Fracture of the upper jaw - bone damage in violation of its integrity. For all types of fractures of the upper jaw, swelling of the soft tissues of the perioral zone occurs. On the skin of the face are usually determined abrasions, lacerations. The height of the face is lengthened, the horizontal parameters are flattened. Localization of bone protrusions, hemorrhages corresponds to the level of damage. Bite broken. The soft sky is shifting down. The diagnosis of an upper jaw fracture is based on the patient's complaints, clinical examination, CT scan results. Until the provision of specialized care is carried out temporary immobilization. The main method of treatment is osteosynthesis with titanium miniplates.
Fracture of the upper jaw - a pathological condition that occurs in violation of the anatomical integrity of the bone. In 1901, the French doctor Rene Le Fort offered the most complete classification of upper jaw fractures. Fractures of the upper jaw make up about 4% of the total number of injuries of the maxillofacial region. In the overwhelming majority of cases, men become patients. Most often in dentistry, diagnosed average fractures of the upper jaw (44%), accompanied by rupture of the mucous membrane and bleeding. Closed fractures are extremely rare. In 15% of cases, not isolated, but combined damage is observed, in which the integrity violation is also determined in the surrounding tissues.
The facial skeleton consists of 3 paired vertical complexes - the zygomacular, maxillary, and maxillary-maxillary, and one unpaired medial septal support. Between the vertical lines in the horizontal direction are the alveolar process, orbit, eyebrows, which together strengthen the facial skeleton. As a result of high-energy lesions (a blow with a heavy object in the face, a fall, in the event of an accident), the deflection and collapse of these supporting structures develop, resulting in a fracture of the upper jaw.
The trajectory of movement of broken off fragments at a fracture of the upper jaw depends on the traumatic force, the attachment point of the masticatory muscles, the area of the fragment. Backward, the damaged fragment is displaced by the kinetic energy of the impact, and downward, as a result of the thrust of the muscles. The medial pterygoid muscles contribute to the uneven movement of fragments in the downward direction, as a result of which the posterior fragments are displaced more than the anterior ones.
Damage taken to classify on various grounds:
- The fracture line defines trauma as oblique, longitudinal, transverse, straight, zigzag and comminuted.
- Jaw fracture with and without offset.
- The number of fragments characterizes a fracture as multiple, single, double.
- The degree of damage to soft tissue allows you to select an open and closed fracture.
- The cause of the pathology can be trauma or bone disease, soft tissue. In the second case, more often a jaw fracture is recorded without displacement.
Depending on the location of the injury, a specific classification is also applied.
A patient with a facial trauma must be helped to free his mouth from blood, to correct his tongue in order to exclude the possibility of mechanical asphyxiation. First aid measures include stopping bleeding if present. To prevent pain shock, it is necessary to give the patient an analgesic drug on the basis of dipyrone.
The bones should be fixed with a bandage to prevent additional damage during patient transport. Then it is necessary to apply a cold compress to the injury site, lay the victim on its side and call an ambulance brigade. Self patient transportation is not recommended.
Jaw Fracture Treatment
All medical manipulations are carried out in a hospital. The patient is put on a splint, prescribed a course of physiotherapy and medication (antibiotics, anti-inflammatory and painkillers). Severe fractures, such as the articular process of the mandible, require surgical intervention.
The treatment begins with the complete alignment of broken bones. Fixation of fragments is ensured by the imposition of a wire structure. Depending on the type and severity of the injury suffered, splinting is applied:
- One way. The wire is attached to the affected area if the bones are damaged in one half of the jaw.
- Bilateral. It is performed using hard wire, rings and hooks.
- Two-jaw. It is used in case of injury of the upper and lower jaw with an offset. Copper wire is attached to the teeth, which together with rubber rings provides fixation of the bones.
Urgent splinting is performed using a plastic tire. It is applied under the chin and cheeks, fixed with a bandage. Such a measure is temporary, used to transport the patient.
The process is aimed at removing the load from the bones, strengthening the movable teeth. This technique is used in the treatment of complex fractures. For fixation of fragments, a special tire is used, having inter-jaw thrusts made of rubber and hook loops.
Broken bones exclude the possibility of chewing, so all taken food must be liquid or have the consistency of sour cream. The patient is recommended to use various broths, fruit and vegetable purees, juices, ground grains.
Removing the tire does not immediately return to the usual menu. The sudden transition to solid food triggers digestive disorders and pain when chewing. The process should be gradual. The recommended menu includes a breakfast of fruit puree, porridge and kefir. For lunch, prepare a cream soup with rabbit or chicken meat, porridge and juice. Dinner may consist of a light broth, vegetable or fruit puree.
