Consequences of a jaw fracture without splinting. Fracture of the lower (upper) jaw: treatment at home. Treatment of a jaw injury

A jaw fracture is a very dangerous injury, as a result of which not only painful sensations appear, but also unpleasant complications associated with the work of different parts of the body and internal organs, from the oral cavity to nervous system. Everyone is subject to such an injury, but most often it occurs in men 25-45 years old. This happens due to falls and bumps, as well as due to clinical anatomy mandible(protruding chin) and a special structure of bones. It also happens gunshot wounds(due to improper handling of weapons, during an attack), but still non-gunshot injuries are more common.

Symptoms of a fracture of the upper or lower jaw with a photo

Such an injury is accompanied by the following symptoms:

Classification of fractures of the upper jaw

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Injuries upper jaw classified according to the level of the fault and its nature. In the latter variant, fractures with displaced fragments and without displacement are distinguished. By level (place) they are:

• Fracture Le Fort I - on the lower level. With a bilateral fracture, it is accompanied by breaking off the bottom of the maxillary sinus and a broken base of the nasal septum.
• Fracture Le Fort II - according to the average level. Often accompanied by separation of the upper jaw and nasal bones from the skull.
• Fracture Le Fort III - after top level. It is accompanied by a complete separation of the upper jaw, nasal bones and cheekbones from the skull, as well as a traumatic brain injury.

Injuries are also distinguished by their nature:

• traumatic - as a result of external influence;
• pathological - as a consequence of diseases (tuberculosis, osteomyelitis, syphilis, etc.).

There can be complete and incomplete fractures:

• with complete interruption of the injured bone;
• incomplete - expressed by cracks, breaks.

Fractures can be open or closed. Injuries of the upper jaw are rarely closed, because. rupture of the oral mucosa occurs. Fractures are also classified according to the number of injuries: single, double, multiple.

Types of mandibular fractures

Mandibular fractures are complete and incomplete, open and closed, single, double and multiple. The clinical picture shows that most often injuries occur in the area of ​​the angles (angular fracture), articular and condylar process. Fracture of the lower jaw is represented by the following classification:

• according to the type of fracture: linear, finely splintered, large-splintered, with and without displacement;
• depending on the consequences: deprivation of a tooth, finding an incisor in the moon;
• at the location of the injury: the branch, the base of the condylar process, the injury in the region of the coronoid process were injured;
• in the direction of impact: oblique, zigzag, transverse and longitudinal.

First aid

In case of a fracture, before examining a doctor, the following steps should be performed:

After all these activities, you should immediately consult a doctor. The presence of a damaged jaw is very dangerous and can cause serious complications. The very best and safe option an ambulance will be called. Usually people with such injuries are placed in the maxillofacial unit.

Diagnostic methods

Determine the presence of a fracture obvious signs and understand what to do next, the doctor will be helped by the patient's complaints and symptoms, but for staging accurate diagnosis and determining the complexity of the fracture, it is necessary to use the following methods:

• initial examination and palpation;
• x-ray;
• CT scan;
• orthopantomography;
• mastication;
• gnathodynamometry;
• myography;
• thermovisiography;
• rheography;

x-ray

X-ray diagnostics is a mandatory procedure that reliably shows the presence of a fracture, its complexity, pathology, whether there are fragments and problems with the roots of the teeth. No additional X-ray preparation is required. However, it should be abandoned by pregnant women, patients with bleeding and people in serious condition.

Usually take several pictures in frontal, lateral and axial projection:

• In direct projection, the picture shows, as a rule, general state jaws. It is done lying on the stomach on the front side.
• Lateral X-ray is used as an addition to the first. On it you can see large defects and the condition of the teeth. The patient is placed on the desired side and a cassette is applied to the cheek.
• Axial projection shows through bilateral fractures of the lower jaw, as well as defects in trauma of the articular and condylar process of the lower jaw. The patient is placed on the stomach and the chin is pulled out.

Inspection and palpation

Inspection and palpation is another way to diagnose. Thanks to them, the doctor will be able to get the first information about the fracture. They are carried out at the same time when the patient is interviewed. Palpation should only be performed by a qualified medical professional. Otherwise, you can cause even more harm and worsen the patient's condition.

During the examination, swelling of the face at the fracture site is immediately visible. If the skin in the edema area is red or pink, then there are complications in the form of inflammatory infiltrate. The blue color of the skin indicates bleeding in subcutaneous tissues. Fractures may be accompanied by blueness of the neck, chest, abdomen.

The asymmetry of the face also signals an injury during examination. Hemorrhage in the eyes may indicate a fracture of the base of the skull. This is also indicated by the release of liquor ( cerebrospinal fluid) from the nose. It is often confused with ordinary bleeding, but it is more dangerous and can lead to inflammatory processes in the brain and a significant weakening of the body. How badly a person is affected depends on their anatomy.

Only at the end of the examination, the doctor proceeds to palpation. Be sure to check the sensitivity of the skin of the nose and lips to find out if the infraorbital nerve is damaged. When there is a suspicion of a fracture of the lower jaw (condylar process), its base and the posterior edge of the branch are felt. These are the narrowest parts of it. If it is impossible to palpate at least one head, we can talk about an injury to the condylar and articular process. To determine the location of the injury to the upper jaw, the doctor presses on the wisdom teeth or last molars.

Treatment Methods

Fractures can only be treated in a hospital. Staples and plates are used to restore the bone. Antibiotics and physiotherapy are prescribed. In the most severe cases, surgery is possible (for example, with a fracture of the articular process of the lower jaw). The main treatment is carried out with splinting and shunting, or, in other words, splinting.

Various types of splinting

Splinting is the most commonly used treatment method. In this case, the broken place is fixed with a special construction made of plastic or wire. A plastic retainer is used if emergency assistance is needed for the victim and for his transportation (for example, in case of a fracture of the condylar process of the lower jaw). Additionally, a bandage is applied. The type of wire splint depends on how much the broken jaw has suffered:

In some cases, fixation can be carried out with a bandage. Before splinting the jaw, bone fragments must be carefully aligned. They put the tire usually for 1 month.

Tigerstedt splint

Serious injury treated with a special Tigerstedt splint. It is an aluminum construction with hook loops and rubber intermaxillary traction. If the rubber band bursts, then you need to re-install the tire. Self-removal of the superimposed tire is strictly prohibited.

What can you eat during treatment?

During the healing of the bone, certain nutritional difficulties arise. The patient cannot chew as before, so the food must be liquid and at the same time fully cover the need for vitamins and minerals.

• baby formulas and cereals;
• puree from vegetables and fruits;
• broths, mashed soups;
• milk, kefir, fermented baked milk, yogurt;
• porridge with milk;
• grated meat diluted in milk or broth.

After removing the splint, it is necessary to start eating solid food gradually. This will not only allow you to gradually develop the chewing function, but also prepare the stomach for normal nutrition, and prevent disturbances in its work.

How long does a fracture take to heal?

The healing of a broken bone can take approximately 21-28 days. How much the bone heals depends on the individual characteristics (anatomy) of the patient's body.

On the 28-30th day after the X-ray of the broken jaw, if everything is fine, the splint is removed. However, do not rejoice ahead of time. Ahead is still waiting for a course of rehabilitation and restoration of all functions.

Rehabilitation and the consequences of a fracture

With jaw injuries, the following complications and consequences may occur:

• Osteonecrosis is the death of a fractured bone, especially when the condylar process of the mandible is injured. With its possible development, an operation is indicated.
• Violation of chewing functions - after a long period of inactivity, the jaws open and close heavily (we recommend reading:). Mechanotherapy helps speedy recovery.
• Change in bite due to improper fusion of fragments. As a result, pain may occur during jaw movements. This is due to early removal of the tire and poor immobilization.

Also, asymmetry of the head and a change in facial features, loss of teeth in the future, the appearance of cracks between the teeth may also appear. Psychological discomfort causes a crunch of the fused jaw. In order to avoid all these consequences, you should consult a doctor in time for timely and qualified treatment.

As a rehabilitation, physiotherapy exercises, enhanced oral hygiene, physiotherapy (massage, electrophoresis, etc.) are recommended. Begins active phase rehabilitation a month after everything heals. You can learn more about first aid for a broken jaw and the splinting process on the video.

