Closed jaw fracture treatment. Symptoms and treatment of a mandibular fracture. If a child is hurt

In traumatology, facial injuries are often encountered (2% -5%). fracture upper jaw characterized by the formation of a gap along the seam connecting the bones of the face and the base of the skull. A seam is a part with a reduced strength of the skeletal system. Therefore, cracks do not appear within the anatomical structure. jaw system, but in adjacent elements. Clinically, the modification is manifested by breaking out the chewing apparatus - a fracture of the jaw with displacement.

The upper jaw has a centralized location and is interconnected with the brain and facial bone systems: zygomatic, frontal, nasal, ethmoid, sphenoid, lacrimal.

It is included in the structure of the eye sockets, mouth and nose. The maxillary sinuses are thin, but able to withstand intense mechanical stress.

Bottom part cranium whose main function is to grind food. It consists of chewing muscles, jaw bone, blood vessels, jaw joint.

The lower chewing part of the skull is represented by one bone, which is formed in a person at the age of 2 years. Children under two years of age, when examined on an x-ray, have a lower jaw, consisting of two parts.

Causes of the fracture

The causes are severe mechanical damage as a result of a traffic accident, a fall from a height, a blow to the face with a blunt object or a leg, etc. The displacement is complicated by a traumatic brain injury (TBI).

Modification of the design occurs in systemic diseases (osteochondrosis, malignant and benign tumors, osteomyelitis). With a lack nutrients, trace elements and vitamins bones weaken, become brittle. A slight impact in such situations leads to damage and displacement of the facial apparatus.

The jaw box moves back - under the influence of the direction of the impact force; down or to the side - under the weight of the debris.

The localization of the crack in the area of ​​the box is different. Places where the gap is formed: the first incisors, small molars, canines, the area of ​​\u200b\u200bthe angle and the condylar process.

Classification

Jaws are common pathologies that occur in middle-aged people: mainly in men aged 20 to 40 years. Fractures are classified according to the severity of the injury and the nature of the displacement. Classification of changes:

1. Complete fracture - complicated by oblique, zigzag and transverse displacement.
2. Incomplete - without displacement.
3. Open - accompanied by damage to the skin, muscles, bleeding. Often occurring, characterized by the interaction of the microflora of the oral cavity with the injured area, which leads to frequent infection and long-term treatment.
4. Closed - visible changes there are no muscles and skin in the surrounding tissues. Refers to injuries of the upper jaw, is less dangerous and easier to treat conservatively.
5. According to the Le Fort I type, the presence of cracks inside the skull and damage to brain tissue.
6. According to the Le Fort II type - the crack passes through nasal septum, the infraorbital nerve is damaged.

Complete fracture

It is classified according to the type of change in position: with and without displacement, comminuted.

• Full with displacement - the tissues are deformed, unnaturally located, not interconnected, the jaw box deviates in the direction of impact or under the weight of the muscle or bone component.
• Complete without shift - characterized by the presence of a gap and a traumatic line without damage.

• splintered - found in clinical practice rarely. Occurs as a result of the impact of a strong mechanical shock on a small area of ​​\u200b\u200bthe bone. Multiple fragments undermine the stability of the entire structure. Treated with surgery.

Le Fort I fracture

Displacement of the high severity of the course and treatment that requires the participation of several medical specialists in neurosurgery and neuropathology. It is conditionally referred to as the jaw, since upper bones separated from the skull.

Symptoms: Doubling of the image due to damage optic nerve, blurring, pain when opening and closing the mouth, unnatural arrangement of teeth, vomiting reflex, sensation of a foreign object when swallowing.

Clinical symptoms:

• significant swelling in the cheeks, nose, temples, under the eyes;
• sunken cheekbones;
• spherical shape of the face;
• swelling of the conjunctiva, its bulging when the eyelids close;
• the mouth does not open completely;
• when changing position - the movement of the eyeball.

The patient, when closing the teeth, experiences a feeling of raising the eyeballs upward. In this position, the doubling of objects is reduced. On palpation, a protrusion is felt. When opening, the pain is localized in the upper part, when closing, an open bite is observed.

Remember! Atypical movement of the upper jaw is the main evidence of an injury.

Fracture Le Fort II

The integrity of the skull and brain is broken. The patient points to the following symptoms: headache temporal region, lacrimation, loss of smell due to damage to the olfactory filaments, vomiting, difficulty in inhaling through the nose and mouth, sensation of a foreign object, numbness of a part of the face.

When observing, the doctor pays attention to pathological form face, severe swelling, protrusion under the lower edge of the orbit, lacrimation, malocclusion, inability to open the mouth.

Species definition shape algorithm therapeutic methods. The bones may move slightly, which cannot be visually fixed. Therefore, the patient is sent to X-ray. Splinters can damage the circulatory system, nearby tissues. Therefore, before the start of treatment, the victim undergoes a thorough examination and examination.

General symptoms

Signs of a jaw fracture - both external and internal changes facial segments. Symptoms are divided into subjective (personal sensations) and those obtained during the examination. It is possible to summarize the whole picture of the course of the disease into clinical components:

• Intense pain, tenderness on palpation.

