#npa management

[npaconsultant1234]

In the last decade, the nature of work of finance consultancies has undergone a dramatic change. These firms have had to adapt to changes in technology, regulation and economic environment to carry out their activities. However, as we approach 2025, this trend continues to intensify and, therefore, greatly affect the future of firms like NPA Consultant Pvt Ltd.

A Decade of Transformation

[npaconsultan]

Comparative Study of NPA account settlement Impact of The Nationalized Banks

A viable, sustainable and strong banking system is crucial for the overall development of the economic structure of a country. The failure of an effective banking system may lead to adverse impacts in various spheres of the economy. Both the Public Sector Banks and the Private sector Banks in India have made considerable contributions in all economic aspects.

However, the amount of non-performing assets or NPA in the balance sheet can have a deep impact on the bank’s profitability. As per the directives of RBI, the accounts become non-performing when the loan account is overdue and the bank fails to recover the capital or interest from the capital for over a period of 90 days.

Plans to increase productivity

Over the past few years, there is a powerful drive going on in the nationalized banks to enhance their profitability. This implies that the PSBs also have to think of improving productivity, which is necessary to survive in the present economic state.

The future of the banks lies in the ability of the banks to build good quality assets consistently even in a competitive environment and minimize the NPAs. Competition and consolidation are the two prime factors that will impact the private and public sector banks in future. The effective methods of NPA account settlement can turn out to be the factors dominating the future of the banking system.

NPA categories

Every bank has to classify all the non-performing assets into three categories, depending on the time frame over which the asset has been in the non-performing stage and the realise-ability of the debts:

Doubtful assets

Substandard assets

Loss assets

The detection of the NPAs and the able management of the debts will help the bank to enjoy more financial stability.

Impact of NPA on banking systems

The level of return on the assets is one of the most significant aspects of the bank’s efficiency. Its high tie for the banks to provide provisions for the NPAs from the present profit ratio. The NPAs can affect the return to the assets in the following ways:

Increase in cost of capital

Reduction in ROI

Fall in the interest income of the banks accounted only on receipt mode.

Disturbance in the capital adequacy ratio with the entry of NPA in the calculations

Doubtful debts and bad debts add to the loss

Limitations in recycling the funds

Mismatch in assets and liabilities

It's high time to consult the NCLT lawyers in Mumbai who can help the banks to regain economic stability.

Comparative study

Thorough research of the ten years’ data from the top Indian banks like Canara Bank and State Bank of India shows that the banks are making policies that try to contain NPA for improving the profitability and asset quality.

HDFC and PNB show superior NPA management systems if you compare them to the systems existing in SMI and ICICI or other private sector banks. The system even supersedes the system of the public sector banks too.

The positive trend in NPA control

Recent research studies on trends of the non-performing assets in the various private banks of India show that the level of NPAs in the public sector banks is alarming. But it also shows some improvement in the asset quality with a little decline in the NPA percentage. Thus, the studies show that the banks can maintain economic stability if they take timely action against the degradation of the good-performing assets instead of concentrating only on the NPAs Analytical study

A thorough analytical study shows that the NPA of all the nationalized banks is showing an upward trend. Therefore, statistical records also pave the way for the banks to apply better measure for NPA management

[npaconsultant-stuff-blog]

What is the process of one-time settlement in banking? | NPA Management

Why do people take loans? It is a great way of helping your finance for various things. You may take a loan for completing your education, buying a new house, the wedding of your kids, to go abroad, or anything else.

If you are a company, then you will take a loan to diversify your business or launch a new project.

You make great planning and ensure that repayment of the loan is done in time. However, no matter how systematic your repayment plan may be, you cannot foresee all the possible bottlenecks. You may become a victim of unforeseen circumstances. There could be an unexpected loss in the business, or you lose your job due to an illness.

Such circumstances will seriously hamper the ability to repay your loan. You will miss the installment and get follow-up calls and reminders from the bank. It affects your credibility and market value.

When a bank or financial institution sanctions a loan, it expects that the loan will be repaid within the stipulated time. For a bank, a loan is an asset that generates income in the form of interest.

When the loan is not paid, it becomes an NPA or Non-Performing Asset. NPA is not desirable for any financial institution. When it goes beyond a threshold, it becomes a risk to the survival of the bank. Hence, it requires concrete npa management methods.

When a bank fails to recover the loan, it approaches the borrower with options like a one-time loan settlement. Though it looks like a simple offer, it may ruin the credit score of the borrower.

