Fracture of the lower jaw: causes, symptoms, diagnosis, treatment. Jaw fracture treatment Oral care after jaw splinting

Comprehensive rehabilitation of jaw fractures

General provisions

In the complex of rehabilitation after fractures of the jaws, such measures as timely and effective fixation of fragments, antimicrobial and restorative therapy, physical methods of treatment, physiotherapy and oral hygiene.

Patients with fractures of the jaws are prescribed antibiotics that have the ability to accumulate in bone tissue (lincomycin, sodium fusidine, morphocycline, vibramycin, oleandomycin). In the first 3–4 days after injury, it is advisable to administer antibiotics locally to the injured area. Along with antibiotics, sulfonamides and nitrofuran preparations are prescribed. General strengthening therapy includes the use of B vitamins, ascorbic acid, methyluracil or pentoxyl orally, autohemotherapy, respiratory and hygienic gymnastics, rational nutrition. The use of UHF-therapy (up to 10 sessions), general UVR (up to 20 sessions) immediately after immobilization of fragments, microwave therapy is shown on the lesion. Exposure to an UHF electric field is prescribed on the 2nd-3rd day after fixation of the mandible fragments with dental sutures and on the 3rd-5th day after osteosynthesis with wire in the treatment of mandibular bone fractures.

Magnetotherapy is carried out on the 4-5th day after osteosynthesis or splinting. Induction magnetic field during the first two procedures it is 9-10 mT, with subsequent 12-19 mT. A sinusoidal current is applied in continuous mode. The first two procedures are carried out within 10 minutes, the subsequent - 15 minutes.

In case of bilateral fractures, the impact is performed using two straight-core inductors, which are located on both sides of the face. The number of procedures depends on the clinical picture (average 5-10 procedures). Starting from the 2-3rd procedure, there is a noticeable decrease in tissue edema and pain in the fracture area.

The presence of metallic inclusions is not a contraindication to the appointment of magnetotherapy in the indicated dosages. To improve the consolidation of fragments on the 12th–14th day after immobilization, calcine electrophoresis is performed on the area of the affected half of the face. For this purpose, a 2–5% solution of calcium chloride is used. An active electrode with calcin chloride (anode) is applied to the skin of the face at the site of the projection of the former fracture, the second electrode (cathode) is applied to the area of the forearm of the right or left hand. The duration of the procedure is 20 minutes. Current strength 3–5 mA. The course of treatment consists of 12 procedures carried out every other day.

The use of physiotherapy exercises contributes to a faster restoration of the function of the lower jaw. Therapeutic exercise is indicated in the stage of the formed young bone regenerate (bone callus) after the removal of tires (4-5 weeks after the fracture).

Patients with fractures of the jaws are not able to take normal food due to impaired function of chewing, sometimes swallowing. A patient with a fractured jaw should be prescribed a physiologically complete diet. However, the food must be mechanically and chemically gentle. Fresh products are carefully crushed, diluted with broth. Exclude spices, limit table salt. Food temperature should be 45-50°C. It can be prepared from special canned products (food concentrates, powdered mixtures, homogenized canned food). For patients with maxillofacial trauma, there are 3 diets (tables), which, according to chemical composition are the same and differ in texture.

The first jaw (probe, tube) diet is distinguished by food of the consistency of cream. It is prescribed for the entire period of treatment, when tires with hook loops are applied and intermaxillary fastening with rubber rings is carried out. These patients have lost chewing function and defective swallowing function.

The second jaw diet is characterized by eating the consistency of thick sour cream. It is indicated for patients who have impaired chewing function, but the swallowing function is preserved. It is prescribed at a certain stage of treatment, when it is possible to remove the intermaxillary fixation, or after osteosynthesis of fragments.

The general table (No. 15) is assigned to patients after the consolidation of fragments.

In case of violation of the function of chewing for eating, it is convenient to use a drinker, on the tip of which a rubber tube 20 cm long is put on. The patient can independently bring the end of the tube to a defect in the dentition or behind the molar fissure and introduce about 10 ml of liquid food into the vestibule of the mouth. Then, using the stored suction ability, he can transfer food to his mouth and swallow it.

If the patient cannot eat independently, the nurse feeds him.

Tube feeding is carried out using a thin gastric or duodenal tube or a vinyl chloride tube with a diameter of 7–8 mm and a length of about 1 m. The probe is inserted into the stomach through the nose after anesthesia of the mucous membrane of the lower nasal passage with a solution of cocaine or dicaine. The segment of the immersed probe should not exceed 45 cm. If the probe accidentally enters the trachea, then this is accompanied by strong cough. Food slurry in a volume of 500–600 ml is gently injected into the stomach with a large syringe in portions of 100–200 ml. After feeding, the end of the probe is clamped with a clamp and fixed on the patient's head with a bandage or plaster. A thin rubber tube can be left in the nasal passage for 14–16 days, and a PVC tube for 3–4 weeks, as it is more resistant to the action of gastric juice.

Parenteral nutrition is prescribed for patients who are unconscious for a long period of time, and also as an addition to enteral nutrition. Nutrients can be administered intravenously, subcutaneously, intramuscularly. More often, the intravenous route is used, the technique of which is not much different from the intravenous drip of drugs. Proteins are introduced into the body in the form of ready-made mixtures of polypeptides and amino acids (aminopeptide, casein hydrolyzate COLIPC, hydrolysin L-103, aminocrovin), fats - in the form of ready-made fat emulsions (intralipid, etc.), carbohydrates - in the form of hypertonic solutions of glucose, fructose or their mixtures, sorbitol. In addition, they introduce vitamins (C, B, A, K), minerals - sodium, potassium, calcium salts. Protein hydrolysates and fat emulsions can be administered intravenously at a rate of 30-40 drops per minute, glucose and salt solutions - faster (up to 60 drops per minute).

Patients with maxillofacial trauma should be fed at least 4 times a day, distributing the daily calorie content differently: breakfast - 30%, lunch - 40%, dinner - 20-25%, second dinner - 5-8%.

Patient care is essential. Distinguish between general and special care. General care involves general hygienic measures, control over the activity of the cardiovascular and respiratory systems, gastrointestinal tract and urinary system.