The patient experiences sharp pain when moving the mouth. When injured, the periosteum is damaged, which is equipped with large quantity nerve endings. Also others nerve fibers may break.

• Bleeding of varying intensity. Blood is directed into the cavity, with penetrating wounds - through the openings of the wounds.

Important! Heavy bleeding indicates a rupture large vessel. Large blood loss can be fatal, so immediate medical attention is required.

• Puffiness. Edema is formed at the site of injury, changes the contour of the face, swelling of red, cyanotic colors appears - signals internal bleeding.
• Violation of the integrity of the skin. As a result of mechanical action, a rupture of the skin, muscles, and soft tissues of the face occurs.
• Bone changes in the base of the skull, cervical spine are concomitant changes that complicate the treatment process. Diagnose damage to the spinal and cervical by discharge through the nose or ears. Homogeneous blood suspensions indicate damage only to the circulatory system. Discharge of a yellowish substance blood clots indicate the presence in the secreted cerebrospinal fluid.

First aid

We provide first aid to the victim before the examination by the doctor. The algorithm of actions is as follows:

• provide peace;
• in the presence of foreign objects release it in the oral cavity;
• fix the jaw with a bandage;
• apply a cooling compress;
• give painkillers;
• watch your tongue so that it does not sunk.

We transport the patient to lying position sideways or head down.

In the hospital

Once an injury is diagnosed, treatment should begin as early as possible. This will avoid complications and reduce the appearance negative consequences in aesthetic and medicinal form. The maxillofacial surgeon is engaged in the restoration of the bone structure. Displacements lasting 10 days or more are difficult to treat, because after time the damage does not grow together correctly.

You can determine the displacement according to the complaints of the victim and when visual inspection. But fragmentation elements, hemorrhages complicate the course of the disease. Therefore, additional methods of studying trauma are used.

Diagnosis of the disease includes following methods examinations: radiography, MRI, CT, orthopantomography.

Radiography is a simple diagnostic method that allows you to determine the type of injury, the presence of displacement, fragments, and the number of cracks. X-rays are taken in all projections. The picture shows the cranial vault and upper cervical vertebrae. The disadvantage of the study is that the patient is exposed to radiation.

The method of orthopantomography is safer. Orthopantomography is performed using an orthopantomograph. It reproduces the jaw box in all projections, including adjacent bones. The study takes a few minutes.

Computed tomography (CT) is used to detail the injury and for complicated fractures. The method gives a complete informative picture of the injured area, since the bones can move in different directions and at different angles.

The condition of soft tissues, the presence of hemorrhages, damage to the brain and other facial organs is examined using magnetic resonance imaging. Tomography diagnoses vascular, muscle ruptures, detects joint prolapse. Vessel analysis by MRI is further achieved using magnetic resonance. Intravenously, the patient is injected with a special reagent, which, passing through circulatory system, illuminates it.

Determining the type of injury helps determine the appropriate therapy.

The sequence of medical actions:

• disinfection of wounds;
• manual reduction under anesthesia;
• fixation of the bones of the face in a normal position by means of splinting and special devices(knitting needles, metal plates)

How long does a fracture heal, how long does it take for an injured jaw to function normally?

Attention! Facial bones grow together for at least a month.

If you are interested in what harm a fracture will bring to health, then this may be a complication of infection through untreated dental diseases. Bad teeth are a source of infection. Osteomyelitis is one of the most common complications that accompanies damage to the tissues of the bone itself. It softens the bone structure and increases the risk of negative consequences.

Death from an injury occurs in 10% of cases out of 100.

Back to normal life

Consequences from trauma can be prevented. The restoration of chewing function depends on the degree of health of the patient himself and the presence of concomitant diseases.

Physical therapy, physiotherapy and careful oral hygiene will help restore health. Exercise therapy is prescribed by the attending physician a month after the injury occurred. It is aimed at the return of speech and facial expressions, the functions of chewing and swallowing. The risk of inflammation or infections will be prevented by a complex of antibiotics.

Food in postoperative period should be sparing: food is served chopped, its temperature should not exceed 50 ° C. Main dishes: mashed potatoes, soups, rolled through a blender, vegetable and meat broths.

If it is possible to restore physiological health, then many external aesthetic disorders are difficult. After an injury, the patient develops asymmetry of the face, deformation of the teeth, malocclusion, unpleasant crunch when chewing.

A jaw fracture is a dangerous disease that can lead to external pathologies and loss of a normal standard of living. For severe injury facial bones with a large loss of blood is possible fatal outcome. The displacement of the bone occurs under the influence strong pressure. Before the arrival of the ambulance, the victim is provided with auxiliary actions that alleviate the patient's condition. Recovery requires long-term treatment and rehabilitation.

In medical practice, a jaw fracture is quite common, and recovery after it is very laborious with highly likely occurrence of complications. Therefore, it is extremely important to know how to properly help the victim, as well as in time to contact a specialist for qualified therapy. The result depends on a large number of factors - clinical picture, the correctness of medical prescriptions and their strict observance.