What is a One-Time Loan Settlement?

It is part of the overall npa management policy of a bank or financial institution. In this process, the bank or financial institute agrees to accept a smaller amount instead of the entire due amount. When it does so, the bank waives off the rest of the amount and makes repayment easier for the borrower. The option may be offered by the bank after six months of non-repayment.

The bank takes various measures to investigate the case before arriving at the conclusion. It will allow them to validate the reason for not paying the loan.

How Does the process of one-time settlement carry out?

First, the bank should believe that the reason for non-payment is legitimate. The bank offers a moratorium period. The option is for those borrowers who want to pay the amount in one go. After an agreement, the bank will waive off a part of the outstanding loan amount to make the repayment easy.

How much amount will be written off will depend on the gravity of the financial condition and the ability of the borrower to repay the loan. Since the borrower is agreed to settle the loan, its repayment status will be recorded as “settled” and not “closed”. The credit score of the borrower will be affected by the difference.

One-time settlement is considered an important tool of npa management policy.

Alternatives

It is quite obvious that opting for a one-time settlement is not advisable unless it is necessary. There are some other alternates to it.

The borrower should liquidate the savings instead of applying for a loan. Also, it should negotiate with the bank to request an extension for the repayment term. Or, it should ask for a restructured repayment plan.

The borrower can request the bank to hold off the interest rate or reduce it for some time.

One-time settlement is the last resort. For a bank also, it is not a profitable proposition. Therefore, it will use it only when there is no other solution.

For more information - https://www.npaconsultant.in/blog/blog-details/what-is-the-process-of-one-time-settlement-in-banking-1

[finlender]

 Finlender: Your Partner in Navigating NPA Accounts

Managing Non-Performing Assets (NPA) is one of the most significant challenges faced by financial institutions today. At Finlender, we understand the complexities and financial strain that NPAs can impose on your business. That's why we offer specialized funding solutions designed to help you navigate these challenges effectively and strategically.

What Are NPA Accounts?

Non-Performing Assets (NPAs) are loans or advances for which the principal or interest payment remains overdue for a period of 90 days or more. These assets do not generate any income and are often viewed as liabilities, impacting the financial health of lending institutions. NPAs can arise from various reasons such as borrowers facing financial difficulties, economic downturns, or inadequate risk assessment processes.

Finlender’s Approach to NPA Management

At Finlender, we offer a comprehensive approach to managing NPAs that goes beyond traditional methods. Our solutions are tailored to support your institution in mitigating risks and recovering value from non-performing assets.

1- Expert Assessment and Advisory: Our team of financial experts conducts a thorough analysis of your NPA portfolio to identify underlying issues and potential recovery strategies. We provide actionable insights and advisory services to enhance your NPA management practices.

2- Strategic Funding Solutions: We offer flexible funding options specifically designed to address the financial gaps caused by NPAs. Whether you need immediate liquidity to cover operational costs or long-term funding to restructure non-performing loans, Finlender provides the necessary financial support to stabilize your institution.

3- Innovative Recovery Mechanisms: Utilizing advanced analytics and recovery tools, we assist in maximizing the recovery of NPAs. Our innovative mechanisms are designed to improve the efficiency and effectiveness of your recovery efforts, ensuring that you can reclaim the value tied up in these assets.

4- Partnership and Collaboration: We believe in building strong partnerships with our clients. Finlender works closely with your team to implement customized NPA management strategies. Our collaborative approach ensures that you receive continuous support and guidance throughout the recovery process.

Why Choose Finlender?

Choosing Finlender means partnering with a financial institution that prioritizes your success. Our proven track record, deep industry knowledge, and commitment to innovation set us apart. We are dedicated to helping you transform your NPA challenges into opportunities for growth and stability.

Tailored Solutions: We understand that each institution’s needs are unique. Our solutions are customized to meet your specific requirements.

Expertise and Experience: With years of experience in the financial sector, our team brings unparalleled expertise to the table.

Client-Centric Approach: Your goals are our priority. We focus on delivering results that align with your business objectives.

Get Started with Finlender Today

Navigating NPAs requires a strategic partner who understands the intricacies of financial recovery. Let Finlender be that partner. Contact us today to learn more about our funding solutions for NPA accounts and how we can help your institution achieve financial resilience.

Finlender – Empowering Your Financial Future.