Special care is oral care. If the patient is unconscious, he needs to wipe his teeth and oral mucosa at least 2 times a day with a solution of furacilin, ethacridine, potassium permanganate. Walking patients themselves take care of the oral cavity. Since after splinting the process of self-cleaning of the mouth is disturbed, it is necessary to thoroughly irrigate the oral cavity at least 8-10 times a day.

The value of oral hygiene in the complex rehabilitation of injuries and injuries of the maxillofacial region

Rational oral hygiene using a toothbrush and paste is both an integral part of general human hygiene and a component of complex rehabilitation after injuries of the maxillofacial region. The effectiveness of general treatment directly depends on the degree of intensity of oral hygiene and the degree of sanitation of the oral cavity. Low level hygiene of the oral cavity against the background of a decrease in immunity, a weakening of the general resistance of the human body after an injury, including in the maxillofacial region, contributes to the development of opportunistic microflora of the oral cavity, which can lead to the development of formidable complications: post-traumatic omteomyelitis, lymphadenitis, phlegmon and abscesses, the development of septic conditions. Therefore, rational oral hygiene and sanitation of the oral cavity (if possible) is in the first place in the list of rehabilitation measures after injuries of the maxillofacial region.

There are many methods for removing dental deposits. Brushing teeth with a toothbrush in horizontal, reciprocating movements is unacceptable, since this removes plaque only from the vestibular surface of the teeth. This method of brushing your teeth leads to the fact that soft plaque is transferred from the surface of the teeth into the interdental spaces. In addition, there is a risk of wedge-shaped defects, especially on protruding teeth, gingival papillae may be damaged, and the lingual and palatal surfaces of the teeth are not cleaned at all.

Considering individual characteristics oral cavity, it is advisable to recommend a combination of individual techniques that fit into the so-called standard method of brushing teeth, which combines horizontal, vertical and circular movements. The accuracy and thoroughness of the procedure for brushing your teeth are the determining factors for the effectiveness of oral hygiene.

It is advisable to clean the teeth of both jaws according to a certain scheme: visually, each jaw is divided into 6 segments: 2 frontal (incisors and canines), premolars, molars, right and left.

Brushing of teeth can be started from the vestibular side of the molars on the right or left of the upper jaw and continue to the opposite side, then clean the chewing surface of the teeth and finish brushing on the palatal surface of the teeth. In the same sequence, the teeth of the lower jaw are cleaned.

All surfaces of the teeth of each segment of the jaw must be cleaned with at least 10 paired brush strokes. Only 400-500 paired movements. The time of brushing your teeth should be on average 3.5-4 minutes. Brushing should be done twice a day: in the morning after meals and in the evening before bed. The bristles of the brush should be directed at an acute angle to the surface of the teeth. It is more rational to start brushing your teeth with sweeping movements that allow you to perfectly clean the vestibular and palatine (lingual) surfaces of the teeth. The chewing surfaces of the teeth are cleaned by reciprocating horizontal movements. Brushing your teeth is finished in a circular motion.

Rules for brushing your teeth

1. A toothbrush is taken with clean hands, washed with warm running water.

2. Toothpaste is applied to the bristles of the toothbrush.

3. Thoroughly rinse the mouth with warm boiled water.

4. The implementation of the "standard method" of brushing your teeth, which combines horizontal, vertical and circular movements. Vertical or sweeping movements should prevail in brushing your teeth.

5. The time of brushing the teeth is 3-4 minutes, which is 350-450 paired movements of the toothbrush on the surfaces of the teeth.

6. In the process of brushing your teeth and at the end of the mouth, rinse with warm boiled water with a fluorine-containing elixir.

7. The toothbrush is washed with warm running water, the bristles are lathered with any toilet soap, the brush is installed in a glass with the head up.

8. You need to brush your teeth 2 times a day: in the morning after breakfast and in the evening before going to bed.

9. The service life of the toothbrush is maximum 1 month. The brush should be sparse, with a curved handle, small head, artificial bristles.

10. Toothpaste is used only for treatment and prevention.

Despite the ever-increasing level of dental care, the emergence of new materials and technologies in the treatment of dental caries, the fact that mechanical cleaning of teeth is necessary is undeniable.

Toothbrushes

The toothbrush is the main tool for removing deposits from the surface of the teeth and gums. Without it, it is impossible to carry out effective hygienic measures.

Natural bristle toothbrushes:

1) there is a median canal;

2) bristles with burrs, porous surface;

3) the end of the bristles delaminates during processing.

Artificial bristles:

1) there is no channel;

2) the surface is smooth, non-porous;

3) the end of the bristle is rounded.

Currently, there are many models of toothbrushes. Each consists of a handle, a head with "bushes" of bristles planted on it. There are types of toothbrushes that differ in the shape and size of the heads, the location and thickness, the length and quality of the bristles, the size and shape of the handles. For the manufacture of toothbrushes, natural bristles and synthetic fibers (nylon, setron, perlon, polyurethane) are used.

The comparison shows that artificial fiber toothbrushes have a number of advantages over natural bristle toothbrushes.

The efficiency of using toothbrushes, and, consequently, the correct individual choice of them depends on the so-called stiffness of the bristle field. There are 5 levels of bristle hardness: very hard, hard, medium hard, soft, very soft.

The exceptions are children's toothbrushes, which are made from soft to very soft bristles. Very hard and hard brushes, if used incorrectly, can injure the gums and hard tissues of the tooth.

Warm water pretreatment makes the brush softer. Medium-hard brushes are the most effective, as their bristles are more flexible, which allows you to clean the gingival sulcus and better penetrate into the interdental spaces. The use of a very soft toothbrush in combination with sloppy brushing can result in pigmented stains on the teeth. In the normal condition of the periodontium and teeth, it is recommended to use brushes of medium hardness.

Important in the design of the brush is the frequency and shape of the bush planting. The optimal distance between the bushes is considered 2.2–2.5 mm. The parallel form of bush planting is the simplest and most effective. Often, brushes are produced with a dense bush planting, which makes their hygienic maintenance difficult, and also reduces the cleaning effect on the proximal surfaces of the teeth.

In addition to the frequency of bush planting, there is the concept of "cutting" the brush field and "bushes". Most modern brushes have a serrated surface, in which the marginal bristles in the bushes sit lower than the central ones. This design allows the central bristles to enter into narrow interdental spaces, but if the bristles are hard, only the central bristles have the cleaning ability, since they do not allow the side bristles to touch the surface of the tooth during cleaning.