What is a jaw fracture

Jaw fracture is severe pathological condition, in which the linear integrity of the bones of the lower jaw is violated to one degree or another. It can be caused by one of the traumatic factors as a result of mechanical impact, or serious illness(osteomyelitis, bone syphilis, tumors). There is also a violation of the integrity of surrounding tissues - facial muscles, blood vessels, nerves.

There are a number of factors that provoke jaw fractures, these are:

• Alcohol consumption. As a result, the risk of injury increases both in road accidents and due to falling or participating in a conflict using physical force;
• Features of the anatomy of the bone, which is movably fixed in extreme points jaws and forms an arc;
• The use of such Vehicle like a motorcycle, especially without reliable protection;
• Features of the structure of the chin. It is on this most protruding part of the lower jaw that the traumatic effect most often occurs;
• Some statistics. A jaw fracture occurs primarily in men aged 21 to 40 years.

Here is a classification of mandibular fractures depending on various parameters:

1. By location. Allocate damage to the lower or upper part of the jawbone;
2. By causal factor. This is a fracture of the jaw due to trauma, as well as as a result of pathological process in the bones soft tissues;
3. According to the degree of violation of the integrity of the jaw. There are both complete fractures and incomplete ones, a break or a crack;
4. By the number of debris. According to this classification, a single fracture of the lower jaw, double, triple or already multiple is distinguished;
5. Along the line of influence. The following varieties are noted - longitudinal, transverse, zigzag, straight, oblique, comminuted;
6. Degree of soft tissue damage. It could be closed fracture lower jaw, when only the bone is affected, and open with injury to muscles, blood vessels, nerves;
7. According to the degree of difficulty. Against the background of an injury, defects can occur, sometimes this does not happen, there are combined cases.

Symptoms

It is not always possible to recognize a fracture of the lower jaw at first glance, and a specialist should give an objective picture. The situation is complicated by the fact that the victim may not be conscious or receive, in addition, a head injury. Therefore, when it is necessary to determine a fracture in the lower jaw, the symptoms should be evaluated separately - both felt by the person himself and objectively.

Pain

With this variant of the injury, pain always appears, wears strong character especially in the area of ​​damage. It intensifies with any manipulation - during a conversation, eating, with other movements. This is most likely due to a rupture of the nerves or periosteum, where there is also a large number of sensitive endings, which has begun an inflammatory process.

Sometimes there is a so-called reflected pain, when bone fragments are displaced. You can detect this by pressing on the chin, a painful sensation of a pronounced nature will occur just at the site of the injury.

Bleeding

Similar symptoms of a jaw fracture are found in any type of injury - open or closed. In the first case, blood enters the oral cavity, or it happens through the skin - this is the result of damage to the blood vessels passing through the bone itself, the periosteum, and soft tissues.

If the fracture of the lower jaw can be classified as a closed type, the fluid cannot come out, it accumulates at the site of the rupture, forming clots.

At very profuse bleeding urgent help is required immediately, this indicates a rupture of a large vessel.

Puffiness of the face

When symptoms occur with some difference in time and for a number of reasons. For example, edema is formed not only due to impact, but also in different parts of the bone due to bleeding under the skin, in soft tissues. Warming, pastosity, reddening of the integument at the site of damage also appears. This happens due to the active transfer of anti-inflammatory substances through the vessels, which become more susceptible to the liquid component of the blood.

Fractures of the lower jaw rarely do without complications or aggravating factors, for example, it is precisely because of the displacement of bone fragments that the relief of the skin at the site of injury apparently changes. Depending on the degree of displacement, this can be determined visually, or only by palpation. This is done very carefully, it is necessary to start from the opposite part of the jawbone, probing its lower edge with your fingertips.

Skin damage

When an injury occurs due to external influence such a consequence is inevitable, suffer skin faces, heads. Sometimes not only fractures of the lower jaw occur, but also other bones (cranial, nasal, maxillary), as well as the spine, the spinal cord may be affected. In this case, abrasions, scratches appear in a large percentage of cases.

Other signs

Along with the above symptoms, other signs of a jaw fracture may be present:

• Decreased sensitivity in the affected area or the entire face due to rupture of nerve endings;
• Difficulty chewing, swallowing, talking;
• tongue drop;
• Increased salivation;
• Dizziness, state of shock;
• Significant and unnatural mobility of the jaw;
• The appearance of gaps between the teeth, their mobility;
• Difficulties in closing the jaws;
• Severe rupture of the oral mucosa.

Diagnostic measures

In case of jaw fractures, classification is of great importance for operational medicinal purpose. The difficulty in taking anamnesis is that big number similar injuries occur with victims who are intoxicated.

In addition to the external examination, radiography, computed tomography, MRI or orthopantomography, clinical and laboratory studies are performed, we will consider these activities in more detail.

Definition of the clinical picture

Any injuries, including mandibular fractures, are assessed both in terms of objective symptoms, as well as the results of a survey of the patient himself. Subjectively, this is felt by the appearance of pain at the site of injury and numbness in the tissue area beyond its border.

Tell your doctor if you have any of the following side effects indicating traumatic brain injury:

1. Headache;
2. Nausea and vomiting;
3. Difficulties with orientation in space;
4. Inhibition of reflexes.

Also, the specialist necessarily conducts a study of the patient's airway patency, determines the frequency respiratory movements, pulse.