READ MORE...NPA and OTS Finance Private Equity Project Finance, Corporate Finance Company in India - Finlender

[the-rsace]

Npa consultant provides various types of NPA services We at npa Consultant provide professional guidance to manage non performing assets Npa Consultant has a team of experts in various field like Legal, Banking and Finance etc

[mediapasta]

Npa consultant provides various types of NPA services We at npa Consultant provide professional guidance to manage non performing assets Npa Consultant has a team of experts in various field like Legal, Banking and Finance etc

[deathnotewiki]

October 8, 2004:

Matsuda breaks into the Yotsuba building and overhears high-ranking employees discussing murder.

Caught by the executives, Matsuda poses as Misa Amane’s manager and promotes her to them.

Matsuda fakes his death by falling off the balcony of Misa Amane’s apartment (the investigation headquarters).

October 8, 2009: NPA director Kanichi Takimura is abducted by Mafia members working under Mello.

[matsuidezawa]

the task force is definitely not as incompetent or useless as everyone says they are. yeah sure they should've suspected light sooner, but come on they're not idiots. aizawa seems to be a competent detective, mogi is REALLY GOOD with paperwork (so good that even L was impressed), soichiro is brave af (2nd kira broadcast) + was actually pretty objective about his son being kira, matsuda thinks quick and is good with guns. we dont really see ide and ukita much, but i wont be surprised if they have done stuff outside the kira case.

true! the task force is so very loyal to L, even if they. sometimes don't agree on things. especially Matsuda.

Ide actually does do some things off on his own. He has his own Kira investigation within the police force. when Aizawa returns to the NPA, Ide asks him to lead them since he knows the most about Kira.

Mogi is also appointed as Misa Misa's manager and is able to be convincingly enthusiastic despite being reserved and hating expressing himself (according to DN13.) His social skills are unexpectedly high for someone who doesn't talk all that much.

Ukita...

he's one of the few officers to put enough trust in L to actually stay for the investigation. they're all willing to risk their lives for it. and he answers calls. I guess

[rinneroraito]

Good Girl

I’ve lost track of how many times I’ve seen Raye Pember die.

My eyes sting and I press my eyelids shut for a good minute or two as I sink back into the couch I shared with The World’s Greatest Detective, L. I bring my feet up on the couch, pressing them against my chest as I exhale sharply. Even though I had my eyes shut, I could feel his wide eyes on me.

“Miss Uehara, if you’re feeling too tired to continue I am allowing you to leave. I can take care of this on my own.”

Eyes still closed I raise a finger at him, prompting him to pause his thoughts or even discard his suggestion.

“I’m alright, Detective. Can we take a break though? Just a few minutes, I want to take my eyes off of the screens so I can have a fresher view of it.”

“That’s alright, you can go ahead and take a break. I’ll be right here.”

“Take a break with me.”

I open my eyes and meet his gaze, the shadows under his eyes making his stare sharper than he intended.

“Just a few minutes, it’s going to help you, too. We can just sit here and talk.” I suggested, but it came out more as a plea than anything.

He scans me with his shadowed eyes, pondering my suggestion.

“Alright, fifteen minutes then. Does that work for you?”

“That’s plenty enough, thanks.” 

I peel my eyes away from him as I reach into my jacket pocket for a lollipop. It could have been the way I was almost begging to take a break from watching the surveillance footage that gave it away, but it was very apparent that I was on edge. I know that he noticed.

My nails scratch against the candy’s wrapper as I try to open it.

“What the fuck...” I mutter to myself in growing frustration as the wrapper stays stuck to the lollipop.

“Let me.” L reaches out a hand to me, offering to open it. I hand it to him with a frown and he takes it from me, holding it daintily with only his thumb and forefinger.

“You seem to be on edge, Miss Uehara, are you getting frustrated over the latest developments in this case?” He asks as he wraps his other thumb and forefinger around the base of the lollipop’s wrapper. Once he gets a firm grip around it, he twists the stick around and the wrapper crunches open.

“Frustrated is one thing, I’m… Angry? Confused? Dispirited” I shake my head. “It’s a lot of feelings to process, a mixture of emotions I have to keep in check or my judgment could be clouded. Not a good look for a Detective or an Investigator to be taken away by their emotions too much, that’s what I believe.”

I turn to him and he’s already peeled off the wrapper from the lollipop.