Well remove plaque without damaging the mucous membrane of the gums, brushes with a flat surface.

The main functional part of the toothbrush is the head. The most effective brushes with small heads. A toothbrush with a short head has a relatively large working field. With this brush, you can clean all areas of the dentition well.

For children, the length of the working part of the toothbrush is 18–25 mm, and the width is 7–9 mm; for adults - length 23-30 mm, and width 7.5-11 mm.

There are electric toothbrushes. In an electric toothbrush, the automatic movements of the head (vibrating and rotating) are carried out by a motor located in its handle. The frequency of movements in an electric toothbrush is quite high, approximately 50 strokes per minute.

Significance electric brush in oral hygiene is evaluated differently. Studies have shown that electric toothbrushes do not offer much benefit. However, the less the patient is informed about brushing techniques using a simple toothbrush, the more advantages are revealed when he uses an electric one, which, due to its novelty and necessity, stimulates the desire to regularly care for the teeth. Automatic movements of the brush free the patient from the need to carry out the correct movements, which, by the way, are often unknown to him. In this regard, the use of an electric toothbrush can be recommended for children, the disabled or patients with insufficient dexterity.

The toothbrush gets dirty easily, so it must be kept absolutely clean. After brushing your teeth, the brush should be rinsed under running water and carefully cleaned of food debris so that it can dry well, for example, in a glass with the head up. This significantly reduces the number of microorganisms in the brush, and the bristles retain their hardness and shape.

As soon as the toothbrush shows signs of wear, it should be replaced as it becomes unusable. Loss of bristles, their flaking, loss of shape, bushiness, shortening of the bristles are signs of unsuitability and the need to replace the brush. Typically, a toothbrush should be replaced 10 times in a year, i.e. a monthly replacement is necessary. It is during this period that the culminating accumulation of microorganisms in the toothbrush occurs, and it becomes a breeding ground for infection; ordinary soaping no longer ensures its perfect cleanliness.

However, even careful oral hygiene using only a toothbrush does not achieve good cleansing from plaque on the lateral surfaces of the teeth and interdental spaces. As a result, it is extremely necessary to use other means in personal hygiene: dental floss, toothpicks, special dental toothbrushes, interdental stimulators, oral irrigators, brushes.

dental floss

For a more thorough removal of plaque and food debris from the interdental spaces, i.e., cleaning of hard-to-reach proximal surfaces of the teeth, waxed or unwaxed threads are used.

Distinguish between round and flat threads. Flat waxed floss is more comfortable as it passes through contact points more easily, does not break, and covers more of the tooth surface. The following method of its application is recommended: a thread 35-40 cm long is wound around 1 phalanx of the middle fingers of each hand. Slowly and carefully insert into the interdental space and then stretch at the base of the gingival sulcus. With the help of several movements of the thread back and forth and up and down, all soft dental deposits are removed from the distal surface of the tooth. Then clean the medial surface. To do this, carefully, so as not to damage the gingival papilla, move the thread, firmly pressed to the tooth, along its surface back and forth through the contact point and remove plaque. Then the thread is advanced through the interdental papilla to the base of the adjacent gingival groove of the next tooth and its lateral surface is cleaned. The procedure is repeated until the lateral surfaces of all teeth are cleaned. You should not advance the thread with great effort, as this is associated with the risk of damage to the gum tissue.

To facilitate the use of floss, there is a special holder.

Thus, after appropriate preliminary instruction and practical demonstration, flossing should be strongly recommended to patients as an excellent tool for cleaning the sides of the teeth and interdental spaces. Threads impregnated with a 2% sodium fluoride solution are used simultaneously for the treatment of the lateral surfaces of the teeth and for the prevention of caries.

toothpicks

Other complementary and well-established oral hygiene aids are toothpicks. They are wooden, plastic, bone, in shape - triangular, flat, round, they are used not only to remove food debris from the interdental spaces, but also mainly to remove plaque from the side surfaces of the teeth. Their use is especially effective if there are spaces between the teeth. If the teeth are tightly packed and the interdental spaces are filled with interdental papillae, the use of a toothpick is limited.

Interdental stimulators

The tool serves to massage the gums and interdental spaces. Interdental stimulators are made of rubber, have different degrees of hardness and colors, and are fixed in the hole of the toothbrush handle.

Used for thorough cleaning of the proximal surfaces of the teeth. The tool consists of a handle and a working fleecy part. Allows you to clean interdental spaces with reciprocating and clockwise rotation movements.

This text is an introductory piece.

ICD-10 code: S02.6 A fracture is a damage to the lower jaw with a violation of its integrity. In peacetime, the causes of fractures of the lower jaw are most often blows and bruises received during a fall, compression, in a fight, etc. Mandibular fractures are the most common of all facial fractures.

Mandibular fracture symptoms

There are a number of signs that make it possible to suspect a fracture of the lower jaw. This is swelling of the soft tissues around the jaw, pain in the lower jaw, aggravated by opening and closing the mouth, improper closing of the teeth. Biting and chewing food is sharply painful or impossible. Often there is a feeling of numbness of the skin in the chin and lower lip, bleeding from the mouth. Also, quite often, a fracture of the lower jaw is accompanied by a concussion of the brain. There may be dizziness, headache, nausea, vomiting, the victim may partially or completely not remember the circumstances of the injury.

Collecting anamnesis, the doctor must find out when, where and under what circumstances the injury occurred. According to clinical signs (preservation of consciousness, contact, the nature of breathing, pulse, blood pressure), the general condition of the patient is assessed. It is necessary to exclude damage to other anatomical areas.

During the examination, a violation of the configuration of the face is determined due to post-traumatic edema of the soft tissues, hematoma, displacement of the chin away from the midline. On the skin of the face there may be abrasions, bruises, wounds.

On palpation of the lower jaw, a bone protrusion, a bone defect or a painful point is detected, more often in the area of the most pronounced soft tissue swelling or hematoma. An important diagnostic criterion is a positive load symptom.(pain symptom): when pressing on a known intact area of the lower jaw in the fracture area, a sharp pain appears due to the displacement of fragments and irritation of the damaged periosteum.