The main task of a dental surgeon during the treatment of a fracture of the upper or lower jaw is to restore anatomical structure 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

It is indispensable for complex, comminuted and multiple fractures with displacement, loose teeth and complete absence of teeth, for periodontitis 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 of the articular head of the 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 prevent the development of such unpleasant complications as:

• 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 your mouth of foreign bodies or blood, lay the victim face down, placing a roller rolled up from clothes, blankets, etc.

Rehabilitation after a jaw fracture

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

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 a better passion of the fragments, 2 weeks after the fracture of the jaw, 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 subsequent dental treatment to restore lost teeth or those damaged after splinting. Our service will help you choose a competent specialist and not waste your money. Compare prices and services of different clinics, get acquainted with the reviews of real patients.

Injuries associated with damage to the bones of the jaw can lead to dangerous consequences for a person, so you should be aware of the symptoms and treatment of a jaw fracture, as well as how much it clamps?

Pathology occurs due to a pronounced mechanical effect on the jaw, or due to other pathologies. There are partial damage to the bones, complete, with displacement, and others. Self-treatment in cases of such injuries.

Causes of a jaw fracture

The main causes are divided into two types: pathological and traumatic.

Pathological, including anomalies of the anatomy of the jaw bones and the consequences of diseases of various etiologies:

• hereditary pathologies;
• malignant and benign neoplasms;
• osteomyelitis;
• cysts;
• tuberculosis;
• treatment with certain drugs;
• metabolic disorder;
• lack of nutrition, vitamins and minerals;
• infections and others.

Traumatic, including the consequences of falls, injuries, blows, injuries, intense loads, road accidents and other conditions. Most injuries are due to:

• driving various types of transport;
• active lifestyle and other incidents;
• abnormal removal of one or more teeth;
• under pronounced physical impact, for example, when using firearms, jaw injuries can be complicated by the appearance of fragments.

Kinds

The bones of the lower jaw are arranged in the shape of a horseshoe, it is easily crushed. The most common localization of fractures is the region of the coronoid process, incisors, canines, angles.

On the upper jaw, the weakest places in the structure are the closure with other bones. With minor injuries, as a rule, displacement occurs without the formation of fragments. With injuries received in the region of the upper jaw frontally, there is a risk of displacement of the fragment down and back. In case of falls, indirect impacts, the risk of fragments formation and their displacement to the base of the skull also remains.

Classification of fractures according to the severity of the lesion:

1. Open, in which bone fragments are displaced towards soft tissues, tearing or damaging them (mucous membranes, muscles, skin). More often observed open fractures of the lower, less often - the upper jaw. With this type, there is a high risk of bacterial damage to damaged tissues, medical care is provided immediately.
2. Closed, in which the bone is damaged, but soft and nearby tissues are not affected. Closed types of fracture are more often localized in the region of the branches of the lower jaw, its angle. They are easier to treat than open ones.

Classification depending on the displacement of debris

1. A displaced fracture is formed with a strong impact of a traumatic force. The bones of the jaw are displaced in relation to each other and other bones. In this case, the displacement can be both sagittal and vegetative, transversal.
2. A fracture without displacement, in which the bone is damaged or divided into fragments, but they are not displaced, are related to each other anatomically. More often than not, these are incomplete fractures.
3. Sometimes this classification includes the type "with a concussion."
4. Comminuted, flowing with the formation of several bone fragments of different sizes at once, randomly located. Characteristic for a powerful traumatic impact on the jaw. Require only treatment in a hospital, self-treatment is not permissible.
5. Complete, in which fragments or fragments (fragments) of the damaged bone are displaced, have a transverse, oblique slope.

Degrees of complete fracture:

1. Single;
2. Double;
3. Multiple;
4. splintered.

Types of injuries of the jaw bones according to Lefort:

1. Lefort - I. The boundaries of the injury pass along the base of the nose, then along the upper wall of the orbit and zygomatic arches. Otherwise, it is called subbasal. In the patient's medical history, there are complaints of visual bifurcation of objects, pain when swallowing. This fracture is characterized by swelling, characteristic symptoms of the eyes.
2. Lefort II. The boundaries of the fracture are located at the base of the nose, bottom wall orbits, then along the zygomaticomaxillary junction. suborbital type. With it, some parts of the face become numb, tears are released, bleeding from the nasopharynx is characteristic.
3. Lefort - III. The boundaries of the fracture pass along the base of the pear-shaped opening, the bottom of the maxillary sinus. Bottom type. The patient will complain of pain, difficulty chewing, bleeding, bite difficulties.

By location, fractures are divided into:

1. Medium - in the region of the central incisors.
2. Incisor - between the lateral and first incisors.
3. Canine - on the line of the canine.
4. Mental - in the area of ​​\u200b\u200bthe chin hole.
5. Angular - in the area of ​​​​the angle of the lower jaw.

In relation to the place of impact, fractures are divided into direct (directly in the area of ​​injury), indirect (in the opposite place).

First aid

On-site medical care, pending qualified care, should be provided as quickly as possible. The basic rules are:

• provide complete rest to the patient in a motionless state;
• restore breathing (cardiopulmonary resuscitation if necessary);
• offer analgesics;
• remove all excess from the oral cavity;
• disinfect the wound;
• stop the bleeding;
• with minimal knowledge, try to combine the bones.

Jaw fracture - treatment

Any kind of injury, both the upper and lower jaw, is treated in a surgical hospital. In complicated cases, surgery is indicated.

Upon admission, the patient is anesthetized, a bandage is applied to him, diagnostics are carried out (X-ray, CT, MRI), bone structures are restored with sutures, staples, plates. Implants are installed if it is not possible to assemble the patient's bones together. Treatment includes antibiotic therapy, physiotherapy. The main methods of treatment are splinting and shunting.

Splinting

Bone fragments are adjusted using a special plastic device. In case of a fracture on one side of the face, the device will be applied on the same side, in case of a complicated one - on both sides with the addition of special rings and hooks.

In case of injury of both jaws, complicated by the displacement of fragments, splinting is performed on both jaws (two-jaw technique). The main goal of the method is to ensure the immobility of healing tissues. Treatment may take up to 2 months. Before the tires are removed, the patient is given an X-ray to make sure that the tissues have healed.

Shunting

The method is used in complicated cases. In this case, the injured bone fragments are fixed with special splints, consisting of hook loops and rubber intermaxillary traction (Tigerstedt's splint).

The method allows, in addition to fixation, to reduce the load on the patient's bones.

Food

Even with a simple fracture, the patient has difficulty eating. Depending on the severity of the injury, the patient is selected a method of nutrition with auxiliary measures.

1. Drinkers with tubes are used in the absence of part of the teeth. It is injected directly into the stomach. Food should be moderately warm, served in small portions, fractionally. The method is suitable for home conditions.
2. Probes are used strictly in hospitals in the first weeks. The probe is inserted into the stomach.
3. Dropper for parenteral food intake if the victim is unconscious.
4. Enemas for nutrition are used in unconscious states and with difficulty feeding the patient through the veins.

What can you eat with jaw damage:

• high-calorie meat dishes, diluted with milk or mashed broth;
• children food;
• milk and sour-milk liquid drinks;
• broths;
• puree soups;
• fruit, vegetable puree and soufflé;
• porridge diluted with milk.

Important: the diet must compensate daily requirement patient in calories.

Video: how to eat with a broken jaw? Personal experience of a video blogger. You can also find other tips on his channel.

Effects

Without unpleasant consequences, jaw fractures, as a rule, do not go away. Injuries can result in:

• asymmetry and deformation of facial features;
• loss of teeth and their movement, while teeth stagger when chewing and at rest;
• malocclusion;
• gaps between teeth;
• psychological discomfort of the patient when the jaw crackles.

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Varieties and forms of fractures

The following types are taken into account based on the reason:

• traumatic nature as a result of physical impact on bone tissue. Often occurs in road accidents, violence against a person;
• pathological ones are caused by bone diseases: tumors, osteochondrosis, etc.