“It’s just as I thought then, considering the scale of this case is nothing compared to what you used to handle at the NPA. Here.” He offers the lollipop back to me, holding it upright by his thumb and forefinger.

“I don’t want it anymore.” I huffed sullenly.

“Please don’t be stubborn, Miss Uehara.”

He stares at me, and despite the piercing abyss that were his dark eyes, there seems to be a gentleness in his gaze. 

“This is an incredibly high profile case after all. The fact that you’re here persevering despite your conflicted emotions and managing them as healthily as you can is nothing short of commendable. Now here, it’s yours. I helped unwrap it for you, please take it.” He reaches the candy closer towards me that it was pressed against my lips, his face still sporting the usual stoicity he’s associated with. 

“You’re doing your best, you’re aware that you need help and you should accept it.”

The light from the screens made him look uncanny, hauntingly captivating.

I gingerly open my mouth and he places the lollipop snug against my tongue. My eyes widen as his thumb and forefinger drop to my chin, pressing them upwards to close my mouth.

His words come out calm and as comforting as he could sound.

“You feel like this case is like that lollipop you were struggling to unwrap. But I’m here to help, and just because I’ve offered my assistance doesn’t mean it’s mine alone, it’s ours. Do you understand?”

Biting down gently on the stick of the lollipop, I nod, still holding his gaze with wide eyes.

“Good girl. You’re doing well.”

My eyes grow wider as I feel my ears start to burn. And I could swear his stoic expression had transformed ever so slightly into something more smug.

“Interesting...” He says as he slowly inches his face closer to mine, tilting his head,  inspecting me.

“Miss Uehara, do you happen to be blushing?”

My hand finds its way on his chest, preventing him from getting any closer. I look away in an effort to hide my flustered expression, trying to get my bearings.

“Let’s get back to work, Detective. You can ask me about that later.”

I look up at him. And for a moment, there was the ghost of a smile on his pale face.

[captainhysunstuff]

Light didn’t meet L’s successors while L was alive because it would have swiftly taken a turn into their version of the Radioapple “Hell’s Greatest Dad” song.

Or the funnier option. Soichiro and Ryuk going at it over custody of Light. (Soichiro’s the most likely character to shout “Take that, depression!”) 

Both ideas are brilliant~!!! 🤣 VERY drawn to the Soichiro vs. Ryuk pitch~!

Soichiro:

Looks like that you need some aid

From the head honcho of the NPA!

Here’s what the top brass have to say:

“Great work!” “Amazing!” “The pride of the force!”

Ryuk:

I’m your guy! You know I’m great!

I’m your pal! Your ultra cool roommate!

Remember when I killed that guy you hate~?

Guy’s victim:

He was a jerk! Thanks, Kira~!

Light:

Oh, you~. 😏

With the successors, would it be Mello and Near vying for L’s attention if he requested their help or something? That’d be pretty darn entertaining, too~. I could even picture Matt interrupting like Mimzy does (maybe he just beat a hard level in a game or managed to break through a firewall). 😆 Who would interrupt the Soichiro vs. Ryuk version? Misa? Sayu or Sachiko? Maybe Matsuda??? I feel any of them could work!

Excuse the enthusiasm, but seeing this at work gave me a real kick and I had something fun to think about the rest of the night. Thank you~.

[npaconsultant1234]

[dicenote]

I just had a terrible idea for a roleswap between my four fav dn characters so here we go

Lawliet "L" Wammy (age: 18)

A brilliant student but a bit of a shut-in

Spends all his time either in school or locked in his room on the computer

True Crime fan before it was cool

His father Quillsh is proud of his impressive grades but really wishes he'd go out more

A bored Shinigami (maybe Ryuk? idk about swapping the Shinigami) directly hands L a Death Note because they thought he'd have fun with it.

L immediately uses it and his detective skills (along with his connections online) to solve cold cases.

"Light" (age: 24)

Real name: Tsuki Yagami

A mysterious, faceless detective who works alongside his mentor "Asahi" to solve cases that seem fun.

"I am the Light that will purge Kira's darkness! I am Justice!"

^^Total drama queen. The maniacal laughter with his voice modifier is just *chef's kiss*

Has no problems with using criminals to get results, but Asahi will often call him out on his more questionable choices.