If one or more of the listed signs appear, you should immediately seek medical help, call an ambulance team. The sooner specialized medical care is provided for a fracture of the lower jaw, the less likely it is that complications, including very formidable ones, will occur.
These complications include: osteomyelitis, phlegmon, neuritis, neuralgia, improper union of fragments, the occurrence of a false joint, etc. Often, the resulting complications cause severe consequences for health and require long-term treatment with repeated surgical interventions.

Diagnosis of a mandibular fracture

Clinical picture data must be confirmed by results x-ray examination. Radiographs allow to clarify the topical diagnosis of the fracture, the severity of the displacement of fragments, the presence of bone fragments, the ratio of the roots of the teeth to the fracture gap. Usually do two x-ray: in direct and lateral projections, or orthopantomogram. In case of fractures of the condylar process, additional information is provided by special styling for the TMJ.

Mandibular fracture treatment

Treatment of victims with fractures of the lower jaw is carried out in a specialized medical institution in a hospital.
The essence of the treatment is to compare the fragments and their stable fixation in the correct position for the period necessary for the formation of callus (about four weeks). The correctness of the comparison of fragments is controlled using control radiography.
There are surgical and orthopedic (conservative) methods of treatment, each of which has certain advantages and disadvantages. Most orthopedic techniques are reduced to the imposition on the upper and lower dentition splinting structures, which are fastened together, providing fixation of fragments of the lower jaw to the fixed upper jaw. The advantage of orthopedic (conservative) methods is low trauma, no threat of surgical complications (damage during the operation of large vessels, nerve trunks).
Significant disadvantages are the forced immobility of the lower jaw during the entire period of fixation, poor oral hygiene (which may result in the development of inflammatory complications), injury to the ligamentous apparatus of the teeth. In addition, stable fixation of fragments using splinting is not possible in all clinical situations. Currently, as a rule, orthopedic treatment methods are used for fractures of the lower jaw within the dentition without significant displacement of fragments.

"gold standard" surgical methods of treatment is currently considered to be the fastening of fragments with the help of bone titanium mini plates. This technique allows to achieve the most accurate comparison and stable fixation of bone fragments. In the postoperative period, as a rule, the patient immediately has the opportunity to open his mouth, oral care is simplified, there is the possibility of early use of physiotherapy exercises, which prevents the development of cicatricial changes in the masticatory muscles; shortening the recovery period.

In the process of treating patients with fractures of the lower jaw, it is mandatory to prescribe antibiotics, given that the bone wound in such fractures in most cases is obviously infected with the aggressive microbial flora of the oral cavity. In addition, vitamins A, C, D, E, calcium preparations, some hormones (parathyroidin, calcitrin, retabolil), immunomodulators (thymalin, timarin, thymazine, etc.) play an important role in drug treatment. It is important to remember that self-medication is unacceptable. Assign drug treatment only a doctor can.

In addition to fixing fragments and prescribing drugs, it is necessary to use various methods physiotherapy and exercise therapy. The timely application of these methods helps to optimize the process of bone formation and prevent the development of complications such as muscle contracture, false joint, delayed fusion of bone fragments, osteomyelitic process.

Treatment of a fracture of the lower jaw in a hospital

Treatment in a hospital is carried out in within 1-2 weeks, after which the patient is discharged for outpatient observation by a dental surgeon at the place of residence. During this period, the intake of calcium, vitamin D, physiotherapy, physiotherapy continues.
When using orthopedic methods of treatment, the doctor of the outpatient clinic performs, if necessary, correction of splints, fixing ligatures, elastic traction. On the 7-10th day, the sutures are removed.
After 4 weeks from the start of treatment in an outpatient setting, the external fixing structures are removed, after which, in the absence of complications, the patient has the opportunity to fully begin his work duties, if they are not associated with heavy physical labor. From heavy physical activity should refrain for another 2-3 weeks.

It is important to remember that the success of the treatment, not least of all, depends on the patient himself, on how conscientiously he follows the doctor's recommendations. So, an important condition for the success of treatment is careful observance of oral hygiene, especially when choosing orthopedic methods of treatment. Tooth splints, wire fixing ligatures, lack of movements of the lower jaw are the reason for the deterioration of self-cleaning of the oral cavity and teeth with the help of saliva and solid food. On splints and ligatures, food residues are retained, which are a fertile basis for the reproduction of aggressive microorganisms that cause a variety of complications from periodontal disease of supporting teeth to the development of phlegmon and osteomyelitis.

It is necessary to rinse the mouth with antiseptic solutions (furatsilin, chlorhexidine) not only after each meal, but also in the intervals between meals and at bedtime. Irrigation of the oral cavity can be performed, for example, using a rubber bulb. In addition, be sure to brush your teeth with toothpaste and a toothbrush, use a toothpick to remove food debris, massage your gums with your index finger several times a day.

An important component of treatment is good nutrition. In this case, the intake of solid food by patients with fractures of the lower jaw is impossible. For such patients, a special diet has been developed - a jaw table, which differs in consistency and its components, depending on the severity of the general condition of the victim and the method of fixation of bone fragments. The first jaw table has the consistency of cream. It is prescribed for orthopedic fixation of bone fragments for the entire period of treatment. The second jaw table (consistency of thick sour cream) is prescribed more often to patients after surgical treatment, as well as after removal of elastic traction and in the first two days after removal of tires. This diet is transitional to the general table. In a hospital, the appointment of a diet is carried out by a doctor, in the dining room of the hospital there is a special menu and daily layout.

In an outpatient setting, after discharge from the hospital, the patient himself must take care of preparing the appropriate food. It should be borne in mind that food should be liquid and high-calorie, include proteins, fats, carbohydrates and vitamins. We can recommend three liquids that dilute (dilute) any food. This is milk, vegetable or meat broth. They breed boiled mashed vegetables (potatoes, carrots, necessarily beets, herbs, tomatoes, sweet peppers, etc.), mashed pasta and well-boiled cereals (buckwheat and oat flakes), cottage cheese and other products. To obtain a sufficient amount of proteins in meat broth, boiled meat passed through a meat grinder twice, and sometimes also rubbed through a sieve, is diluted.