Based on the degree of damage:

• an open fracture of the jaw, when the fragments go beyond the boundaries of the gums and, as a result, the mucous membrane is torn;
• closed, in which the tissues of the face remain intact.

Signs of a fracture

1. Intense jaw movement.
2. Severe pain from any movement.
3. Movement of teeth, the appearance of gaps between them.
4. When closing the mouth, difficulties arise.
5. Increased salivation.
6. The tongue sinks or the bone is damaged.
7. The mucous membrane is severely torn.
8. Wounds bleed.
9. The face becomes asymmetrical, puffiness occurs.
10. There are difficulties in speech, chewing, swallowing.
11. The susceptibility of the face is reduced due to nerve damage.
12. The patient experiences shock, dizziness.

Causes of injury

A fracture can be caused by the following reasons:

• intense load in everyday life, when falling, performing sports exercises, accident;
• pathology of bones, formations and cysts;
• incorrect extraction of teeth.

When the jaw is damaged, displacement can occur in three types:

• sagittal;
• vegetative;
• transversal.

This plays a very important role in identifying the correct therapy regimen, choosing the equipment that will be used for correction. As a rule, with a fracture of the jaw with a displacement, the treatment of the symptoms of the consequences of what to eat are special splints that are fixed on the teeth. The doctor collects the bones with his hands. The person is currently under local or general anesthesia. Fragments can be fixed using nylon devices. The jaw can be attached with special metal spokes that are installed outside. After adjustment, the patient needs peace of mind with mandatory antimicrobial actions.

We consider in detail all aspects of such a complex facial injury as a displaced jaw fracture: treatment, symptoms, consequences, photos. What to eat is a separate issue, because in the postoperative period, fixation of the jaws is necessary, the patient is given splints. And the consistency of food, for obvious reasons, is exceptionally liquid.

Patients must be prescribed a special diet. This must be done due to the fact that the patient will not be able to fully move the jaws.

The consistency of all food should be puree, so a person should consume soups, broths, fruits and vegetables, ground through a meat grinder.

How is the treatment carried out

medical qualified assistance can only provide medical workers. Before they arrive at the scene, the victim should be completely calm to ensure the immobility of the limbs. Analgesics can improve health. It is worth remembering that it is impossible for a fracture of the lower and upper jaws to be treated at home. The symptoms, photos and signs can be found below.

Therapeutic measures include the following:

• wound disinfection;
• alignment of the nasal septum, if present;
• comparison of fragments and alignment of bones;
• correct adjustment of the jaw using a special splint. She is completely immobilized, the device lasts for about a month and a half, until the bones grow together. Sometimes specialists insert special plates into the jaw using screws using the operational method;
• anti-inflammatory treatment. At the end of the main course of therapy, they begin the recovery stage. Rehabilitation should be aimed at the renewal of vital abilities.

The upper jaw breaks much less frequently than the lower.

Share the following features:

• in patients, the cheeks swell, there is profuse bleeding between the teeth;
• numbness in the area under the eyes is possible, hematomas also appear, blood is released from the nose, strong highlight saliva, no sense of smell;
• in severe cases, people lose their sight, cannot open their mouths.

Often patients complain of severe nausea and severe pain. Vital functions are complicated. It is difficult for a person to talk, breathe, eat. In parallel with damage to the jaw, patients are diagnosed with concussion.

Splinting method

One of the main methods of treatment is splinting. The event involves the adjustment of fragments with the displacement of the plastic device.

The type of event will depend on the type of damage:

• with a unilateral fracture, the device is applied on one side;
• more rigid equipment is applied on both sides. In addition to it, special rings and hooks are installed;
• in case of a fracture of the upper and lower jaws with displacement, it is necessary to use a two-jaw technique.

If plastic equipment is used, then it is installed under the patient's chin and a bandage is wound. However, this procedure is performed when assistance needs to be provided immediately in order to deliver the victim to the emergency room.

Consequences of a fracture

To avoid unpleasant consequences, it is necessary to seek professional help in time. The following complications are possible:

• movement of teeth
• appearance of gaps between teeth;
• facial deformity;
• the appearance of a malocclusion.

If necessary, surgery may be needed to restore the affected areas of the face. For fractures mild form and a timely visit to the doctor, compliance with all his recommendations, mobility resumes within a month.

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What is a jaw fracture?

A jaw fracture 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:

A complete fracture is considered when the fragments of the jaw have been displaced. They may vary in shape and quantity.

A fracture is called incomplete when no displacement is observed.

With an open injury, both the mucous membranes of the mouth and the soft tissues of the face are damaged.

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

A comminuted fracture of the jaw is rare, as 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. Edema is usually severe, with reddening of the skin and an increase in its temperature. When the fracture is closed, blood accumulates in soft tissues and forms a clot. With an open injury, blood enters the oral cavity more often than into the external environment. The stronger the blood loss, the larger the 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, the wound is pressed or packed 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.

If severe pain occurs, it is necessary to alleviate 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. An intramuscular injection will be even more effective, but, as a rule, it is rarely possible to do it when providing first aid. 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 a medical institution for further therapy by professionals. 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 meningitis, concussion and osteomelitis. 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, hematomas resemble 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.

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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 under both local and 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:

The middle part of the jaw is directed downward.

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. 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 of the jaw 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 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.

On the subject: 12 folk ways for home treatment

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.

The minimum time for bone fusion is a month, which means that during this time the victim will have to consume only liquid food. Its consistency should be equated to the state of sour cream. Therefore, it is advisable to feed the patient with broths and soups, vegetables and fruits, passed through a meat grinder or blender, boiled cereals. Be sure to include milk drinks in the menu.

Learn more: What to eat and what not to eat with a fracture?

When the tire is removed, do not immediately switch to solid food. It must be introduced gradually. This is important not only for the normal restoration of the functioning of the jaw, but also for the prevention of malfunctions in the digestive tract.

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Types and pathogenesis of jaw fracture

Depending on what kind of damage occurs, jaw fractures can be:

• complete;
• incomplete;
• open;
• closed.

A complete fracture is characterized by displacement of jaw fragments, which, in turn, are oblique, transverse, double, multiple or comminuted. In the case of an incomplete fracture, there is no displacement of the jaw fragments. An open fracture is accompanied by ruptures of the soft tissues of the face, in addition, the mucous membrane of the oral cavity is damaged. With a closed fracture, the site of injury is covered by soft tissues.

A fracture of the upper jaw, which occurs due to traffic accidents, falls, gunshot wounds, is characterized by a concussion, severe hematomas, and difficulty breathing. In more serious cases, when there is a displacement of fragments of the facial bone or cartilage of the nose, breathing becomes absolutely impossible.

Fracture symptoms

Depending on which part of the fracture occurred, the symptoms may be similar or significantly different. However, a jaw fracture is characterized by:

• severe pain in the area of ​​injury;
• mobility of fragments and/or fragments;
• bruises, hematomas and even hemorrhages from the eye sockets;
• serious violations of chewing, speech and respiratory functions;
• malocclusion;
• nausea, dizziness and malaise;
• weakness and general malaise.

All of the above symptoms should be serious signal for urgent appeal to the doctor.

Diagnosis of a jaw fracture

Jaw fractures of any kind are most often diagnosed by the above symptoms, as well as by palpation of the area of ​​injury.

However, to make an accurate diagnosis and determine the full clinical picture x-ray examination which is mandatory in the event of such an injury.

Before proceeding to a description of the most common methods of treatment, it is necessary to consider the measures for providing first aid to the victim. First aid is characterized by:

• fixation of the lower jaw with a dense cloak-like bandage;
• stopping possible bleeding using a sterile dressing and cotton swabs;
• stopping arterial bleeding by pressing the damaged vessel;
• the release of the oral cavity from foreign fillers that make it difficult to breathe ( we are talking about blood clots, vomit, etc.);
• language fixation;
• providing the victim with a state of rest;
• applying a cold compress to the fracture site.

After all first aid measures have been provided, the victim is urgently taken to the nearest hospital, where he will be provided with qualified medical care.