Magnetic resonance imaging

This high-precision method is able to detect not only a fracture of the lower jaw or other bones, but also to identify the condition of blood vessels, nerves, periarticular tissues, intra-articular discs, the degree of muscle damage, the presence of hemorrhage and joint ruptures. it The best way see the effects of trauma on soft tissues with the necessary accuracy of the result, especially its use with contrast.

If there are no implants or metal elements in the patient's body, there are no contraindications for such a procedure.

Radiography

Mandibular fractures are usually detected using this simple method giving exact result- the very fact of damage is determined, including its exact localization. During the study, not only the lower, but also the upper jaw is visible in frontal and lateral projection, the picture shows a number of cervical vertebrae, the facial skeleton, the base and the vault of the skull.

So the specialist can find out where the fracture site is and how many there are in total, whether fragments are present, whether there is displacement, hemorrhage. Minus this method- irradiation of the body, which in some cases is highly undesirable.

Orthopantomography is considered a more gentle method to detect fractures of the lower jaw. This is also an X-ray performed while fixing the patient's head and rotating the source around it. x-rays and films. Can get it panoramic shot dental system for about five minutes, showing whether there are fractures of the jaw, how many of them, whether the molars and temporomandibular joint are not damaged.

A clear layered image of the studied areas makes this type of study the most successful if the patient is not lucky enough to break his jaw. Computed tomography appointed in some cases:

• If you suspect a fracture of the bones in the neighborhood;
• If a jaw fracture is to be treated through surgery;
• If the x-ray revealed two or more fractures and additional diagnostics are needed;
• In case of damage to the dentition.

Thanks to the technique, it is possible to quickly obtain a clear and detailed image, which also reveals the presence of a traumatic brain injury, which is extremely important when there is a risk of hemorrhage.

There is also a disadvantage - this is a small dose of radiation during the passage of this procedure, which is present in any radiological examination.

First aid

Everyone needs to know what to do if a jaw fracture is suspected, so that in the future the victim has as few complications as possible. Based on his condition, it is necessary to call an ambulance, or independently transport him to a medical facility. In doing so, you can perform the following actions, depending on the situation:

Possible Complications

Prompt referral to specialists guarantees the most favorable outcome for this type of injury. But there is always the possibility of the following complications:

1. The appearance between the teeth of gaps that did not exist before;
2. Appearance malocclusion;
3. Molar displacement;
4. Deformation of the maxillofacial bone.

If the victim had a slight single fracture, with a prompt request for help and compliance with all prescriptions, the course of treatment is no more than a month. In some cases, further surgical intervention to restore the affected areas of the face.

Treatment Method

Treatment of a mandibular fracture includes the following steps:

• Treatment of wounds, disinfection;
• Alignment of the nasal septum, if necessary;
• The combination of bones, fragments;
• Jaw adjustment with a splint, sometimes plates are used, which are fixed with screws;
• Recovery procedures.

The treatment prescribed for a fracture of the jaw, on average, takes up to one and a half months, so that the bone has time to grow together, followed by rehabilitation. Anti-inflammatory drugs are used - antibiotics, tonic, antifungal agents.

Also, high-quality treatment of fractures is impossible without proper hygiene oral cavity at home. The tire and the teeth themselves must be thoroughly cleaned of food debris, you need to use antimicrobial rinses, antiseptics, a soda solution helps a lot.

In addition, to cure the patient is called upon special gymnastics which must be carried out immediately after removing the tire. Physiotherapy is also shown, this is an electromagnet operating at ultrahigh frequency, low-frequency pulsed magnetic effects, ultraviolet, calcium electrophoresis at the fracture site.

Each person strives to ensure that his face looks perfect - any irritation, inflammation, and even more trauma can ruin it. One of the most severe injuries of the facial part of the head is considered to be a fracture of the jaw: lower or upper. Trauma involves damage to the integrity of the bones due to the impact of a traumatic factor that exceeds their strength.

Most often, such injuries occur from a direct blow to the jaw area or as a result of a fall. The symptoms of a fracture are quite easy to identify, since the victim is not able to open his mouth wide, his bite changes, and at the moment he speaks, he experiences severe pain. With this injury, it is very important to be able to properly provide first aid, and the treatment of a fracture should be carried out only by a qualified one.

Types and causes of a broken jaw

Jaw fractures are among the most frequent injuries facial skeleton. According to statistics, about 70% of all cases of fractures fall on the fracture of the lower jaw. bone skeleton person's face. In connection with anatomical features the bones of the lower jaw, which resembles a horseshoe in shape, can have single, double and even multiple fractures. The injury is often accompanied by a concussion.. The location of fractures most often becomes the area of ​​the canines (canine fracture), incisors (middle or incisive fracture), the chin area (mental fracture), beyond the 8th tooth (angular fracture), at the base of the condylar process, near the coronoid process (cervical fracture) etc.

The main causes of injury can be called direct blows, when a traumatic force is applied directly to the jaw area, or reflected blows resulting from bending. Fractures in the area of ​​the dentition are usually open.