In addition, you can use ready-to-eat products: sour cream, cream, milk, kefir, juices, fruit and vegetable puree (preferably from fresh fruits and vegetables).

Be sure to use vegetable oil in all dishes, as it contains a lot of unsaturated fatty acids, which have a beneficial effect on bone tissue regeneration.

Food is taken warm 5-6 times a day. With tight contact of the dentition (two-jaw splints), food is introduced with a drinking bowl with a rubber tube into the gap behind the last tooth. In the presence of a defect in the dentition (missing a tooth or several), it is used to introduce food through a drinking tube or with a spoon. With surgical methods of treatment, when the lower jaw is not fixed to the upper one, it is possible to eat with a regular spoon.

Medicines in the form of tablets or dragees are ground to a powder and dissolved in a tablespoon of warm water, after which they are administered using a drinker or spoon.

It is strictly forbidden during the treatment period to take alcohol, which, with such a meager diet, is quickly absorbed, causing severe intoxication up to poisoning. Alcohol can provoke vomiting, which is life-threatening during double jaw fixation, since the patient, being unable to open his mouth on his own, can choke on his vomit.

Attention! the information on the site is not a medical diagnosis, or a guide to action and is for informational purposes only.

jaw fracture is a severe pathological situation in which the linear integrity of the bones that form the lower jaw is disturbed. 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 suffer most often 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. Tooth fracture- this is a tooth injury received under the influence of mechanical force. With a fracture, the anatomical integrity of the tooth root or its crown is violated. The causes of a tooth fracture are mechanical injuries resulting from a blow, a fall, or during chewing, when solid foreign bodies are present in the food. The anterior teeth of the upper jaw are more prone to fractures than the teeth of the lower jaw, often fractures of the teeth are combined with their incomplete dislocations.

Causes

Fractures of the lower jaw occur as a result of exposure to some traumatic factor, the force of which exceeds the margin of safety of the bone. In most cases, this occurs as a result of falls, bumps, traffic accidents, sports and professional accidents. Nevertheless, the consequences of a traumatic impact are far from being the same in all cases and depend not only on the intensity, but also on a number of other factors, among which the physiological and structural state of the bone before the injury is of particular importance.

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 prevention tactics are selected. There are the following types of fractures:

Basically, in clinical practice, there are traumatic fractures, which, due to the peculiarities of the shape and anatomy of the jaw, differ from fractures of other bones of the skeleton. First, due to the arcuate shape of the bone, when pressure is applied anteriorly in the chin area, the resultant force acts on the lateral portions of the arc. This is due to the rigid fastening of the jaw in the temporomandibular joint, which does not allow it to move and thereby dampen the impact energy. Thus, under the influence of one traumatic factor, a multiple fracture of the jaw quite often develops ( usually in the area of the mandibular symphysis and angle of the jaw). Secondly, the jaw is a fairly strong bone that requires a lot of force to break. From a physical point of view, for a jaw fracture in the region of the corner, it is necessary to apply energy corresponding to 70 accelerations of free fall ( 70g), and for a fracture in the symphysis area, this indicator must be increased to 100. However, it should be understood that under pathological conditions and with violations of bone development, the force of the necessary blow is significantly reduced. 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 with certain types of 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:

Fractures of the lower jaw, like fractures of other bones of the body, are divided into open and closed depending on the contact of bone fragments with the external environment. However, unlike other bones, jaw fractures have their own characteristics, which are associated with the proximity of the oral cavity. Fractures of the lower jaw are of the following types:

Depending on the displacement of bone fragments, the following types of jaw fractures are distinguished:

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. This situation 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 small area bones ( e.g. hit with a hammer), and secondly, comminuted fractures require surgical treatment, as they significantly destabilize the bone.

Knowledge of the degree of displacement of bone fragments is necessary for planning a therapeutic approach, since significantly displaced fragments require much more labor-intensive treatment, which involves surgical comparison and fixation of the bone. In addition, the displacement of bone fragments, which after a fracture have rather sharp edges, can cause damage to the nerves and blood vessels, which is an extremely unfavorable situation and requires immediate medical attention. Odontogenic osteomyelitis Odontogenic osteomyelitis is an infectious and inflammatory lesion of the bone tissue of the lower jaw, which arose against the background of a dental infection. In other words, this pathology is an infection that has penetrated into the lower jaw from the primary focus, localized in the tooth or teeth. It is relatively rare, but it is quite dangerous and difficult to treat.

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.

Symptoms

The symptoms of a jaw fracture are quite varied. In most cases, this pathology is combined with a number of external manifestations, as well as with a number of subjective sensations. However, since quite often a fracture of the jaw is combined with craniocerebral injuries, in which the victim may be unconscious, it is precisely those clinical manifestations that the doctor can see during examination that are most important. A fracture of the lower jaw is accompanied by the following symptoms:

Among other symptoms of a jaw fracture, 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.

Tooth fracture

Tooth fracture- traumatic damage to the tooth, accompanied by a violation of the integrity of its root or crown. Meet different kinds tooth fracture: fracture of the enamel, dentin and root of the tooth. Manifested by sharp mobility and displacement of the injured tooth, intense pain. In case of crown fractures, the tooth can be saved with subsequent cosmetic restoration, in case of a root fracture, its removal is required. With a root injury, there is a high risk of developing periostitis, osteomyelitis, and other complications.

Tooth fracture

Tooth fracture- this is a tooth injury received under the influence of mechanical force. With a fracture, the anatomical integrity of the tooth root or its crown is violated. The causes of a tooth fracture are mechanical injuries resulting from a blow, a fall, or during chewing, when solid foreign bodies are present in the food. The anterior teeth of the upper jaw are more prone to fractures than the teeth of the lower jaw, often fractures of the teeth are combined with their incomplete dislocations.

Clinical manifestations of a fractured tooth

When a tooth is fractured, severe unbearable pain occurs, the victim has difficulty opening his mouth and closing his teeth. In addition, a fracture of the tooth is preceded by some kind of trauma, bleeding of the gums and pathological loosening of the tooth. Painful sensations during mechanical and thermal irritation depend on the type and location of the fracture, as well as on the mobility of the tooth. During the examination, swelling of the soft tissues of the oral cavity and petechial hemorrhages in the skin and mucous membranes are detected. Fracture of the crown of the tooth is clinically manifested in the form of its defect, often such a fracture is accompanied by the opening of the pulp chamber. When the root of the tooth is fractured, the tooth becomes mobile, its percussion is sharply painful, and the crown sometimes acquires a pink tint. Tooth fracture can be minor in the form of a chipping of the tooth enamel, or significant when there is a fracture of the dentin with or without exposure of the pulp and a fracture of the tooth root. Complete fractures are called fractures with opening of the pulp, incomplete - without opening the pulp.