Consequences of a jaw fracture
Trauma can cause cracking between the teeth, loss of teeth. The consequence is often a change in facial features, a double jaw fracture increases the risk. Even timely seeking qualified medical assistance does not exclude the likelihood of a specific bone crunch when chewing, talking, yawning. A similar phenomenon in many patients causes psychological discomfort.
Improper imposition of the tire or its premature removal can cause improper adhesion of the bones, which changes the bite. The consequences of the injury include the violation of the chewing function as a result of prolonged inactivity of the jaw.
Trauma can cause a complication in the form of the death of the damaged bone. Osteonecrosis treatment is performed surgically.
Rehabilitation after a broken jaw
After applying the tire to the patient for the first 3 days, an antibiotic is introduced into the affected area that has an ability to accumulate in the tissues, for example, Vibramitsin, Lincomycin. Fortifying therapy, including taking vitamins of group B, breathing exercises, hygienic measures, proper nutrition, requires close attention after a fracture of the jaw.
From the fifth day after splinting, the patient is prescribed magnetic therapy sessions. Each procedure, except for the first two, lasts 15 minutes. The course depends on the severity of the patient's condition and is 5-10 sessions. Magnetotherapy helps relieve pain and swelling.
How many jaw fractures heal?
With high-quality primary rehabilitation with the use of enhanced hygiene measures, massage, electrophoresis, bone healing occurs within 21-28 days. Minor deviations from this period are allowed, taking into account the severity of the fracture, the presence of complications. Individual anatomical features of the patient can also affect the speed of bone healing.
The bus is removed after 28-30 days, but the treatment period is not limited to this. Full healing occurs only after a course of active rehabilitation, allowing to restore the motor, chewing activity.
How to develop a jaw after a fracture?
At the stage of callus formation, physiotherapy is applied. Procedures allow you to do physical therapy immediately after removing the tire. All exercises are performed carefully.
Prolonged inaction of the jaw does not allow the mouth to open wide at once. Experts warn that in the first days even the smallest loads can cause severe pain.
It should begin with the restoration of the ability to freely open and close the mouth. Such actions do not require a lot of physical activity; during the rehabilitation period the patient may need to use a spatula for this. Until the patient can open and close his mouth independently, he is not recommended to perform other exercises that increase the load on the cheekbones.
Gradually, muscle stretching exercises are included in the process. They are gently heated by friction with their hands, special attention is paid to the area in the joint zone, after which they begin to move the jaw, opening it widely (taking into account the possibilities), shifting it to the side. The patient regulates the duration of classes independently, focusing on the appearance of fatigue or muscle pain. At the same time daily load should be increased.
For recovery it is useful to perform exercises with the pronunciation of letters. The muscles are preheated, then the vowels are pronounced. The task is complicated by the pronunciation of hard voiced consonants. At the same time it is necessary to achieve maximum clarity of pronunciation.
What is a jaw fracture?
A jaw fracture is a trauma to the face, with damage to the integrity of its bones. It occurs when the intensity of the traumatic factor exceeds their strength. This damage is common, the cause may be any injury: severe blows to the face, falling on a hard surface.
Most often, traumatologists observe a fracture of the articular process, although there are injuries in the region of the angle of the mandible, in the middle of the body of the bone of the mandible, in the projection of the mental process. Fracture may be complete and not, open and closed.
The signs of injury are obvious: a person is not able to open his mouth widely, he is in pain when trying to talk, the bite is changing. Sometimes there may be double vision, numbness of the face area, deformation of the cheekbones. A complete list of symptoms will depend on the nature of the injury and the location of its location.
If we talk about the fracture of the lower jaw, then we should consider the main types of such injury:
A complete fracture is considered in the case when there was a displacement of fragments, jaw. They may vary in shape and quantity.
An incomplete fracture is called when no displacement is observed.
With open injury, the mucous membranes of the mouth and the soft tissues of the face are damaged.
With a closed injury, the bone does not break through the adjacent tissues, but remains inside them.
Comminuted fracture of the jaw is rarely observed, since its occurrence requires the application of incredible strength. He needs compulsory surgery.
The following symptoms are characteristic of a mandibular fracture:
Puffiness and hemorrhage in the damaged area and the asymmetry of the face caused by these phenomena. Edema is usually severe, with redness of the skin and an increase in its temperature. When a fracture is closed, blood accumulates in the soft tissues and forms a clot. With open injury, blood often enters the oral cavity than into the external environment. The stronger the blood loss, the larger the vessel was damaged, and the faster the first aid and the delivery of the victim to a medical facility are required.