Officer Misa Amane (age: 23)

During the Kira case, her alias is Misaki Anai

Just recently hired on the NPA

Often gets sent to fetch people coffee, much to her dismay

Wants to protect innocent people, but is unsure about her stance on Kira most of the time

Works on the Kira Task Force alongside Light and the other NPA officers

(Maybe Aizawa's the chief in this timeline? Idk about putting Quillsh on the NPA, it might be more fun to see how Kira would operate without that inside info)

Pretends to be Matsu-Matsu's manager to keep an eye on him

(She has way too much fun with the manager gig and hates having to pass it off to Mogi later. Or maybe she's a lot sneakier during the Yotsuba arc. idk)

Touta "Matsu-Matsu" Matsuda (age: 22)

Not-so-successful model (but he's having fun with it)

After finding a dropped Death Note and reading the rules, he figures out that Kira must have one too

He uses secret messages to find Kira on a Kira fansite

The two of them try to crack cases and go after criminals together

I'm still debating if Matsu gets the Shinigami Eyes. If he thinks it's the only way he can be useful to Kira he might do the trade. But also I want him to live so 😭😭

He's a pretty good cover for L once the two of them meet in person- L can pretend that he's made a friend in school to keep his father off his back

[npaconsultant-stuff-blog]

The handling of NPA Management and debt settlement are both vital to a bank s financial stability The debt balance cannot be reinvested until it is repaid

[justkidneying]

Skull Fractures: Le Fort I-III

Le Fort fractures are a specific type of midfacial fracture which can be split into three types: Type I, Type II, and Type III. These three types vary in severity and presentation. They are most commonly caused by high-speed or high-impact forces.

Facial and Cranial Anatomy 

Le Fort fractures of all types involve different bones which make up the facial structure. You can look up a picture of the skull if you don't know what I'm talking about, but you should have an idea of what's going on from. Anyways, the skull is 22 bones and that's too much to get into right now. Onto important stuff.

The mandible is not part of the skull and isn't part of what makes a Le Fort fracture, though facial trauma may also cause the fracture of this bone. It is also an important part of the facial anatomy and its misalignment with the other bones can help diagnose Le Fort fractures. 

Le Fort Type I

Le Fort type I injuries are the least damaging type of Le Fort fracture, though they still cause significant damage to the facial structures. This type of fracture involves the maxilla and pterygoid plates (four structures that are up inside the skull/back of the mouth) primarily. Due to the involvement of the maxilla, it can also be referred to as a trans-maxillary fracture. 

There are several mechanisms of injury for this type of fracture. Most commonly, it is caused by a downward blow to the face. This can be the result of a fall, assault (like stomping on someone's head), or motor vehicle accident, which causes the maxilla of the patient to impact a hard surface and detach from the rest of the facial structure. 

The downward force on the face causes the fracture of the internal structures of the maxillary sinus as well as the pterygoid plates. The fracture extends to the maxillary antrum, or the antrum of Highmore, which is a large sinus cavity that sits superior to the upper teeth and posteriorly to the nose. All three walls of the sinus are fractured, and the maxillary structures break away in a palate-facial separation.

Type I fractures oftentimes present with swelling in the upper lip and ecchymosis (bruising) to the maxilla and cheeks. The most telling sign of maxillary dissociation is malocclusion of the teeth. This means that the upper teeth are not in alignment with the lower teeth, which can be seen in dissociations and fracture of the maxilla and mandible. The triangular area of the face that comes away from the cranium is made of the maxilla, palate, and pterygoid plates.

The soft tissue damage of this fracture is mostly within the oral cavity, sinuses, and nasal cavities. This can cause the respiratory ability of the patient to become compromised. Because of the damage to the nasal passages and the possibility of fracture of the inner bones of the skull, a nasopharyngeal airway (NPA) device is not recommended. NPAs are devices made of a pliable foam or rubber, which are inserted through the nares, and allow for the linkage of the nasal openings to the pharynx (throat). When heavy facial trauma, especially to the nasal area, is present, NPAs are not indicated. Instead, airway management should be done with an endotracheal tube, which goes into the trachea (windpipe). This bypasses the damage done to the oral or nasal cavities and allows for the establishment of respiratory function. 

Other symptoms of the patient should be managed until they can reach a trauma center for further treatment, with the patient's airway, breathing, and cardiovascular function taking precedence. 

Le Fort Type II

Type II fractures are more severe than Type I. They involve more facial structures and cause a greater portion of the face to separate from the skull. This type of fracture involves the nasion, which is commonly referred to as the bridge of the nose. It also involves the medial wall of the orbit and the inferior orbital rims. Importantly, this type of fracture does not involve the zygomatic bones (cheek bones).