Fracture of the lower jaw can be classified into the following types:

• complete - with displacement of bone fragments and the jaw itself;
• incomplete - without displacement;
• open - in which the mucous membrane of the oral cavity is damaged, as well as soft tissues in the face;
• closed - when a broken bone remains inside and does not break through the soft tissues of the face;
• comminuted - which occurs only as a result of exposure to a very large force and requires mandatory surgical intervention.

A fracture of the upper jaw, according to medical statistics, accounts for about 30% of all cases of jaw injuries. As a rule, the injury is classified according to the line of fracture.

In practice, this could be:

• the bottom line, when the fracture has a direction from the pear-shaped aperut (its beginning) to the process of the sphenoid bone;
• the midline, when the fracture occurs along the nasal bone, capturing the bottom of the orbit and the pterygoid process;
• the upper line, at which the fracture goes to the cheekbone area, through the bones of the nose.

Broken jaw symptoms

For mandibular fractures, symptoms such as severe and sharp pain, which will intensify when trying to move the jaw, speak or palpate the site of injury, ajar mouth position, violation of the natural ratio of teeth between the upper and lower jaws, salivation with an admixture of blood, the formation of swelling, hemorrhage, which provokes asymmetry of the face.

Symptoms can also be supplemented by increased tooth sensitivity. When especially severe injuries may take place pain shock, heavy bleeding, disorder respiratory function.

If the injury is accompanied by a massive displacement of fragments, which most often happens during an accident, then even a fatal outcome is possible. This is due to the ingress of blood into the respiratory tract, as well as as a result of brain damage.

With a fracture of the upper jaw, the following symptoms may be observed:

• the appearance of swelling of the lips, nose, cheeks and bleeding in the area between the teeth and the lip, which most often occurs with fractures under the roof of the sky, with a fracture of the nose and a fracture of the maxillary sinus;
• a feeling of numbness and the formation of a hematoma in the area under the eyes, nasal bleeding and salivation from the mouth, lack of smell or its violation, which often occurs when the upper jaw is torn off the base of the skull and when crossing the fault line of the bridge of the nose and orbit;
• violation visual function, the inability to open the mouth, a noticeable asymmetry of the face with the formation of hematomas around the eyes, as well as lowered down eyeballs, which is typical for trauma with a detachment of the jaw and a fracture of the base of the skull.

Regardless of the type of fracture and its location, the victim will feel severe pain, nausea (sometimes with the occurrence of a gag reflex). Vital functions, including chewing, breathing and speech will be complicated. In this regard, it is very important to be able to properly and timely provide first aid to the victim.

How to provide first aid?

If the victim has minor injuries to the jaw, and the symptoms of injury are not significantly expressed, then you can limit yourself to first aid, which involves creating maximum rest until the ambulance arrives. Both jaws of an injured person can be gently fixed together with a bandage or other dressing. Before the arrival of the ambulance, the patient should be in a supine position on his back..

If the damage is more complex and there is a violation of the respiratory function, significant blood loss and intense headache, it is necessary to act more decisively. In this situation, you need to try to stop the bleeding, using improvised means for this or simply pressing the wound with your fingers. Next, you should eliminate the factors that complicate breathing. To do this, the victim can be placed face down or move the tongue forward. There should be no fillers in the mouth, such as vomit or blood clots. If the patient has signs of lack of breathing, then artificial is necessary. An ambulance must be called immediately.

The victim can be offered to take an anesthetic, for example, analgin. If it is not possible to take a tablet, then it must be dissolved in water and allowed to drink or be injected. For decreasing pain syndrome, vasoconstriction and removal of puffiness, you can use cold, for example, ice wrapped in any cloth.

Treatment and its features

Treatment of a jaw fracture after the victim is admitted to the hospital begins with a thorough examination.

Usually, diagnostic measures in this case suggest:

1. visual and manual inspection for the presence of facial deformity, pain on palpation, the integrity of the dental arch, the presence of a hematoma in the sublingual region.
2. x-ray examination jaws in several different projections or overview shot, which allows you to determine the location of the fracture and the presence of displacements.

The first treatment will be aimed at comparing bone fragments, immobilization by means of a special splint, splinting by applying wire dental splints, threads or metal rods. In the future, wounds are sutured, and in case of serious damage, plate sutures are applied. To prevent traumatic osteomyelitis, a course of antibiotic therapy is carried out. The whole process of treatment can take, depending on the severity of the injuries received, from 1 to 2 months.

In case of jaw injuries, it is very important to provide the patient with good nutrition, since eating in many cases can be difficult. The diet should consist of high-calorie foods, and its intake can be from a special drinker or by means of feeding from a teaspoon.

Could there be consequences

During the diagnosis of jaw injuries, it is necessary to exclude a concomitant lesion spinal column. For this, an X-ray examination of the cervical spine is additionally performed. It is also necessary to exclude the presence of intracranial bleeding and concussion of the brain. These injuries are treated in parallel.

Basic and very dangerous consequences incorrect and unskilled treatment of a fracture of the jaw, there may be a displacement of the dentition, the formation of interdental spaces, the formation of malocclusion as a result of displacement of the teeth, the development of meningitis, osteomyelitis. Thus, the sooner the treatment of the injury is started and the more qualified it is, the more chances the patient has to avoid unpleasant consequences and return to a fulfilling life.

