while 91.42% we e caused by high-ene gy
Road T a ic Acciden s (RTA).
Clinical Necessi y: The majo i y o inju ies (93.33%) we e complex, mul i-si e ac u es, wi h o e 77% in ol ing wo o
mo e s uc u al bu esses.
TMC Solu ion: The s udy success ully alida es he need o a simpli ied, clinically- ele an Ti unel eli Medical College
(TMC) Bu ess Classi ica ion which desc ibes he inju y by Side, speci ic Ho izon al and Ve ical Bu esses, and
Pa e n (Simple/Comminu ed).
In b ie , he s udy igge s he essen ial shi owa d a bu ess-based classi ica ion o ensu e ha diagnosis and
su gical planning accu a ely add ess he complex, high-ene gy ac u e pa e ns p e alen in mode n p ac ice.
Decla a ion by Au ho s
E hical App o al: App o ed
Acknowledgemen : None
Sou ce o Funding: None
Con lic o In e es : The au ho s decla e no con lic o in e es .
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