This fracture is best traced beginning at the nasion. The fracture extends laterally to the medial wall of the orbit and downward into the inferior orbital rim. It then crosses downward into the maxilla. Inside of the structure, the fracture extends superiorly to the hard palate, and ends with the separation of the pterygoid buttress. The section of bone that breaks away from the cranium is pyramidal in structure. 

The involvement of the orbit in this fracture increases the severity of this fracture because of the complexity of orbital bones as well as the involvement of the soft tissue of the eyes. The forces which are of a great enough magnitude to fracture this portion of the face can create severe damage to the delicate tissues inside the orbit, including blood vessels and the eyes themselves. 

Type II fractures present distinctly from Type I fractures. In Le Fort Type II fractures, there will be mobility in the maxilla, but the nasal region will move with the maxilla away from the other facial structures. The increased severity also opens a possibility of cerebrospinal fluid (CSF) leakage from the nasal passages. CSF leakage can be confirmed using a piece of gauze to absorb some of the fluid. As the CSF dries, it will create a distinct two-ringed figure, which mucous does not. CSF is also very clear and watery compared to mucous, which is yellowish and sticky. 

Due to the damage to the nasion and surrounding area, the intercanthal space (the distance between the corners of the eyes) has a high possibility of widening. This will lead to severe deformity of the normal facial structure. Bruising will be significant, with presentation of bruising on both orbital areas, or bilateral periorbital ecchymosis, sometimes called “racoon eyes.” 

As with Type I fractures, an NPA is not indicated, particularly when CSF leakage is present. This indicates a fracture deep enough to compromise the integrity of the intracranial space. If an NPA is used in this case, even the soft tip of the  device could worsen the intrusion into the cavity or cause severe damage to the sensitive nervous system structures. The airway should be established using an endotracheal tube instead. The patient should be transported with haste to the nearest trauma center.

Le Fort Type III

Type III fractures are the most severe type of Le Fort fracture. This type is also called a full facial-cranial separation. It involves the nasion, two walls of the orbit, the orbital rim, the zygomas, and the pterygoid plates. 

The path of this fracture can be traced starting at the nasion.  From there it extends laterally through the medial orbital rim and orbit. The fracture extends horizontally across the entire orbit and to the lateral rim. Finally, it extends downwards across the zygomatic arch and through the superior pterygoid plates. This fracture extends bilaterally through both sides of the facial structure5.

Due to the fracture extending horizontally through the orbit, there is a great risk of damage to the soft tissues of the eye. The fracture also extends parallel to the base of the cranium, and will cause a complete separation of the midfacial skeleton from the cranium. Because of this extreme dissociation, there is an increased risk of cerebrospinal fluid leakage. This leakage can result in infection or serious brain injury. 

This type of fracture is most typically caused by large amounts of force to the nasion and superior maxilla. This force is of a great enough magnitude to cause a fracture to extend through the entirety of the facial structure in a posterior and downwards direction. 

Many signs from Type I and II carry over, including bilateral periorbital ecchymosis, orbital edema, and buccal ecchymosis. However, Type III presents uniquely with a sign commonly called “dish-face deformity.” This condition results from the breakdown of the structure of the face, and results in a lengthened and shallowed face. There may also be a condition known as “orbital hooding” present, which is the drooping of the upper eyelid commonly seen when zygomatic structure is compromised. Battle’s sign may also be seen, which is the bruising of the mastoid region, or the region behind the ear. Enophthalmos, the sinking of the eyes posteriorly into the sockets, may also be seen. This is due to the severe damage to the orbital area. CSF may also leak out of the ears and nasal passages, called CSF otorrhea and CSF rhinorrhea, respectively. Blood may also be within the inner ear in a condition called hemotympanum. 

The severe damage to the facial bones, along with intracranial hemorrhaging and CSF leakage will most likely cause a patient with a Type III fracture to be treated as critical. Airway integrity should be maintained with an endotracheal tube, but if the oral airway is compromised, stabilization can be difficult without a tracheostomy. A tracheostomy is a procedure where an opening is made in the neck into the trachea, where a breathing tube can be inserted. This bypasses any oral damage and allows for the respiratory function of the patient to be secured. The patient should be rushed to a trauma center, as the signs presenting give an impression of a condition that can be lethal. 