In what cases is the victim sent to the hospital? In cases where:

• there are soreness and bite changes after the injury;
• it is impossible to open the mouth wide, and when trying to open and close the mouth, the jaw moves to the side;
• double vision occurs, numbness of the skin under the eye, with a change in the shape of the zygomatic arch;
• impaired speech, chewing function;
• there is profuse salivation after injury.

It must be remembered that the victim should be transported in a sitting position, lying on his side or face down. In the event that the state of the victim has reached the point of unconsciousness, he needs to be transported in the supine position. In this case, the head should be turned to the side.

In case of a jaw fracture, not only medications that promote rapid healing and eliminate pain, but also an operative method of treatment. At the first stage, bone fragments are compared together and fixed in one position. To provide the victim with complete rest and immobility, a dental splint, polymer or wire thread, as well as special devices are applied.

The wounds are treated, then the large blood vessels are tied off, the tracheas are dissected, followed by the introduction of a special tube to facilitate breathing. If there is an open wound, antimicrobial therapy with antibiotics is carried out in order to prevent infectious and inflammatory complications at the fracture sites. Vitamins are prescribed to improve the patient's well-being.

In the case of surgery:

• bones are sewn together with a special wire or nylon core;
• bones are fixed with metal needles;
• bone fragments are fixed with the help of special bone metal plates;
• bones are fixed with special structures.

In cases where there has been extensive destruction of the bone, which has led to serious extensive damage to the face, complex reconstructive plastic surgeries are performed and complex facial and jaw prostheses are used. In any case, the main goal of treatment is the fastest and most effective achievement of fusion of the jaw fragments and restoration of the bite of the teeth.

Recovery after a fracture

In the case of an uncomplicated fracture, the recovery process covers three or four weeks. It all depends on which method of treatment was chosen, how strong the body of the victim is, whether all the prescriptions and prescriptions of the doctor were observed by the patient. Upon completion of treatment, mechanotherapy and therapeutic exercises are prescribed. These procedures are accompanied normal functioning chewing muscles and mobility of the temporal and jaw joints.

Nutrition for a broken jaw

A complete treatment must include proper nutrition, rich not only in vitamins, but also in proteins and proteins. Food should be introduced into the victim's mouth with a small spoon or drinker.

It is very important that the victim's diet includes fruits and vegetables. But since the patient is not yet able to chew on his own, soups and mashed potatoes are prepared from fruits and vegetables, or a fine grater is used.

Sequelae of a jaw fracture

Jaw fractures can lead to various consequences and are characterized by:

• pathological displacement of one part of the dentition in relation to the other;
• the formation of gaps between the teeth along the fracture line;
• displacement of fragments of the jaw due to the impact of muscle strength and own gravity;
• displacement of teeth from their usual position;
• the formation of bite anomalies;
• meningitis;
• osteomyelitis and others.

In conclusion, it should be added that any person, regardless of gender and age, does not hurt to exercise care and discretion in order to avoid possible injuries, bruises and damage. In the event that it was not possible to avoid injury for certain reasons, it makes no sense to delay the visit to the doctor or use self-treatment methods.

Every minute is precious and plays a decisive role in the future fate of the victim. There are cases when the condition of the victim does not allow him to independently take all the measures necessary to save his life, family members, relatives and friends should help him in this.

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Symptoms and Diagnosis

Symptoms of a fracture of the lower jaw are identical to a fracture of any bone of the human skeleton: sharp pain, inability to move the injured organ, swelling, possible hematoma. A fracture is often accompanied by malocclusion, bloody saliva and an open mouth. One of the symptoms of bone damage is numbness of the lower lip on the right or left side. In severe injuries, a person may have severe bleeding (including from the ears), asphyxia, or a state of shock.

More accurate diagnosis performed by the dentist by extraoral and intraoral palpation. Thus, bite deformation, changes in natural contours, the integrity of the dental arch and dental margins are examined. The patient is asked, if possible, to close his mouth and determine the displacement of the bite or move the jaw forward to identify the restriction of mobility.

In the presence of a hematoma and pain in the area of ​​the damaged bone, the doctor prescribes an x-ray of the upper and lower jaws. overview shot gives a complete image of the bones of the facial skull and leaves no ambiguous moments when making a diagnosis.

First aid

As a first aid for this fracture, it is necessary to prevent shock and suffocation in the victim. If a person has lost consciousness immediately after the injury, care must be taken to ensure that his tongue does not sink, blocking the airways. To do this, turn the victim on his side or fasten his tongue. At heavy bleeding you need to transfer the artery and firmly press the wound with a piece of clean cloth or cotton. Then a bandage is applied to the damaged area to immobilize the organ, and a cold compress is applied. In this condition, the patient can already be transported to the nearest medical institution. If, along with the jaw, the patient's airways are injured, then the trachea is dissected and a breathing apparatus is installed.

Classification of mandibular fractures:

• The nature of the injury (complete, incomplete, displaced, single or multiple, etc.);
• Area of ​​bone damage ( alveolar process, median fracture, condylar process, jaw angle, chin).

The specificity of the injury received is determined by the following indicators:

• Open fracture (when the integrity of the soft tissues or mucous membrane is broken);
• Closed fracture of the lower jaw;
• Fracture of the lower jaw with displacement (when the bone fragments have moved significantly in relation to each other);
• No offset;
• Solitary (when there is one fault line);
• Multiple (when there are several bone fragments and some of them can be displaced).

Treatment

The treatment of a fracture of the lower jaw in most cases is surgical, so it is necessary to mentally prepare in advance. Either under general or under local anesthesia the doctor repositions the jaw fragments, and then fixes them for further fusion. In this case, different methods of fixing the bone are used, the so-called method of direct and indirect osteosynthesis:

1. Direct osteosynthesis
   • For installation inside the bone (screws, pins, spokes, rods).
   • For installation on the surface of the bone (plates, wire, staples).
2. Indirect osteosynthesis
   • Kirschner spokes.
   • Extraoral devices that fix the lower jaw behind the upper.

In parallel, a course of anesthesia is prescribed, as well as antibiotic therapy to avoid infection and complications. General strengthening therapy with proper nutrition and the use of special preparations to restore bone tissue is also shown.

During this period, the patient needs special care behind the oral cavity: food is only liquid and should come through a tube or a teaspoon.

Be sure to read the article about what vitamins are needed for fractures.

Of the additional physiotherapeutic methods, magnetotherapy and electrophoresis are prescribed. These procedures are successfully applied on the 2nd-3rd day after the reposition of fragments, as well as on the 3rd-5th day after osteosynthesis. Magnetotherapy helps the patient to get rid of edema in the area of ​​bone damage. From the 3rd day of this procedure, there is usually a noticeable improvement in the area of ​​injury. Two weeks after immobilization, calcium electrophoresis is prescribed, which is carried out in 12 sessions every other day.

Prevention of unwanted consequences

An open fracture, large lesions, multiple operations - all this can lead to complications. Among the most dangerous are bone infections - traumatic osteomyelitis (which is difficult to treat) and meningitis.

In addition to infectious, there may be functional disorders: pathological displacement of a row of teeth, abnormal bite, the formation of unnatural gaps between the teeth, deformation of the symmetry of the bone. These defects can affect the chewing and swallowing functions, the correctness of speech.

We must not forget that the lower jaw is part of the human face and any deformation of it can lead to undesirable aesthetic consequences. In such situations, the victim undergoes a course of reconstructive plastic surgery, which involves special prostheses for the face.

The period of bone tissue regeneration in case of a fracture averages 1.5–2 months. Subject to all prescribed rules and medical recommendations, the prognosis is favorable - a patient with such an injury may be subject to a full recovery. The main thing is to provide qualified medical assistance in time Upper wisdom tooth hurts From tooth sensitivity Eye teeth are what

A fracture is a violation of the integrity of the bone as a result of certain causes. Among injuries of the facial bones, deformity of the lower jaw is more common, and it is precisely double fractures of the lower jaw, and sometimes even triple ones, due to its shape.

The mechanism of occurrence of a fracture of the lower jaw

Such an injury is typical for a certain age, which is due to lifestyle or bad habits. Jaw structure and alcohol consumption are considered predisposing factors. Because of the latter, the risk of accidents, fights, falls increases significantly. The appearance of this injury is associated with the influence of 2 factors:

1. Traumatic. Deformation occurs after the application of force, for example, after an accident, blows, sports injuries;
2. Pathological. This reason is due to changes in the structure of the bone due to the presence of pathologies: tumors, osteomyelitis.

