Fracture of the lower jaw – the pathological state arising at violation of integrity of a mandibular bone. Patients complain of emergence of a painful swelling in a damage zone, increase of pain when chewing, opening a mouth. The bite is broken, in an oral cavity ruptures of a bone, mucous with stripping of edge, come to light. Teeth on the damaged fragment are mobile. The diagnosis "a fracture of the lower jaw" is made, proceeding from complaints, the local status, data of a X-ray analysis. Primary treatment of a fracture of the lower jaw consists in elimination of pain, antiseptic processing of a wound, a temporary shinirovaniye. Constant fixing of otlomk is reached in the conservative or surgical way.
Fracture of the lower jaw
Fracture of the lower jaw – the injury of a bone which is followed by full or partial violation of its integrity. Among ChLO injuries fractures of the lower jaw diagnose most often. The combined injuries of a maxillary bone and the lower jaw reveal at 15% examined. The main group of patients is made by men aged from 20 up to 40 years. Fractures of the lower jaw occur at children in 15% of cases. On prevalence the first position is taken by body fractures (over 65%), on the second place – damages of a corner (37%), on the third – branch changes. Violation of integrity of mental department is diagnosed for every twentieth patient. The ratio of unilateral and bilateral injuries of a mandibular bone makes 1:1. About a quarter of patients need performing expeditious treatment of a fracture of the lower jaw.
Reasons of a fracture of the lower jaw
The fracture of the lower jaw arises owing to influence of force which size exceeds plastic characteristics of a bone tissue that happens, for example, as a result of frontal and lateral blows in the lower third of ChLO, when falling from height on the person of heavy objects, in case of road accident. Localization of the line of a change corresponds to the site of a bone with the reduced density. Shoots, podborodochny department are more subject to traumatic damages a corner of the lower jaw, myshchelkovy and articulate. In stomatology the pathological fractures of the lower jaw resulting from application of forces, not exceeding physiological also meet. Similar damages are observed at rezorbtivny processes of a bone tissue at patients with inflammatory and destructive (at osteomyelitis, radikulyarny cysts) diseases or in case of development of a malignant tumor.
Fractures of the lower jaw happen not only direct, but also reflected. At a direct change integrity of a bone is broken in a point of influence of the injuring force. Localization of the reflected fractures of the lower jaw directly depends on the area and the direction of blow. At bilateral compression of a mandibular bone in the field of painters the maximum tension of a bone tissue concentrates in the site of the median line. At direct influence of high-amplitude force in a chin zone the most vulnerable are necks of the lower jaw. The unilateral fracture of a neck often happens reflected, arises owing to side blow. Dislocation of otlomk at a fracture of the lower jaw is defined by a trajectory of influence of the injuring force, the area of the damaged site, group of the muscles attached to its surface.
Classification of fractures of the lower jaw
On localization fractures of the lower jaw divide into 2 groups:
- Body fractures. More often happen open, clinically are followed by a gap mucous, bleeding. Distinguish median (the line of a break passes between the central cutters), mental (violation of integrity is observed in the site between a canine and premolyary or between premolyara), side (the zone of damage is localized in the field of painters), angulyarny (the bone in the site of a corner is injured) fractures of the lower jaw.
- Branch changes. Refer violations of integrity of a branch of a mandibular bone (the line of a break at the same time has the parallel or perpendicular direction of rather longitudinal axis) to this category and two of its shoots – articulate and coronal. In turn the change of an articulate shoot can pass at the level of the basis, a neck or a head. Diagnose the closed changes of a branch of a mandibular bone more often.
Fractures of the lower jaw also divide on linear (one line of a change is observed), splintered (it is formed several fragments which are crossed among themselves under different corners) and combined, opened and closed, unilateral and bilateral.
Symptoms of a fracture of the lower jaw
At a fracture of the lower jaw patients complain of emergence of a painful swelling in the site of damage. Unpleasant feelings amplify when chewing, a food nibble. In case of violation of integrity of large blood vessels there is bleeding. At a side linear fracture of the lower jaw the person gets an asymmetric configuration. Traumatic injury of a nizhnelunochkovy nerve causes a sleep of a mental zone and a lower lip. Skin color is changed owing to formation of bruises, hematomas.
At open changes on a mucous membrane reveal gaps with an exposure of edge of a bone. Determine hemorrhages by a transitional fold. The articulation at a fracture of the lower jaw is broken. Character of a smykaniye of teeth is defined by the level, symmetry of damage. At patients gradualness of a tooth alignment is observed. The Fissurno-bugorkovy contact is broken. The teeth which are in the line of a change are mobile (2-3 degrees). Often reveal complete dislocations of teeth.