The main task of a dental surgeon during the treatment of a fracture of the upper or lower jaw is to restore the anatomical structure of the broken bone and the correct ratio of the dentition. Many methods help to achieve this, however, the effectiveness of treatment also depends on how correctly and quickly first aid was provided.

Before hospitalization

First aid to the victim includes:

• stopping bleeding (pressing or packing a wound, applying cold);
• if necessary cardiopulmonary resuscitation;
• anesthesia (analgin, revalgin intramuscularly);
• immobilization of the jaw with fixing bandages (contraindicated if the victim is unconscious, as this increases the risk of suffocation from retraction of the tongue or ingestion of vomit into the respiratory tract).

Treatment Methods

1. Operative, or the method of osteosynthesis, consists in fastening fragments of the jaw with special, often metal, structures.
2. Conservative, or orthopedic - involve the use of special splints that fix the fracture site.

Osteosynthesis

Indispensable for complex, splintered and multiple fractures misaligned, loose teeth and total absence teeth, with periodontal disease and other inflammatory diseases of the gums in the area of ​​injury. Also, osteosynthesis is effective in fractures of the condylar process, complicated by dislocation. articular head lower jaw.

The fastening materials can be steel knitting needles and rods, pins, tinane nitride wire with shape memory, fast-hardening plastics, polyamide thread, special glue.

However, the most convenient and safest method today is osteosynthesis with metal miniplates. They allow you to dissect the skin and muscles on one side only, which simplifies the operation itself and reduces the recovery time. Another indisputable advantage of them is the ability to reliably fix fragments in areas with significant dynamic loads.

Splinting of the jaw

This is the immobilization (fixation) of bone fragments using a special plastic or wire structure.

The technique, created by military doctors at the beginning of the 20th century, is successfully used by dentists today. Tire manufacturing materials have changed, methods of its imposition have been improved.

Today, there are many types of tires in the arsenal of a specialist:

• from standard Vasiliev band splints, the simplest and cheapest treatment method;
• up to the Tigerschdedt aluminum splints, which are performed individually for each patient, due to which they are more effective. In addition, they evenly distribute the load and minimally injure the teeth.

The type of splinting depends on the type of injury and can be unilateral (with a fracture of one jaw) or bilateral (when both are damaged).

If the teeth are preserved, it is not difficult to apply a bent tooth wire splint. It is bent according to the shape of the dental arch and fixed with bronze-aluminum wire ligatures, which, like a hairpin, cover the tooth on both sides. Manipulations are performed under local anesthesia.

In case of a fracture of both jaws, a structure with a more rigid base is installed, in addition to the wire, hooks and rings are also used to immobilize the lower jaw.

Is it possible to do without splinting?

Even if the case is not severe - the fracture is unilateral, closed and without displacement - it is imperative to take measures to exclude the development of such unpleasant complications, how:

• accidental displacement of fragments,
• re-injury,
• the development of soft tissue inflammation,
• fracture site infection.

For this, it is necessary to immobilize the jaw with any accessible method. It can be a sling bandage, but it is much more convenient and efficient to use a splint. With a complicated fracture, splinting is indispensable, regardless of the site of injury.

What will happen to the tooth at the site of injury?

If it is mobile, fragmented, dislocated, or prevents the jaw fragments from being repositioned, it will have to be removed. The same fate awaits the tooth in the presence of periodontal disease, cysts, granulomas and other inflammations. In other cases, the teeth can be saved, but require careful observation.

Management of a displaced fracture

In such cases, before applying the splint, it is necessary to compare the fragments of the jaw, for which purpose the correcting orthopedic devices are used. A broken upper jaw requires traction with special splints.

Such injuries are very dangerous because they can cause asphyxia. But properly rendered first aid will prevent suffocation. Clear oral cavity from foreign bodies or blood, lay the victim face down, placing a roller rolled up from clothes, blankets, etc.

Rehabilitation after a jaw fracture

For successful treatment fracture of the jaw, anti-inflammatory and restorative therapy, physiotherapy, mechanotherapy and special oral hygiene are also important.

1. Within 3-4 days after the injury, antibiotics must be prescribed to prevent inflammation, which are injected directly into the area of ​​​​damage.
2. General strengthening therapy is the intake of vitamins C, P, D and group B, drugs that stimulate tissue regeneration and restore the level of leukocytes in the blood.
3. Among the effective physiotherapy, we note UHF therapy, general UVR, magnetotherapy. Already after the third procedure, swelling and soreness are noticeably reduced, the swelling subsides. For better passion of fragments, 2 weeks after a jaw fracture, electrophoresis is performed using a two to five percent solution of calcium chloride.
4. Mechanotherapy, or physical therapy, accelerates the restoration of jaw function, helps if after an injury the mouth does not open well or does not open at all. It can also be practiced at home, starting from 4-5 weeks after the fracture, when the tires are removed and the callus is formed.
5. Special hygiene involves irrigation at least 8-10 times a day. Victims who are unconscious are treated with a special solution at least twice a day for teeth and mucous membranes.

How to eat?