All such injuries are usually divided into 2 types. A closed fracture of the lower jaw passes without breaking the skin. An open fracture of the lower jaw has damage to the mucous membranes, skin and is considered a primary infected wound.

Signs and symptoms of a mandibular fracture

Damage to bone tissue has a pronounced symptomatology, which facilitates diagnosis and diagnosis. The main signs of such an injury are:

• Pain on palpation in the area of ​​the fracture;
• swelling of the face;
• Bleeding due to vascular damage (intraoral or external);
• Skin damage;
• Facial asymmetry;
• Pathological mobility, etc.

With a fracture of the lower jaw with displacement of fragments, crepitus is felt on palpation, which is the main symptom of bone damage. For other types of this injury, a deeper diagnosis is required using additional devices.

Classification of mandibular fractures

Because of the shape of the jaw, a fracture can occur anywhere, but the most common is a mandibular angle fracture. Deformities of this bone have their own classification, which basically divides injuries according to their location, nature, etc.

Fracture of the process of the lower jaw is observed more often than other types. Alveolar injuries appear in the anterior part due to the structure and thickness of the bone in certain places. The deformation of the condylar processes is characterized by the movement of the jaw in the direction of its fracture. Bilateral mandibular fracture is characterized by an open bite and occlusion of only the chewing teeth.

An angle fracture occurs due to a muscle tear. Median injuries are most easily determined due to the pronounced deformation of the dentition. The front lower teeth, and the continuity of the dentition is also disturbed. But in addition to the localization of deformations, fractures of the lower jaw are distinguished without displacement and with it.

Diagnosis of a mandibular fracture

The definition of such an injury is based on the collection of anamnesis, extraoral, intraoral examination, X-ray. It all starts with visual inspection and palpation. Almost always, when injured, the nerve suffers, causing numbness of the lower lip. Based on this phenomenon, it is already possible to make a preliminary diagnosis.

Intraoral examination is aimed at a thorough examination of saliva for blood impurities, the presence of hematomas, the integrity of the mucosa, the ratio of the jaws. Next, an analysis is made of the movement of the jaw back, forward, to the sides, as well as opening and closing the mouth.

X-ray examination provides more accurate information about bone deformity. For this, several types of images are used: OPG, CT or MRI, which allow you to determine not only the exact location of the injury, but also its type. If you suspect a pathological process, especially osteomyelitis, you can’t do without a picture, because. therapy for such lesions will change.

Mandibular fracture treatment methods

Such an injury is a serious injury to the bone with possible bleeding, shock, wound infection (with open type), severe pain. Therefore, the first aid in case of deformation is to anesthetize the affected area and use a special bandage for a fracture of the lower jaw. But this helps only for a short time, during which the patient must be taken to the hospital.

The most effective is surgical treatment - osteosynthesis, which can be of several types:

1. Bony. It consists in applying a plate to the deformation, for fixing which screws are used;
2. Outer. Through the damaged pieces of bone, needles are inserted perpendicularly, fixed on a special apparatus;
3. Intraosseous. It is carried out using a conductor, which is inserted into the brain canal and passed through the injury site;
4. Transosseous. Pins, wires are used, which are inserted at an angle through the fracture to secure both parts of the bone.

Previously, preference was given to the use of tires, but due to the large number of shortcomings, they are rarely used. Now in the first place is precisely osteosynthesis, which is most effective in such injuries.

Splinting for a fracture of the lower jaw

Splinting refers to orthopedic treatment deformation data, which was widely used earlier. It consists in fixing the bones in a stationary state for a certain time, most often no more than 1.5 months. This procedure takes place under anesthesia and is a metal structure that is fixed on the teeth.

But this type of therapy also has many disadvantages. For example, the inability to open the teeth, which affects the quality of nutrition. In addition, the tire has a strong effect on the teeth, which is why they will hurt at first. It is impossible to thoroughly brush the teeth, which can lead to multiple caries. For these reasons, doctors are increasingly opting for mandibular surgery, where a fracture will heal faster.

Catering for a fracture of the lower jaw

Recovery after a fracture of the lower jaw takes a long period - at least 1-2 months. During this time, the patient should receive food, rich in vitamins, phosphorus, zinc, calcium. Food should be crushed to a state of puree, other food is prohibited.

It is important to consume at least 150 g of meat daily, it is better to grind it in a blender. The meat is boiled, then ground, this gruel is diluted with broth and served to the patient. Proper nutrition is important, because. the resulting trace elements contribute to the rapid healing of deformities.

Consequences and complications of a mandibular fracture

Such deformities are often accompanied by shock, bleeding and infection of the wound, which can lead to sepsis and death. Therefore, with a fracture of the lower jaw, treatment at home is prohibited.

Anesthesia, temporary immobilization of the jaw is allowed, but treatment should only be carried out by a doctor in a hospital setting. In severe and extensive injuries, surgery is required, which is aimed at complete bone reconstruction, performed under general anesthesia.

The main consequences are malocclusion, abnormal position of the teeth, loss of sensitivity, headache, nausea. Perhaps the development of osteomyelitis and the presence of pathologies of other organs, for example, concussion. But with proper treatment, the risk of complications is minimized.

The jaw is a severe pathological situation in which the linear integrity of the bones that form the lower jaw is disrupted. This happens under the influence of some traumatic factor, the intensity of which exceeds the strength of the bone.

Mandibular fracture is a fairly common pathology that occurs among all age categories, but young men aged 21 to 40 most often suffer from it. This is due to several factors that are determined by both socio-economic status and lifestyle, as well as anatomical and physiological characteristics.


Factors predisposing to a jaw fracture are:

• anatomical features of the bone that forms the jaw, which forms an arc, movably fixed at the extreme points;
• anterior part of the lower jaw ( chin) is one of the most prominent parts of the face;
• in most cases, when falling from motorcycles or other moving objects, the initial impact falls on the chin ( therefore it is recommended to wear closed helmets);
• young people lead more active image life, and therefore more at risk of injury;
• alcohol consumption increases the risk of injury, both from falls and road traffic accidents, and from a variety of conflicts involving the use of physical force.

It must be understood that a jaw fracture is serious pathology which should be treated by a competent maxillofacial surgeon. The earlier it started adequate treatment- the lower the risk of developing various complications and the higher the chance to fully restore the structure and function of the jaw. AT clinical practice jaw fractures older than 10 days are considered chronic, and fractures for which the time from the moment of injury exceeded 20 days are considered improperly fused. Such situations present significant difficulties for further treatment.

It should be noted that the jaws are predisposed not only to various traumatic injuries but also to additional infectious complications. This is due, first of all, to the fact that the bones that form the jaws are located rather superficially in the oral cavity and are separated from the potentially infected environment by only a thin mucous membrane ( for this reason, about 80% of mandibular fractures are considered open). The second risk factor is the teeth, the defects and diseases of which in one way or another affect the state of the jawbone and adjacent formations. Often, it is an untreated dental infection that acts as a source of infection and provokes the development of osteomyelitis ( infection bone tissues), which is important both before the injury, as it weakens the bone, and after, as it increases the risk of complications.

According to various sources, the mortality rate for jaw fractures fluctuates around 10%. However, this figure does not reflect the real danger of this pathology, but rather the fact of its frequent combination with other life-threatening injuries. In many cases, high-intensity injuries are accompanied by damage to the base of the skull and brain stem, which is a deadly condition. Isolated uncomplicated fracture of the jaw rarely plays the role life threatening human pathology.

Anatomy of the lower jaw

The following formations of the lower jaw are of clinical importance:

• bone of the lower jaw;
• chewing muscles;
• nerves and vessels that feed the jaw;
• temporomandibular joint.