Diagnostics

A fracture of the jaw can be suspected on the basis of a patient interview, examination data and clinical examination. However, in most cases, for the final diagnosis, additional instrumental studies are required to diagnose both the fracture itself and a number of existing and potential complications of this phenomenon. It should be noted that in pathological fractures, the diagnostic process is not limited to identifying the site and type of fracture, but also involves a number of additional radiographic and laboratory studies aimed at identifying the initial bone pathology. However, since the vast majority of people admitted to traumatology departments of hospitals with a fracture of the jaw suffered from various traumatic circumstances, their examination is considered routine and includes an examination and a number of additional procedures. A jaw fracture is detected using the following methods: During a clinical examination, the doctor identifies the main objective ( visible or felt by an outside observer) and subjective ( perceived exclusively by the patient) symptoms, and also finds out the circumstances of the incident. TO objective symptoms jaw fractures 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.

Subjective signs of a jaw fracture usually include pain in the area of the fracture and primary injury, as well as a change in sensation on the fragment located behind the fracture line. This is due to the fact that during a fracture, a structural or functional ( due to swelling and inflammation) damage to the nerve, which reduces the sensitivity of the corresponding zone or causes specific sensations of numbness in it. Since this ailment is often combined with craniocerebral injuries, it can be accompanied by nausea, vomiting, headaches, lethargy, loss of orientation. Such sensations should be reported to the doctor, as they may indicate rather severe complications that must 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 airways, 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 Plain radiography is a fast, effective and non-invasive method that allows you to accurately determine both the presence of a jaw fracture and its location. This study is indicated in all cases with suspected jaw fracture, as well as in most cases with craniocerebral injuries. 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 bone tissue very large, so you can get 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 the direct and lateral projection, which also covers 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. With 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, 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. In terms of hygiene environment, 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 Orthopantomography is an x-ray method of research that allows you to get a panoramic picture of the dentoalveolar system. It is performed using a special device - an orthopantomograph, in which the image is obtained by rotating the x-ray source and the film around the fixed head of the patient being examined. As a result of this, a panoramic image of the dentition, as well as the upper and lower jaws and nearby bone formations, is obtained on the film. 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 ) Today, computed tomography is the preferred method for diagnosing jaw fractures, as it provides more accurate and detailed information. The method is also based on X-ray radiation - the patient is placed in a special CT scanner, and the X-ray machine rotating around it takes many pictures. After computer processing, a clear layer-by-layer image of the area under study is obtained, and if necessary, it is even possible to create a three-dimensional image of the facial skeleton. 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.

It should be noted that the advantage of computed tomography is the clarity of the resulting image and the detail of the image. In addition, this method is extremely informative for traumatic brain injuries, and due to the speed of execution, it allows you to quickly diagnose cerebral hemorrhages. A significant disadvantage of computed tomography is the slightly higher dose of 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, due to the high degree of image detail and the absence of the need to take images in additional projections, this method is comparable in terms of safety to other radiological procedures. Magnetic resonance imaging (MRI ) Magnetic resonance imaging is a modern and highly informative method used in the diagnosis of jaw fractures. It is based on obtaining an image of soft tissues by fixing the properties of water molecules changed in a magnetic field. This method is more sensitive in the study of periarticular tissues, provides information about the state of the jaw vessels and nerves, allows you to assess the degree of damage to muscles, ligaments, intraarticular discs, determine hemorrhage into the cavity of the joint capsule and rupture of the joint capsule. All these pathologies can be detected only by this method, since other radiological procedures based on x-rays are relatively poor at imaging soft tissues. 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.

Treatment

Surgical treatment of jaw fractures

Surgical treatment of a jaw fracture, which is indicated for most patients, and which is called osteosynthesis in medicine, is the main effective method for restoring bone integrity. The following types of osteosynthesis are used to treat fractures:

In addition to the above methods used to fix fracture fragments, other methods are used in traumatology practice, the choice of which depends on the severity of the patient's condition, the type and complexity of the fracture, as well as the skills of the surgeon. 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

To apply a bone suture, the fracture area is exposed from the soft tissues from the lateral and inner sides. Holes are made in the fragments, through which, after comparison, a wire is passed, with which the fragments are fixed. The wire can be made of stainless steel or titanium. In some cases, synthetic threads are used instead of wire, however, due to their lower strength, this method is of limited use. 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.

The advantage of this method is the preservation of the ability to independently eat and perform oral hygiene, as well as the exclusion of complications in the temporomandibular joint.

Bone metal plates

Extra-osseous metal plates are widely used in maxillofacial surgery, since, firstly, they can reduce soft tissue injuries during surgery ( it is necessary to cut the skin and muscles from only one, lateral side), which positively affects the recovery period and the time of bone fusion, and secondly, it allows better fixation of fragments in areas subject to strong dynamic loads. To fix bone fragments, small narrow plates 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

In addition to the methods of surgical treatment listed above, in some cases it is possible to achieve comparison of bone fragments and non-surgical way. This approach has a number of advantages, since, firstly, it does not require surgery, and therefore it is devoid of a number of risks, and secondly, it is not associated with soft tissue injuries in the fracture area, which disrupts blood microcirculation and slightly increases the time for bone fusion. However, the need for external fixation bone and limited jaw function are disadvantages of this method. Closed comparison of fragments of the lower jaw involves the imposition of a special fixing splint, which is attached to the teeth and stabilizes the bone fragments. To date, closed comparison of bone fragments is used in cases where the bone fracture line allows it, when surgical intervention is associated with high risks, as well as in fractures with a large number of small bone fragments, which cannot be surgically matched.