Diagnosis of a fracture of the lower jaw
The diagnosis a fracture of the lower jaw is made on the basis of complaints of the patient, the local status, data of a X-ray analysis. During fizikalny survey the dentist reveals characteristic vneshnerotovy symptoms of a fracture of the lower jaw: puffiness of soft fabrics in the site of damage, change of color and violation of integrity of skin. The deviation of the median line is observed. At palpatorny inspection it is possible to find roughnesses, bone zapadeniye. If the line of a fracture of the lower jaw passes in area of a corner or branch, the insignificant pressure upon a chin leads to strengthening of morbidity in the place of damage. And, on the contrary, if the patient has a mental change, bilateral pressing in angulyarny sites causes emergence of the expressed pain in a frontal zone.
For definition of localization of a fracture of the lower jaw stomatologists use diagnostic test at which they the pallet put on transverzal on chewing surfaces of the lower painters. Easy percussion by the acting part of the pallet at close tooth alignments causes in the patient morbidity in that place where there passes the line of a fracture of the lower jaw. For diagnostics of integrity of an articulate shoot palpate the site of skin ahead of a trestle. For the purpose of definition of a trajectory of the movement of an articulate head use test at which the dentist puts forefingers in acoustical passes of the victim. The patient at the same time slowly carries out the movements in the vertical and transverzalny planes. Lack of movements of an articulate head confirms existence of damage of a myshchelkovy shoot.
In the course of diagnosis of a fracture of the lower jaw data of a X-ray analysis have key value. Often carry out several pictures in different projections (forward, side roentgenograms). At suspicion of a mental fracture of the lower jaw along with a survey X-ray analysis do the aim roentgenogram. Apply special laying to definition of integrity of a myshchelkovy shoot (according to Schueller, Parma). On the roentgenogram at a fracture of the lower jaw find violation of integrity of a bone in the form of a thin strip of an enlightenment. It is necessary to differentiate a fracture of the lower jaw with other injuries of bones of ChLO, and also with bruises of soft fabrics. Fizikalny inspection is performed by the maxillofacial surgeon.
Treatment of a fracture of the lower jaw
Treatment of fractures of the lower jaw includes antiseptic processing of a wound, elimination of a pain syndrome. For achievement of a resistant repozition and fixing of otlomk of edge of a bone smooth, eliminate interposition of soft fabrics between fragments. The teeth which are on the line of a change are subject to removal. For the purpose of prevention of accession of a secondary infection mucous in the site of a gap take in. Primary immobilization at a fracture of the lower jaw consists in creation of the motionless block consisting of the lower jaw pressed to maxillary bones. For this purpose use bintovy bandages or a method of intermaxillary ligaturny connection. At linear fractures of a body of a jaw without shift, and also in case of angulyarny fractures of the lower jaw without shift to fixing and an immobilization of fragments apply a two-maxillary wire shinirovaniye of a jaw.
Due to the low efficiency of a manual repozition of otlomk at angulyarny and myshchelkovy fractures of the lower jaw with shift use a surgical method of treatment more often. Among the main the technician of an open osteosynthesis apply a bone seam, mini-plates, polyamide thread. By means of a bone seam make cuts of soft fabrics for connection of fragments, skeletirut a bone from the shchechny and oral party. From the line of a fracture of the lower jaw delete splinters, edges of a bone smooth. In otlomka on both sides from the line of damage do openings for fixing of a wire. After laying mucous a rag the wound is taken in. At a fracture of the lower jaw in addition use nazubny tires to achievement of more rigid immobilization.
Mini-plates are shown at slanting, splintered changes of a branch and a body of the lower jaw. The section is done only from the shchechny party, after an otseparirovaniye mucous a rag carry out processing of a change. On otlomka on both sides from the line of a fracture of the lower jaw bore through openings, by means of screws fix mini-plates. Stack on the place mucous a rag, impose seams. For prevention of development of post-traumatic osteomyelitis to patients appoint antibacterial medicines. Efficiency of treatment of fractures of the lower jaw depends on timeliness of rendering the specialized help, the nature of a fracture, existence of complications. Primary bone callosity at a fracture of the lower jaw is formed within 20 days, secondary – for 6-8 weeks. At the early address of the patient with a body fracture the forecast favorable. Damage of a branch and its shoots can lead to permanent functional violations.