Bone of the lower jaw

The lower jaw is a horseshoe-shaped bone, in which the following parts are distinguished:

• Body of the lower jaw. The body of the lower jaw is represented by a horizontal part of the bone, in the upper part of which the dental alveoli are located, and in the lower part there is a bone base. Dental alveoli are small cavities in which the roots of the teeth are placed, and which are separated from each other by bony septa. The lower jaw bears 16 permanent teeth on its body, which are fully formed by mature age. These teeth are represented by two pairs of incisors located in front, one pair of canines located slightly backward, two pairs of small molars and three pairs of large molars, which are behind all other teeth. At the base of the lower jaw is the canal of the mandibular bone, in which the nerves and blood vessels are located. In the area between the second and first small molar is the mental foramen, which is the place where the nerve exits the canal.
• Branches of the lower jaw. The branches of the lower jaw are ascending ( at an angle of 120 - 150 degrees) bone processes, the upper part of which is involved in the formation of the temporomandibular joint. On the inner surface of both branches there is a hole through which the nerves and blood vessels enter the canal of the lower jaw. Top part branches is represented by two pronounced processes - the coronary, to which one of the masticatory muscles is attached, and the condylar, which forms the articular surface of the temporomandibular joint.

The place of convergence of the body and branches of the lower jaw is called the angle of the lower jaw. This area characterized by the presence of pronounced bone tuberosities, which is due to the attachment of a large number of powerful masticatory muscles.

It should be noted that in the course of its development, the lower jaw undergoes a number of serious age-related changes, which are reflected both in its structure and in its strength. In childhood, the angle formed by the body and branches of the lower jaw is greater than in adulthood and is approximately 150 degrees. This is due to the insufficient development of the chewing muscles, as well as some features of the teeth. Teeth in children begin to erupt in the first year of life, however, up to 7-10 years, they are represented mainly by milk teeth, which, unlike permanent ones, do not have roots. In old age, there is some reverse development of the lower jaw, which is manifested by the loss and erasure of permanent teeth, which leads to a change in bite, an increase in the mandibular angle, and also to a violation of the physiological act of chewing. In addition, with age, there is a gradual weakening of the masticatory muscles. Hormonal and metabolic changes lead to gradual thinning and weakening of bone tissue, which significantly reduces its strength.

Chewing muscles

The chewing muscles are represented by the following muscles:

• Actually chewing muscle one end is attached to the zygomatic bone and its arc, and the other - to outer surface angle of the mandible in the region of the previously described tuberosity.
• temporalis muscle in its shape it resembles a triangle, which is attached to the surface of the temporal bone of the skull with one of the bases, and with the opposite apex - to the coronoid process of the lower jaw branch. Before attaching to the lower jaw, this muscle forms a tendon that runs under the zygomatic arch.
• medial pterygoid muscle located on the inner surface of the lower jaw. At one end, this muscle is attached to the pterygopalatine fossa ( slit-like space between the maxilla, palatine and pterygoid bone), and others - to the inner surface of the masticatory tuberosity of the angle of the lower jaw.
• Lateral pterygoid muscle begins at the outer edge of the inferior surface of the sphenoid bone ( one of the bones of the base of the skull) and stretches to the neck of the condylar process of the lower jaw. Due to the contraction of this muscle, the lower jaw moves forward. With unilateral contraction, a unilateral lateral displacement of the jaw occurs.

The lower jaw is lowered by contraction of the following muscles:

• jaw-hyoid muscle;
• digastric;
• geniohyoid muscle;
• genio-lingual muscle.

It should be noted that not only the chewing muscles and muscles that open the jaw are attached to the lower jaw, but also a number of other equally important muscle fibers, which, however, are not of great importance in the displacement of bone fragments during fractures.

Vessels and nerves of the mandible

The blood supply to the lower jaw is provided by the following vessels:

• inferior alveolar artery is a branch of the maxillary artery, which originates from the external carotid. This blood vessel passes into the mandibular canal through an opening on the inner surface of the mandibular ramus. Throughout its course, the artery gives off many branches to the alveoli of the lower jaw, thus providing blood circulation at the level of the teeth and mucous membranes of the jaw. At the exit from the mandibular canal, the vessel forms the mental artery, which, branching in the chin area, provides blood supply to the skin and muscles of the corresponding zone.
• Facial artery located in the region of the angle of the lower jaw. Partially provides blood supply to the masticatory muscles. However, the importance of the facial artery in fractures of the jaw is related to its location, since it is often injured along with the bones of the facial skeleton. Damage to the facial artery, despite its relatively small diameter, can cause quite serious bleeding.

The nerves of the mandible are represented by the mandibular branch of the trigeminal nerve. This nerve departs from the brain stem and provides the regulation of the motor activity of the masticatory muscles, is involved in the formation of sensitive perception from the surface of the buccal mucosa, the bottom of the mouth, and teeth. In addition, the mandibular branch of the trigeminal nerve is involved in the perception of general sensitivity from the surface of the entire tongue ( touch, pain, temperature), as well as the taste sensitivity of its anterior two-thirds.

Temporomandibular joint

The joint capsule, which is a connective tissue bag that envelops the joint, is attached at the edges articular surfaces bones and consists of two cavities separated by an intraarticular disk.

Three ligaments support the stability of the temporomandibular joint, one of which ( lateral ligament) limits the posterior displacement of the head of the condylar process during joint movements, and the other two ( pterygomandibular and stylomandibular ligament), formed by thickening of the fascia, keep the lower jaw in a suspended state, thereby reducing the load on the joint.

It must be understood that due to the integrity of the skeletal skeleton of the lower jaw, both temporomandibular joints function simultaneously and in combination. Movements occurring on one side ( with unilateral muscle contraction), one way or another, are reflected in the position of the articular surfaces on the other side.

The temporomandibular joint is capable of performing the following movements:

• Lowering and raising the lower jaw. When lowering and raising the lower jaw, the movement is carried out due to the movement of the articular surfaces under the intraarticular disc, that is, in the lower part of the joint. This type of movement is usually combined with the opening and closing of the mouth.
• Displacement of the lower jaw anteriorly and posteriorly. The movement of the anterior and posterior displacement of the lower jaw is carried out due to the movement of the articular surfaces of the upper part of the joint, which is located above the intraarticular disc.
• Displacement of the lower jaw to the left and right. Lateral displacements of the lower jaw are the most difficult, since with this type of movement, the head of the condylar process of the lower jaw, together with the intraarticular disc on the side opposite to the displacement, leaves the articular fossa and shifts to the side, while the head of the opposite joint rotates around its own axes.

Causes of mandibular fractures

In medical practice, it is customary to distinguish two main types of fractures, in which the integrity of bone structures is violated, but which are the result of several different cause-and-effect relationships. Depending on the type of fracture corresponding to the classification based on the initial cause of the fracture, the most appropriate treatment and prophylactic tactics are selected.


There are the following types of fractures:

• pathological fracture. The term "pathological fracture" refers to a situation in which bone damage occurred against the background of a traumatic factor of low intensity or daily physical activity. This type of fracture is based on some structural and functional pathology of the bone tissue, which caused its significant weakening. Today there is a large number of diseases that, to one degree or another, can provoke pathological fractures. Osteomyelitis is of the greatest importance for a fracture of the jaw, since this disease often affects the jaw bones, spreading from foci of chronic infection in the tissues of the teeth. In addition, pathological fractures may occur due to the development of malignant or benign neoplasms within the bone ( both primary, developing from cells of either the bone itself or the bone marrow, and metastatic, brought by blood or lymph flow from distant foci). Violation of the metabolism of certain substances, malnutrition or insufficient intake of vitamins and minerals, chronic infections, congenital diseases, treatment with drugs that suppress cell division, and many other conditions and ailments can cause serious structural changes in the bone, leading to its weakening and subsequent fracture.
• Traumatic fracture. A traumatic fracture is a bone injury that has developed against the background of any mechanical impact of high intensity. In most cases, this type of ailment develops as a result of a direct or indirect blow that occurs against the background of a fall, a traffic accident, a gunshot wound, or many other possible causes. With this type of disease, the state of the bone structures and their function before the fracture are within the normal range.

According to statistical data, the cause of mandibular traumatism largely determines the location of the fracture. This is most likely due to the fact that certain types injuries, the mechanism of impact and the place of maximum absorption of energy are similar. In car accidents, fractures usually occur in the region of the mandibular symphysis and condylar process ( on both sides), in motorcycle accidents - in the area of ​​the symphysis and dental alveoli ( i.e. at the level of the body of the jaw), and in case of injuries resulting from an act of physical violence - in the area of ​​the condylar process, body and angle of the jaw.