Recovery period

The effectiveness and recovery time in the postoperative period depends, first of all, on the time of the operation relative to the moment of injury and on the type of osteosynthesis chosen. Also important is the general condition of the patient and the degree of compensation of his chronic and acute diseases. Timely prescription of antibiotics and restorative agents reduces the risk of complications, thereby reducing the 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 gentle in mechanical and chemical terms, 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.

Causes

Depending on the displacement of bone fragments, the following types of jaw fractures are distinguished:

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. This situation 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 require surgical treatment, as they significantly destabilize the bone.

Symptoms

Tooth fracture

Tooth fracture- traumatic damage to the tooth, accompanied by a violation of the integrity of its root or crown. There are various types of tooth fractures: enamel, dentin and root fractures. Manifested by sharp mobility and displacement of the injured tooth, intense pain. In case of crown fractures, the tooth can be saved with subsequent cosmetic restoration, in case of a root fracture, its removal is required. With a root injury, there is a high risk of developing periostitis, osteomyelitis, and other complications.

Tooth fracture

Clinical manifestations of a fractured tooth

Diagnostics

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.

Subjective signs of a jaw fracture usually include pain in the area of the fracture and primary injury, as well as a change in sensation on the fragment located behind the fracture line. This is due to the fact that during a fracture, a structural or functional ( due to swelling and inflammation) damage to the nerve, which reduces the sensitivity of the corresponding zone or causes specific sensations of numbness in it. Since this ailment is often combined with craniocerebral injuries, it can be accompanied by nausea, vomiting, headaches, lethargy, loss of orientation. Such sensations should be reported to the doctor, as they may indicate rather severe complications that must 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 airways, 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 Plain radiography is a fast, effective and non-invasive method that allows you to accurately determine both the presence of a jaw fracture and its location. This study is indicated in all cases with suspected jaw fracture, as well as in most cases with craniocerebral injuries. 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 the direct and lateral projection, which also covers 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. With 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, 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 Orthopantomography is an x-ray method of research that allows you to get a panoramic picture of the dentoalveolar system. It is performed using a special device - an orthopantomograph, in which the image is obtained by rotating the x-ray source and the film around the fixed head of the patient being examined. As a result of this, a panoramic image of the dentition, as well as the upper and lower jaws and nearby bone formations, is obtained on the film. 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 ) Today, computed tomography is the preferred method for diagnosing jaw fractures, as it provides more accurate and detailed information. The method is also based on X-ray radiation - the patient is placed in a special CT scanner, and the X-ray machine rotating around it takes many pictures. After computer processing, a clear layer-by-layer image of the area under study is obtained, and if necessary, it is even possible to create a three-dimensional image of the facial skeleton. 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.

Treatment

Surgical treatment of jaw fractures

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

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

The advantage of this method is the preservation of the ability to independently eat and perform oral hygiene, as well as the exclusion of complications in the temporomandibular joint.

Bone metal plates

Closed comparison of fragments

In addition to the methods of surgical treatment listed above, in some cases it is possible to achieve comparison of bone fragments and non-surgical way. This approach has a number of advantages, since, firstly, it does not require surgery, and therefore it is devoid of a number of risks, and secondly, it is not associated with soft tissue injuries in the fracture area, which disrupts blood microcirculation and slightly increases the time for bone fusion. However, the need for external bone fixation and limited jaw function are disadvantages of this method. Closed comparison of fragments of the lower jaw involves the imposition of a special fixing splint, which is attached to the teeth and stabilizes the bone fragments. To date, closed comparison of bone fragments is used in cases where the fracture line of the bone allows it, when surgical intervention is associated with high risks, as well as in fractures with a large number of small bone fragments, which cannot be surgically compared.

Recovery period

The effectiveness and recovery time in the postoperative period depends, first of all, on the time of the operation relative to the moment of injury and on the type of osteosynthesis chosen. Also important is the general condition of the patient and the degree of compensation of his chronic and acute diseases. Timely prescription of antibiotics and restorative agents reduces the risk of complications, thereby reducing the 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.

A fracture of the lower jaw is a serious injury that most often affects men aged 20-40 years. As a result of such injury, a partial or complete violation of the integrity of the bone occurs. Fractures of the lower jaw are diagnosed much more often than injuries of the upper.

This phenomenon is dangerous for human health, since it can provoke severe complications up to death. To prevent undesirable consequences, if signs of a fracture of this single movable skull bone are detected, you should immediately consult a doctor. In most cases, the life of the patient depends on the timely provision of assistance.

Features of the structure of the lower jaw

The lower jaw is a horseshoe-shaped unpaired bone of the skull, designed for chewing food. The upper parts of its middle and two ascending branches end in two processes: anterior (coronary) and posterior (condylar, or articular). The lower jaw has the following anatomical features:

The articular process, the middle part of her body and the area of \u200b\u200bthe angle are typical places that are most often injured.
In the region of the angle of the lower jaw is the facial artery. It has microscopic parameters, however, if it is damaged, heavy bleeding can begin and a hematoma can form.
Along the mandibular bone are the branches of the trigeminal nerve, which is responsible for the sensitivity of the mucous membranes of the cheeks and tongue. Its injury causes a partial or complete loss of the susceptibility of these organs to the effects of external factors.
The lower jaw and the bones of the facial skeleton are connected through the temporomandibular joint, which makes it possible to chew food. Despite the apparent strength, this connection is quite easy to break.

How are fractures classified?

A jaw fracture is classified in many ways. According to the severity of violations of the integrity of the mandibular bone are divided into open and closed. In relation to the area of injury, they are direct and indirect. Based on the line of the crack, this type of fracture is divided into single, double and multiple. The classification of mandibular injuries includes bilateral and unilateral varieties.

In addition, there are fractures of the lower jaw with displacement of bone fragments and without their displacement. The described type of injury is also classified as a fracture of the canines, incisors, coronoid processes, as well as damage in the area of the angle, which is also called an angular fracture of the lower jaw.

open and closed

An open fracture is characterized by displacement and protrusion of parts of the bone, as well as a violation of the integrity of the mucous membranes, muscles and skin. In this situation, the probability of infection of the affected tissues is high. Often, in addition to the maxillofacial surgeon, a cosmetologist is involved in the treatment. The lower jaw of this type of injury is much more likely than the upper jaw. With a closed type of fracture, only the bone is damaged, the integrity of the soft tissues is not violated.