Since during intensive care and during the recovery period, the jaws are rigidly fixed and habitual chewing of food is out of the question, a correction in the diet is necessary during this period.

Food should be the consistency of low-fat sour cream. These are broths, pureed soups, carefully chopped vegetables and fruits, milk drinks, liquid cereals. Spices are excluded, the use of salt is limited. The temperature of the dish should be no higher than 45-50 ° C. It is most convenient to eat food through a straw.

It is necessary to gradually switch to the usual diet after removing the tire. This is important not only for the restoration of chewing functions, but also for the prevention of disorders in the digestive tract.

When are the splints removed, and how long does the jaw heal?

The older the patient and the more complex the fracture, the longer the rehabilitation period will be required. Approximately it is from 45 to 60 days. Splints are removed on the 30-45th day, if the treatment did not include osteosynthesis, and on the 5-14th day after it.

How much does it cost to treat a broken jaw?

The price depends on the nature of the injury, whether osteosynthesis was performed, what tires were used, whether the patient attended physiotherapy procedures. But let's say for sure that the service is not cheap. Only osteosynthesis will cost from 14,000 to 55,000 rubles.

It is also necessary to take into account the cost of the subsequent dental treatment to restore lost or damaged teeth after splinting. Our service will help you choose a competent specialist and not waste your money. Compare prices and services various clinics Read testimonials from real patients.

- This is a trauma to the face, with damage to the integrity of its bones. Occurs when the intensity of the traumatic factor exceeds their strength. This damage is common, any injury can be the cause: strong blows to the face, falling on a hard surface.

Most often, traumatologists observe a fracture of the articular process, although there are injuries in the region of the angle of the lower jaw, in the middle of the body of the lower jaw bone, in the projection of the mental process. The fracture can be complete or not, open or closed.

Signs of trauma are obvious: a person is unable to open his mouth wide, when he tries to talk, he experiences pain, the bite changes. Sometimes there may be double vision, numbness of the face, deformity of the cheekbone. The full list of symptoms will depend on the nature of the injury and its location.

Fracture of the lower jaw

If we talk about a fracture of the lower jaw, then the main types of such an injury should be considered:

Complete fracture is considered in the case when there was a displacement of fragments, jaws. They may vary in shape and quantity.

A fracture is called incomplete when no displacement is observed.

At open injury the mucous membranes of the mouth and the soft tissues of the face are also damaged.

At closed injury the bone does not break through adjacent tissues, but remains inside them.

Comminuted fracture the jaw is rarely observed, since it requires the application of incredible force to occur. He needs mandatory surgery.

The following signs are characteristic of a mandibular fracture:

Swelling and hemorrhage in the damaged area and the asymmetry of the face caused by these phenomena. , as a rule, strong, with reddening of the skin and an increase in its temperature. When the fracture is closed, blood accumulates in the soft tissues and forms a clot. With an open injury, blood enters the oral cavity more often than into the external environment. How stronger blood loss, topics larger vessel was damaged, and the faster the first aid and delivery of the victim to a medical facility is required.

Sensation of pain when touched. It intensifies when you try to talk, as the periosteum is damaged.

Displacement of fragments of varying degrees of severity, their mobility.

Change in bite.

Increased sensitivity and electrical excitability of teeth.

Depending on where the injury is localized, there are:

Fracture passing through the center of the incisors - median.

The injury between the first and lateral incisors is incisal.

A fracture localized in the canine region is a canine fracture.

The injury opposite the chin is mental.

Injury to the body of the jaw, the one that is located between the 5th and 8th teeth.

In the upper third of the jaw - a fracture of the branch of the jaw.

Fracture of the base of the condylar process.

A cervical fracture, that is, one that is located near the process of the jaw (condylar) and a coronal one, located near the coronoid process.

First aid, if a person has received a fracture of the lower jaw, is as follows:

To begin with, the jaw must be fixed. This is done with a bandage. Under the teeth, you need to put a flat hard object, for example, a ruler. Then the lower jaw is pressed against the upper jaw and immobilized by wrapping it with a bandage. If a person is not conscious, then this cannot be done, since it will be possible to skip swallowing the tongue or getting vomit into the airways.

If there is bleeding, then it must be stopped. To do this, it is pressed or plugged with a clean, preferably sterile material. If you additionally act on the site of injury with cold, then this will help reduce blood, and also somewhat alleviate the pain symptom.

It is important to leave the oral cavity clean from possible fillers, in particular: blood clots and vomit.

Try not to disturb the person before the arrival of the medical team. It is better that he sits, if this is not possible, then you can lay him face down or on his side.

When strong pain need to lighten them. For this, analgin, revalgin, naproxen are used. Since a person with such an injury will not always be able to swallow a pill, it is necessary to crush it into powder and, having dissolved in water, give the victim a drink. It will be even more effective intramuscular injection, but, as a rule, when providing first aid, it is rarely possible to do it. It will help alleviate the condition and the cold, which will narrow the blood vessels, reduce swelling and pain. But before applying ice, it must be wrapped with a cloth.