Typical places for the formation of a jaw fracture line are:

• the area between the first incisors;
• area of ​​attachment of fangs;
• the area between the small molars;
• area of ​​the angle of the lower jaw;
• condylar process of the mandible.

Fractures of the lower jaw are of the following types:

• Open fracture. Open fractures of the mandible are the most common form of injury to this bone. This is due to the fact that when a fault line occurs in the region of the jaw body, on which the dental alveoli are located, a mucosal defect occurs, and the bone fragments come into contact with the oral cavity. Fractures of the jaw branches can also be open, however, due to the peculiarities of their location ( covered with powerful chewing muscles on one side and the base of the skull on the other), this type of injury is extremely rare. A jaw fracture can be either open or closed. Open fractures pose a certain danger, since the bone exposed to the external environment is considered potentially infected with pathogenic bacteria, which in the oral cavity great amount. Without taking proper measures during treatment ( or in the absence of treatment as such) in the lower jaw, an infectious-inflammatory focus can develop, which is quite difficult to treat.
• Closed fracture. A closed fracture is characterized by the location of bone fragments within intact ( intact) skin. Closed fractures, as already mentioned above, are characteristic of the branches of the lower jaw and its angle. Closed fractures are much less dangerous and require only matching of bone fragments during treatment.

• Displaced fracture. A fracture with displacement of fragments occurs when bone fragments lose their normal relationship and are displaced under the influence of any internal ( bone heaviness, muscle pull) or external ( direction and force of impact, displacement during movement) factors.
• Fracture without displacement of fragments. In a fracture without displacement, there is a pathological defect between the bone fragments ( fissure or fracture line), but the fragments correlate correctly. Similar situation It is typical for incomplete fractures, in which part of the bone tissue retains its integrity, as well as for fractures that have developed under the influence of a traumatic factor of low intensity.
• Comminuted fracture. A comminuted fracture of the lower jaw is quite rare, but it is characterized by the presence of many bone fragments, which are displaced to one degree or another. A feature of this fracture is that, firstly, for its occurrence, it is necessary to apply a large force to a small area of ​​​​the bone ( e.g. hit with a hammer), and secondly, comminuted fractures need surgical treatment, as they significantly destabilize the bone.

Odontogenic osteomyelitis

With osteomyelitis of the lower jaw, the developed infectious process stimulates an inflammatory reaction, under the influence of which the environment and local metabolism change. In addition, thrombus formation increases, local blockage of blood vessels occurs, necrosis occurs ( dying off) bone tissue. In the cavity under the tooth, pus forms, the dental ligaments weaken, the causative tooth and adjacent teeth acquire pathological mobility, begin to stagger. Due to malnutrition of the bone, it becomes more fragile, loses its original strength. This is especially pronounced in total osteomyelitis, that is, in cases where the pathological infectious-inflammatory process covers the entire lower jaw.

Odontogenic osteomyelitis is one of the most common causes of pathological mandibular fractures. This ailment is accompanied by severe pain in the affected area, aggravated by chewing, putrid breath, bleeding from the mouth, redness and swelling of the skin over the focus.

Mandibular fracture symptoms

A fracture of the lower jaw is accompanied by the following symptoms:

• Pain. Pain in a fracture of the jaw is pronounced and especially strong at the site of the fracture or the site of exposure to a traumatic factor. The pain sensation is greatly enhanced by the movement of the jaw, as well as by chewing or during a conversation. The appearance of pain is associated with damage to the periosteum ( thin layer of bone containing a large amount nerve endings ), as well as with the development of an inflammatory reaction at the fracture site. Nerve damage, which can occur in some rare and severe cases, is also accompanied by severe pain.
• Bleeding. Since in more than eight cases out of ten the fracture of the jaw is open, bleeding occurs in patients. Usually blood is poured into the oral cavity, however, the vessel can also bleed through the skin, depending on the site of damage and the impact of injury. Bleeding occurs as a result of damage to blood vessels located in the periosteum, bone and soft tissues. With closed fractures, bleeding also exists, but due to the inability to enter the external environment, blood accumulates at the site of injury and forms clots. It should be noted that large volumes of blood loss indicate damage to a large vessel and require emergency medical care.
• Swelling of the face. Puffiness occurs not only in the zone of influence of the traumatic factor, but also in other places where fractures occur. Edema is manifested by a significant increase in the volume of soft tissues in the area of ​​the fracture, pastosity, warming and redness of the skin. Edema occurs due to the action of pro-inflammatory substances on the blood vessels, which expand and become more permeable to the liquid component of the blood. It should be noted that an increase in half or the entire face with a jaw fracture can also occur due to bleeding in the soft tissues or under the skin.
• Damage to the skin. Since a fracture of the lower jaw in most cases develops after exposure to some strong traumatic factor, it is usually accompanied by various injuries to the face and head. In most cases, the presence of abrasions and wounds is noted. Sometimes a fracture of other bones of the face is detected ( upper jaw, skull bones, nasal bones), as well as damage to the cervical spine and spinal cord.
• Changes in the relief of the lower jaw bone. The displacement of bone fragments, which occurs during a fracture, to some extent changes the relief of the skin covering the corresponding area. This can be seen as a visual inspection ( with significant displacement), and only with careful palpation of the jaw. Feel the jaw carefully, starting from the part opposite to the fracture ( or the furthest), following the bottom edge with your fingertips.
• Reflected pain. With pressure on the chin, a pronounced pain sensation occurs in the area of ​​​​the fracture. This is due to some movement of bone fragments and irritation of nerve endings.

Among other symptoms of a broken jaw, bleeding from the nose or ears deserves special attention, since cerebrospinal fluid can leak along with the blood through the damaged base of the skull. You can distinguish such bleeding by laying a clean napkin. With normal bleeding, one reddish spot remains on the napkin, while with bleeding combined with loss of cerebrospinal fluid, a yellowish spot appears on the napkin, diverging to the periphery.

Diagnosis of a jaw fracture

A jaw fracture is detected using the following methods:

• plain radiography;
• orthopantomography;

Clinical examination

Objective symptoms of a jaw fracture include:

• unilateral displacement of the jaw due to shortening of the body on one side;
• pathological jaw mobility;
• visualization of bone fragments in the depth of the wound;
• violation of the relief of the bone;
• asymmetry when opening the mouth;
• spasm of masticatory muscles;
• crepitus ( crunch) bone fragments during movement.

Since this ailment is often combined with head injuries, it may be accompanied by nausea, vomiting, headaches, lethargy, loss of orientation. Such sensations should be reported to the doctor, as they may indicate a rather severe complications to be taken into account when planning treatment.

In addition to identifying signs of a fracture, the doctor, especially at the stage of providing primary care, checks the patency of the victim's airway, detects the presence of respiratory movements and heart contractions ( pulse). If there are any abnormalities, the doctor provides the necessary medical care by restoring the airway and performing cardiopulmonary resuscitation.

Plain radiography

The method is based on the ability of X-rays to pass through the tissues of the body and form a negative image on a special film. At its core, this method is similar to photography, with the difference that X-rays are used to form an image, not the visible spectrum of light. Since solid formations, such as bones, are capable of absorbing and retaining rays, a shadow image is formed on the film placed under the tissue, which will correspond to the bone formation. The degree of absorption of X-rays by the bone tissue is very high, due to which it is possible to obtain a fairly clear image of the jaw and adjacent bone formations.

If a fracture of the lower jaw is suspected, X-rays of both the upper and lower jaws are performed in frontal and lateral projections, which also cover the area of ​​the facial skeleton, the vault and base of the skull, and several cervical vertebrae. As a result, diagnostics is not limited to only one bone, but covers the whole anatomical formation.

In case of a fracture of the lower jaw, radiography allows you to determine the location of the fracture gap, the number of fractures, the presence or absence of fragments, and the degree of their displacement. In case of a fracture of the upper jaw, the involvement of adjacent bone structures is assessed on the x-ray, as well as darkening of the maxillary sinuses ( as a result of hemorrhage in them).