Treatment

As with any trauma patient, those with Le Fort fractures should be stabilized to ensure the continuation of life before any effort is made to repair the damage to the face. This gives the patient’s airway, breathing, and circulatory systems precedence in their care. Once the patient reaches the emergency room of what is hopefully a trauma center, more specialized care can begin. This includes testing, scans, and stabilization. 

Computerized tomography (CT) scans are very useful to determine the extent of the fracture and the type. These scans use several x-rays and an interpreting computer system to create several  two-dimensional slices of the structures captured. This is important in severe facial injuries, as simple film x-rays do not typically provide enough data to accurately diagnose and see all of the damage done to the face. In Le Fort fractures, the most appropriate type of CT scan ordered is a non-contrast, fine cut scan with axial cuts. Contrast is a substance injected intravenously that allows for a better view of body structures on the scan, but it is not used in this case. Typically, contrast used in trauma cases is for abdominal injuries. The CT scan should be fine cut, which means that the slices of data gathered from the patient are 2 mm in width. This means more can be seen from the scan. 

The two main areas of treatment in facial fractures are reduction and fixation. Reduction is the process of putting the structures back where they are meant to sit. Reduction can either be open or closed. Open reduction requires the “opening” of the face through surgical means. Typically, this means that the fracture was too complex to be reset through external manipulation. A closed reduction is done without exposing the bone. This is done externally through manipulation of the structures. Fixation is the process of keeping the bones in the correct place, typically through the use of metal plates, wires, and screws.

Intermaxillary fixation can be used to repair or stabilize the fracture. This should be done after all CT scans are completed. Intermaxillary fixation uses metal pieces screwed to the maxilla to demobilize it. Typically, metal plates are also screwed to the mandible and wire is connected between the mandible and the maxilla. This will reestablish proper occlusion of the teeth. Intermaxillary fixation can be used to stabilize the face while other surgeries are done, or as the treatment itself.

Facial reconstruction is most likely with Type III fractures. In a broad sense, facial reconstruction includes the reduction and fixation detailed previously. However, it also includes more fine and cosmetic reconstruction. After a more severe fracture and the resulting fixation, the skin and formation of the face can be altered from the patient’s original appearance. Due to this, there may be more extensive work required by a plastic surgeon after the initial treatment to repair the bone structure.

The goals of the fracture repair are to reestablish proper structure and restore the integrity of the face. The correct facial projection should be reclaimed, as to correct any deformity or dish-face condition. The sinus cavities should also be repaired so that they have proper function and location within the facial structure. The realignment of the orbital and nasal structures is also important to the overall soundness of the facial structure and function. Finally, malocclusion should be remedied, as proper occlusion of the teeth is necessary for not only facial structure, but the function of the teeth and mouth in chewing food.

Outcomes

The recovery of this type of fracture can be long and difficult, but the ultimate outcome is generally good. Mortality rates of patients with complex facial fractures, which includes Le Fort fractures, are estimated around 11.6%. Mortality of patients with simple facial fractures is estimated around 5.1%. For Le Fort fractures specifically, there are different mortality rates for each type. For Type I, there is a 0% mortality rate. For a Type II fracture, there is a 4.5% mortality rate. For Type III fractures, there is an 8.7% mortality rate. 

Besides death, disability can also be the result of Le Fort fractures. The following conditions have been reported as a result of Le Fort fractures: difficulty breathing (31% of patients), difficulty chewing (40% of patients), vision issues (47% of patients), double vision (21% of patients), and excessive tearing and poor eye drainage (37% of patients). These disabilities can greatly affect the ability of the patient to return to normal activities. For Type I and II fractures, 70% of patients were able to return to work. For Type III fractures, only 58% reported being able to return to work. The facial deformities resulting from these fractures and their repair have an impact on the patient’s mental wellbeing. Of patients who had facial surgery, 89.1% reported satisfaction with the outcome of their appearance.

End Notes

Wow this was fucking long, wasn't it? I guess I just got going and couldn't stop. Now you know everything you need to know about Le Fort fractures, which was probably nothing. But anyways, I wanted to include the outcome of severe injuries like these because I feel like in fiction I don't see it enough. Like if you get that fucked up you're gonna need some help for a while. I also think I see too many NPAs in patients that don't need them or shouldn't have them, so I think that might be some valuable information. I'm gonna write on the structure of the nose eventually, but for the love of god don't stick anything up there, especially if someone has head trauma.

Thanks for reading :))

[devendrajain15]

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