DISEASE OF THE JAWS : FRACTURES OF THE JAW (FRACTURAE) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Causes of fracture of the jaw: a shot, a gunshot wound or disease process (caries of the bone, fibrous osteitis, cystoma, a malignant tumor).
Usually occurs in the place of greatest flexion mandibular arch (the middle line, the area of the canine). The most frequent localization of fractures is the region of the canines. With the exception of fractures of the edentulous jaws and rare subperiosteal fractures, fractures of the body of the jaw accompanied by rupture of the mucous membrane of the gums. Fractures throughout the alveolar process is usually also accompanied by gingival wound of the integument; they are most often observed in the area of the front teeth. Other types of mandibular fractures non-firearm type (vertical branches and shoots) are usually not accompanied by rupture of the soft tissues. Gunshot fractures of the jaws almost without exception accompanied by a wound of the soft tissues of the face and mouth and can be taken as open compound fractures. The most common types of gunshot fractures of the mandibular Central and lateral fractures; often there are comminuted and multiple fractures. Often gunshot fractures are accompanied by the formation of a bone defect, as the destructive power of injuring a shell fragment or bullet that kills or destroys the plot of the jaw.
Fracture of the alveolar process of the upper jaw is of approximately the same character as that of the lower jaw. Fractures of the body of the jaw give a very complex outline the Main lines of fracture of the upper jaw:
Symptoms and recognition. Diagnosis of fractures of the jaws in most fresh cases is not greater difficulty. Displacement of fragments of the jaw changes the contours of the soft tissues of the face, especially in fractures of the lower jaw. In later cases, soft tissue swelling interferes with visual inspection. When viewed from the vestibule of the mouth it is necessary to examine the integrity of the mucous membranes. Special attention should be paid to the examination of the dentition, the ratio of upper and lower teeth and the position of individual groups of teeth. For fracture characteristic displacement of the individual segments of the dental arch and the violation of the line of occlusion in some areas. Especially characteristic displacement of the lower jaw, so as to it are attached the muscles with the versatile traction - lifting and lowering of the lower jaw.
At the Central mandibular fracture fragments are displaced to the midline; often one fragment is lifted upwards, whereby the dental arch becomes stepwise.
At lateral fracture of menisci part of the lower jaw is drawn up, the remainder, a large portion of the mandibular arch the back; in addition, both parts are shifted to the middle line. If a lateral fracture occurred on both sides of the jaw, the jaw is drawn backward and downward. In the opposite direction, i.e. forward, the jaw moves, if bilateral fracture occurred behind the attachment of the masticatory muscles, i.e. if there is a fracture of both the ascending branches of the jaw. When unilateral fracture of the ascending branch of the jaw is displaced in the opposite direction. Fracture of the articular process entails a displacement of the chin in the direction of damage; sometimes you can appearance malocclusion, when articulate only the last molars. When fracture of the articular process of crepitus is felt when a finger in the external auditory canal. In gunshot wounds are often the size of soft tissue injuries are more significant than bone lesions; therefore, on the basis of external impressions, sometimes very painful, it is impossible to judge the size of bone destruction. Crucial feeling. The main symptom is the mobility of the fragments, individual teeth, groups of teeth, mobility of the alveolar process of the jaw body and its branches. When comparing the particular findings with the data of the inspection and the violation of the functions can be supplied differential diagnosis of fracture of the jaw. The x-ray data clarifies clinical studies.
When fracture of the upper jaw displacement of fragments are not as sharply. Due to the separation between the cranial and facial bones and upper jaw fragments hanging down. The result is a characteristic expression of the face: the face of several extended, mouth half open, around the eyes bruising (symptom score). With the appearance of edema of the face becomes mask-like appearance. The study of skin sensation anesthesia sets in the area innervated by the first, second, third branch of the trigeminal nerve. Fracture of the body of the upper jaw is often accompanied by bleeding from the nose due to rupture of the mucous membrane of the maxillary cavity and nose.
Fractures of the alveolar fragment belong to minor injuries; fractures of the body of the jaw, unilateral lateral mandibular fractures - to-moderate damage; fractures ecologically in the upper jaw and bilateral Central on the lower jaw is heavy. The severity of the latter group is defined as. With the passage of the lines of fracture in the orbital cavity usually develop severe phenomena on the part of the brain. Central bilateral mandibular fractures are dangerous because of the possibility of occurrence of asphyxia (suffocation) due to displacement of the tongue and the epiglottis, because of the possibility of complications with the lungs, due to breathing problems.
First aid for broken jaw is the following:
Ligation of the bleeding vessel, sewings, tamponade. When first aid (pre-medical and medical) should be limited to the tamponade pressure. Restoring the stillness of the bone fragments using the locking outer bandage also helps stop the bleeding. Wound toilet is held by the General rules. The mouth should be cleared of loose foreign bodies, soft tissue, from blood clots. It should extremely take care of the teeth and bone fragments, has not lost connection with soft tissue. Eroded teeth, hanging on a piece of gum, you need to remove; do not delete parts of the alveolar bone and jaw, attached to the soft tissues, but have lost touch with the main bone mass. All these parts must be carefully put in normal position and locked, as possible their engraftment.
Sutures on the skin with contaminated open fractures should be performed with very great caution. The main event at the first aid in such cases must be to restore correct positioning of the flaps of tissue, and anchoring them to the brim. This is achieved by applying the retaining situational seams.