It should be noted that, despite its advantages, radiography has a number of significant drawbacks, among which the most significant is the need to irradiate the patient. From the point of view of environmental health, one of the tasks of which is to assess the radiological background and its effects on the body, performing several radiographic procedures increases the dose of radiation to a person, but the overall health impact is relatively small. However, since the effects of ionizing radiation can "cumulate", it is highly discouraged to be exposed to radiation unnecessarily.

Orthopantomography

This research method allows you to determine the presence and number of fractures of the jaw bones, damage to the temporomandibular joint and teeth. The whole procedure takes no more than five minutes and is relatively harmless.

CT scan ( CT)

CT provides clear information about the presence and number of fractures, localization of the fracture gap, allows you to identify small fractures of the upper and lower jaws, fractures and cracks in nearby bone structures, visualize small fragments that may not be visible on a simple radiograph.

Computed tomography is indicated in the following situations:

• in the presence of two or more fractures, determined radiographically;
• jaw fractures involving the dentition;
• suspicion of fractures of adjacent bone formations;
• before surgical treatment of jaw fractures.

A significant disadvantage of computed tomography is several large dose radiation to which the patient is exposed during the procedure. This is due to the fact that the device produces many consecutive shots, each of which irradiates the patient. However, given the high degree of image detail and the lack of need for additional projections, this technique is comparable in safety to other radiological procedures.

Magnetic resonance imaging ( MRI)

If damage to the vessels of the lower jaw, face and base of the skull is suspected, magnetic resonance can be performed using contrast. This method involves the intravenous administration of a special substance, which, under the conditions of a magnetic field, will be clearly visualized in the picture. As a result, due to the presence of this substance in the vascular bed, damage to even the smallest vessels can be detected.

The great advantage of MRI is the absolute safety of the method, which allows it to be used many times in the process of diagnosing and treating jaw fractures. The only contraindication for MRI is the presence of implants or metal elements in the patient's body, as they, moving under the influence of a magnetic field, can damage human tissues and organs during the procedure.

First aid for suspected jaw fracture

Do I need to call an ambulance?

• cardiopulmonary resuscitation ( if necessary);
• stop bleeding;
• anesthesia;
• immobilization and fixation of the jaw.

Cardiopulmonary resuscitation ( if necessary)

At traumatic fracture of the lower jaw, blockage of the upper respiratory tract often occurs with the development of acute respiratory failure, which, without proper and timely assistance, can lead to death. In addition, traumatic brain injuries are often combined with dysregulation of cardiac and respiratory activity, which also requires immediate action.

Cardiopulmonary resuscitation involves:

• Checking and securing the airway. Checking the patency of the airways under normal conditions is carried out by opening the lower jaw and revision of the oral cavity. However, in conditions of a fracture of the lower jaw, when, when it is opened, fragments may be displaced with damage to blood vessels and nerves, and there may also be a spastic contraction of the masticatory muscles that prevent opening the mouth, this procedure can be difficult. The presence of vomit in the oral cavity and the retraction of the tongue are the most common causes of airway obstruction and the development of asphyxia ( lack of breath). To prevent this, if the patient is unconscious, his tongue should be fixed. To do this, the tongue must be pierced 1.5 - 2 cm from the tip and tied to it with a thread, the other end of which should be sewn from the outside to the clothes or collar so that the tongue rests against the inner surface of the teeth. It is important that the thread is kept taut at all times. The patient should be laid on a horizontal surface on one side in case of vomiting due to a possible concussion.
• Breath testing and artificial respiration. Breathing is checked by listening to the lungs or observing respiratory movements chest. If there is no breathing and the patient is unconscious, then mouth-to-mouth artificial respiration should be started. To do this, the patient's mouth is slightly opened, covered with a clean handkerchief or any other cloth, and, having closed his nose, air is blown in. This procedure does not effectively ventilate the lungs of the victim, but helps to restore his own breathing.
• Pulse check and chest compressions. To assess the function of the heart muscle, it is necessary to feel the pulse on the radial artery ( on the palmar surface of the wrist from the side thumb ) or on the carotid artery ( slightly lateral to the thyroid cartilage on the throat). In the absence of a pulse, an indirect heart massage should be performed, which involves rhythmic pressure on chest in the region of the heart with a frequency of 90 - 100 per minute.

Stop bleeding

Anesthesia

Anesthesia can be carried out with the following drugs:

• analgin at a dose of 500 mg;
• naproxen at a dose of 500 - 750 mg;
• revalgin at a dose of 1 - 2 ml.

Given the specifics of the damage and the impossibility of taking the drug in tablet form, it is preferable injection form administration, that is, in the form of intramuscular injections. In the case of only tablets, they can be crushed to a powder state and, having dissolved in a small amount water, give the victim a drink. In this case, it is important to pre-clean the oral cavity from knocked out ( in the presence of) teeth, blood clots and foreign bodies.

Ice can also be applied to the injured area for pain relief. The beneficial effect is due to the fact that local cold reduces the sensitivity of nerve endings, and also reduces swelling and bleeding.

Immobilization and fixation of the jaw

Surgical treatment of jaw fractures

The following types of osteosynthesis are used to treat fractures:

• External osteosynthesis is a technique for treating fractures, in which special needles are inserted through the bone fragments perpendicular to the axis of the bone, which are then fixed outside the bone on a special apparatus. Such a tactic allows you to compare the fragments and unload the fracture site, thereby partially restoring the functionality of the bone for the duration of treatment.
• Intraosseous osteosynthesis It is carried out with the help of a special conductor, which is inserted into the medullary canal of the bone and passed through the fracture site. Usually this method is used to treat fractures of the diaphysis of long tubular bones.
• Bone osteosynthesis involves the imposition of a metal plate on the fracture site after restoring the anatomical position of the fragments. To fix the plate, screws or screws are used, which are screwed into the bone. This method allows you to quickly return the function of the bone and does not require the imposition of gypsum.
• Transosseous osteosynthesis. At transosseous osteosynthesis needles, wire or nails fixing the fracture are passed at an angle through the fracture site in such a way that both parts of the bone are fixed to the fracture line.

Indications for osteosynthesis are:

• the presence of large and small bone fragments;
• strong displacement of fragments and, as a result, the impossibility of comparing them without surgical intervention;
• fractures behind the dentition;
• pathological inflammatory or neoplastic process in the fracture area;
• reconstructive operations;
• a small number of healthy stable teeth on bone fragments.

Bone suture

This method of osteosynthesis is indicated in all cases of fresh fractures of the lower and upper jaws, in which there is no significant displacement of bone fragments.

Contraindications to this method are:

• inflammatory process in the fracture zone;
• the presence of many small bone fragments;
• osteomyelitis;
• gunshot wounds in the area;
• the presence of bone defects.

Bone metal plates

To fix bone fragments, small narrow plates made of titanium or stainless steel are used, which are screwed into the fracture area so that the fracture line is rigidly fixed.

Also, fast-hardening plastics, special glue ( resorcinol epoxy resins), memory metal staples, Kirchner spokes.

For closed osteosynthesis, various extraoral wires and staples can be used. These include S-shaped and unified hooks, Kirschner wires, static and dynamic extraoral devices for immobilization, etc. The choice of fixation method is individual and is largely determined by the characteristics of the fracture.

Closed comparison of fragments

To date, closed comparison of bone fragments is used in cases where the fracture line of the bone allows it, when surgery is associated with high risks, as well as in fractures with large quantity small bone fragments that cannot be surgically repositioned.

Recovery period

The use of physiotherapy, physiotherapy exercises and regular oral hygiene according to medical prescriptions are the basis for a quick recovery with full restoration of jaw function.

Physiotherapy exercises can be carried out as early as 4-5 weeks after the fracture, of course, after removing the tires. It is aimed at restoring chewing and swallowing functions, as well as speech and facial expressions.

The food regimen should be mechanically and chemically gentle, but at the same time cover the daily need for nutrients. The food is crushed, diluted to a liquid state with broths, heated to 45 - 50 degrees.

What physiotherapy is indicated after a fracture?

With a fracture of the jaw, the following physiotherapy is indicated