After carrying out these activities, the person must be taken to medical institution for further professional therapy. An x-ray is used to diagnose a fracture. Since this is a serious injury, often accompanied by a spinal injury, an additional x-ray of its cervical region is often prescribed before starting treatment. This is done to prevent damage. spinal cord. It is also necessary to make sure that the person does not have a concussion and intracavitary cranial bleeding.

Fracture of the upper part is somewhat less common and accounts for up to 30% of all cases of jaw damage.

It is classified according to the line of fracture:

The lower line (lefor one) has a direction from the beginning of the pear-shaped aperut to the process of the sphenoid bone (pterygoid).

The middle line (lefort two) runs along the bones of the nose, capturing the bottom of the orbit and the pterygoid process.

The top line (lefort three) is directed to the cheekbone, through the bones of the nose.

The danger of injury lies in its consequences, which can be expressed in, concussion and. The higher the break line is, the more often undesirable consequences occur.

Signs of a fracture of the upper jaw, depending on its type:

If there is a fracture under the palatine vault, with a fracture of the maxillary sinus and a fracture of the nose, the victim has swelling of the cheeks, nose and lips, with severe bleeding between the lip and teeth.

If part of the upper jaw is torn off from the base of the skull, and the fault line crosses the orbit and bridge of the nose, then there is numbness of the area under the eyes, and pronounced hematomas in the same place. Blood flows from the nose, often it is impossible to stop salivation. The sense of smell is either completely absent or significantly impaired.

If, the separation of the jaw is supplemented by a fracture of the base of the skull, then the function of vision will be impaired, the mouth will not open. The face will be asymmetrical, reminiscent of glasses, eyeballs are lowered down.

Regardless of the type of fracture, a person often experiences nausea, vomiting may occur, the bite will be disturbed, and pain is pronounced. All other functions are difficult, somehow: respiratory, chewing and speech. A concussion almost always accompanies this injury.

First aid, in addition to the basic measures in the form of immobilization, anesthesia and bleeding control, should be supplemented by the restoration of respiratory function. To do this, it is necessary to remove all foreign objects from the mouth, in particular, fragments of teeth and vomit. If a person feels sick, then you should immediately put it on its side, or face down.

Displaced jaw fracture

In case of a jaw fracture, the displacement of fragments can be observed in three directions: sagittal, vertical and transversal. It is they who play a decisive role in determining the tactics of treatment and choosing the device that will be used to reduce them.

The most commonly used tires are made of wire, with fixation by the teeth. The bones are collected manually by the surgeon, the patient at this time can be both under local and under general anesthesia. Fixation of fragments can also be carried out using a nylon vein. Next, the jaw is fixed with metal knitting needles or plates that are superimposed on the outside.

When fixation is carried out, the patient is advised to rest, with the implementation of antimicrobial measures.

Double jaw fracture

A double fracture of the jaw is characterized by the fact that it diverges in three directions:

middle part jaw pointing down.

Lateral go inward and upward.

This injury is dangerous because, after receiving it, a person may die from asphyxia, which will occur as a result of the tongue falling. Therefore, it is necessary to carefully monitor its condition.

Sequelae of a jaw fracture

In order to avoid the consequences of a jaw fracture, you should not self-medicate, but seek medical help as soon as possible. medical care. As complications are distinguished:

Displacement of one dentition.

The formation of pronounced gaps between the teeth, which will be located at the site of the fracture.

Strong displacement of fragments with deformation of the face, due to muscle strength.

Displacement of teeth with the occurrence of an abnormal bite.

Meningitis.

Osteomelit.

Treatment of a jaw fracture is the prerogative of a doctor. The sooner it is started, the better for the patient.

Basically, the activities are reduced to the following actions:

Treatment of an existing wound, its disinfection.

If there is a displacement of the nasal septum, then its alignment.

Comparison of possible fragments, and combination of whole bones.

Reliable fixation jaws with a special splint. It needs to be completely immobilized. A splint is applied for up to 1.5 months, until the jaw bones grow together. Sometimes doctors implant metal plates into the jaw through surgery. They are fixed with screws.

Carrying out anti-inflammatory therapy.

When the main course is completed, and the tire is removed, then it will be possible to proceed to the rehabilitation stage. It should be aimed at restoring several vital important functions: chewing, swallowing, speech, vision.

Splinting for a broken jaw

Splinting is one of the main methods of treating a jaw injury. The procedure is the fixation of fragments using a structure consisting of plastic or wire.

The type of splinting depends on the nature of the injury:

Superimposed on one side, when the fracture is one-sided, for this a wire is used that fixes the damaged areas.

Superimposed on both sides, while the design has a more rigid base. In addition to it, there are hooks and rings.

When both the upper and lower jaws are broken and there is displacement, then it is advisable to use double jaw splinting. For fixation, copper wire is used, with fastening by the teeth and fixing the jaws with rings.

If a plastic version is used, then it should be placed under the chin and fixed with a bandage around the head. But this method is indicated in the case when assistance must be provided in a short time to deliver the victim to the traumatology department.

When the fracture is complicated and there is a significant displacement of fragments, then before splinting, it is necessary to compare them.

Nutrition for a broken jaw

Correction of the diet in such injuries is a necessity. This is due to the fact that during intensive care and during recovery, the jaws will be in a fixed state, which means that a person will not be able to fully control them.