Direct and indirect

Fractures, depending on the location of the damage in relation to the point of application of the traumatic force, are classified into direct and indirect. In the first case, injury to the bone occurs directly at the specified point. Indirect damage occurs at some distance from it, in a more fragile area. Along with this, there is also a mixed type fracture, during the formation of which a combination of the first two types occurs.

Single, double and multiple

With a single fracture of the articular process of the lower jaw, 2 fragments of different sizes are formed, the smaller of which is displaced upward until it comes into contact with the units of the upper dentition and slightly inward under the influence of the lateral pterygoid muscle. In this case, the dental arch narrows, and the midline shifts towards the fracture. The teeth of this fragment, located next to the crack, do not come into contact with the upper units. The closure of the jaws occurs only in the area of large and sometimes small molars.

If there is a double fracture, the middle of the fragments is displaced down and inward by the jaw-hyoid muscle attached to it, the smaller one - up and slightly inward, the larger one - down and to the middle fragment. If a multiple fracture occurs, the bone fragments move in different directions under the influence of the bundles attached to them. In this case, they often end up behind each other, shifting in the direction of the contracting muscles.

Bilateral and unilateral

With a unilateral fracture, the median line shifts towards the crack. In the area of damage, the teeth are tightly closed, and in a healthy area they do not touch. For a bilateral fracture, a characteristic feature is the upward displacement of both branches of the mandibular bone. In this case, only the large molars are closed, in other words, an open bite develops.

With displacement of fragments and without displacement

Displacement injury is quite dangerous and occurs as a result of strong physical impact. Fragments of the bone are shifted in relation not only to each other, but also to other bones.

There are 3 types of such displacement: sagittal, vegetative and transversal. During a fracture without displacement, the anatomical arrangement of the bones is not disturbed. Often these damages are incomplete.

Traumatic and pathological

Traumatic fractures occur as a result of a strong external impact. This can occur during traffic accidents, active and traumatic sports, and fights.

Pathological fractures are the result of various severe processes in the body, such as osteoporosis, osteomyelitis, osteochondrosis, tuberculosis, the development of malignant and benign formations.

About first aid and further therapy - on the video:

Symptoms of a jaw fracture

To understand that the mandibular bone is broken is quite simple. Fracture symptoms:

the shape of the face changes;
pain syndrome develops, aggravated by any attempt to open the mouth;
there is profuse bleeding with an open type of fracture - in the oral cavity, from the ears and nose;
there is swelling and damage to soft tissues;
hematomas appear;
friction of fragments against each other is accompanied by a crunch.

First aid for trauma

The likelihood of complications and how long treatment and recovery will take depends on how timely and correctly the victim will be provided with first aid. Emergency care is:

Decontaminate the wound and apply a bandage to it to prevent infection.
Pain relief. To relieve pain, you can use non-steroidal anti-inflammatory drugs such as Ketorolac, Diclofenac. Injections are recommended to enhance the analgesic effect. In cases where a fracture is associated with serious complications, it is necessary to use potent agents, such as Promedol.
Stop bleeding. In order for the blood to stop flowing, you should press the bleeding vessels with your finger and apply a pressure bandage. If the blood is not strong, you can limit yourself to a piece of sterile cotton wool soaked in hydrogen peroxide.
After the bleeding stops, the broken jaw is necessarily fixed. For this purpose, it is better to use a sling bandage.

After immobilization of the lower jaw, the patient is urgently delivered to a medical facility (we recommend reading: how to set the jaw when it is dislocated?).

Treatment of jaw fractures

Injuries of the jaw bones are treated in the department of maxillofacial surgery. Treatment methods are classified into conservative (orthopedic) and surgical (osteosynthesis). If you can do without surgery, reposition is carried out. During its conduction, the anatomical position is attached to the bone, as a result of which the jaw fuses correctly. If it is not possible to apply this method, an elastic stretcher is used.

antibiotic therapy;
taking vitamin D to speed up tissue repair;
the use of anti-inflammatory drugs (Ibuprofen, Ketanov, Movalis);
means that restore phosphorus-calcium metabolism (Calcemin, Calcium D3 Nycomed).

Indications for osteosynthesis are multi-comminuted injuries, reconstructive operation, neoplastic process in the area of damage, as well as injury to the condylar process, complicated by displacement of the articular head. During the procedure, damaged soft tissues are exposed, reposition and immobilization of bones are performed using metal structures.

Diet

The diet at the stage of recovery has characteristic features. For a certain time, the chewing function is impaired to varying degrees, so you should eat only liquid food. If it is impossible to chew and swallow food, the patient is prescribed food, the daily calorie content of which is from 3000 to 4000 calories. In this case, food that has the consistency of liquid cream enters the body through a probe.

In those cases where the patient can chew and swallow food, he is shown a diet with the same nutritional value, but the food has the consistency of thick sour cream. After discharge from the hospital, it is necessary to eat sour-milk products, meat broths, drink strained juices and compotes from fresh fruits, berries and vegetables. Food should be varied.

Recovery activities

Rehabilitation is an obligatory stage of treatment. Thanks to calcium electrophoresis, magnetotherapy and infrared radiation, the injured jaw heals much faster. These methods are especially effective for angular fracture. Remedial gymnastics helps to develop the joint. It includes regular facial exercises and self-massage of facial muscles. On average, the duration of the recovery period is 1.5–2 months.

Along with this, in order to avoid infection of damaged tissues, oral hygiene should be especially carefully monitored. After each meal, it is necessary to rinse the oral cavity with antiseptic agents. If it is impossible to fully open the mouth, you can rinse it with a straw.

As soon as the opportunity arises, you need to brush your teeth twice a day, not forgetting to remove food debris from the interdental spaces.

Possible Complications

As a result of violation of the integrity of the mandibular bone in most cases, various complications occur. The most common consequences include:

heavy bleeding;
hematomas;
dislocation of the temporomandibular joint;
osteomyelitis;
violation of the closure of the jaws (we recommend reading: why can the jaw click when you open your mouth?);
false arthrosis;
defects in the dentition;
improper fusion of bones;
neuritis of the facial nerve;
complete or partial loss of the ability to chew food.

To avoid these consequences, if symptoms of a fracture are detected, you should immediately consult a doctor. It is strongly not recommended to self-medicate.