Sensation of pain when touched. It is aggravated by the attempted conversation, because the periosteum is damaged.
Displacement of fragments of varying severity, their mobility.
Increasing the sensitivity and electrical excitability of the teeth.
Depending on where the injury is located, there are:
Fracture, passing through the center of incisors - median.
Trauma between the first and lateral incisors - incisal.
The fracture localized in the canine region is canine.
The injury opposite the chin is mental.
Trauma to the body of the jaw, the one that is located between 5 and 8 teeth.
Fracture on the 8th tooth - angular.
In the upper third of the jaw - a broken branch of the jaw.
Fracture of the condylar base.
Cervical fracture, that is, which is located near the process of the jaw (condylar) and coronary, located near the coronoid process.
First aid, if a person has a fracture of the mandible, is as follows:
To start the jaw must be fixed. This is done using a bandage. Under the teeth it is necessary to put an even hard object, for example, a ruler. Then the lower jaw is pressed against the top and immobilized by wrapping a bandage. If a person is not conscious, then this can not be done, since it will be possible to skip swallowing the tongue or getting into the airways of the vomit.
If there is bleeding, then it must be stopped. For this, the wound is pressed or tamponized with a clean, preferably sterile, material. If you additionally affect the place of injury with cold, it will help to reduce blood, and also somewhat alleviate the pain symptom.
It is important to keep the oral cavity clean of possible fillers, in particular: blood clots and vomit.
Try not to disturb the person before the arrival of the medical team. It is better that he sat, if there is no such possibility, then you can lay him face down or on his side.
If you experience severe pain, it is necessary to alleviate them. For this is used analgin, revalgin, naproxen. Since a person with a similar injury will not always be able to swallow a pill, you need to crush it into a powder and, dissolving in water, give a drink to the victim. Intramuscular injection will be even more effective, but, as a rule, it is rarely possible to do it during first aid. It will help alleviate the condition and cold, which will narrow the vessels, reduce swelling and pain. But before you apply the ice, you must wrap it with a cloth.
After these activities, a person must be delivered to the hospital for further therapy by professionals. For the diagnosis of fracture using x-ray examination. Since this is a serious injury, often accompanied by spinal injury, an x-ray of his cervical part is often prescribed before starting treatment. This is done to eliminate damage to the spinal cord. It is also necessary to make sure that the person does not have a concussion of the brain and intracavitary cranial bleeding.
Jaw fracture with offset
In case of fracture of the jaw, the displacement of fragments can be observed in three directions: sagittal, vertical and transverse. They play a crucial role in determining the tactics of treatment and the choice of apparatus that will be used to reduce them.
Most often used tires made of wire, fixing the teeth. The bones are assembled by the surgeon manually, the patient at this time can be under both local and general anesthesia. Fixation of fragments can also be carried out with the help of a capron core.Next, the jaw is fixed with metal spokes or plates that are superimposed on the outside.
When fixing is carried out, rest is recommended to the patient, with the implementation of antimicrobial measures.
Double jaw fracture
A double jaw fracture is characterized by the fact that it diverges in three directions:
The middle part of the jaw is directed downwards.
Side retract inward and upward.
This injury is dangerous because after it is received, a person can die from asphyxia, which will occur as a result of sticking of the tongue. Therefore, it is necessary to carefully monitor its condition.
Nutrition at jaw fracture
Correction of the diet in such injuries is a necessity. This is due to the fact that during intensive therapy and for the duration of recovery, the jaws will be in a fixed state, which means that a person will not be able to fully manage them.
The minimum time of bone fusion is a month, which means that during this time the victim will have to eat only liquid food. Its consistency should be equal to the condition of sour cream. Therefore, it is advisable to feed the patient with broths and soups, vegetables and fruits, minced or blender, boiled porridges. It is necessary to include milk drinks in the menu.
When the tire is removed, do not immediately switch to solid food. It is necessary to enter it gradually. This is important not only for the normal restoration of the functioning of the jaw, but also for the prevention of gastrointestinal dysfunction.
Education: Diploma in "General Medicine" received in 2009 at the Medical Academy. I.M. Sechenov. In 2012, completed a postgraduate course in the specialty "Traumatology and Orthopedics" in the City Clinical Hospital. Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
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It is possible to divide the fractures into two large groups. The cause of fractures of the first group is the impact on the bone of various forces: a fall, a blow, and more. The cause of the fractures of the second group is the weakness of the bone itself and its fragility. In the second type, the risk of fracture increases in.
A hand fracture is an injury to one or more limb bones. This concept combines fractures of the humerus or forearm, fractures localized in the area of the elbow joint. This also includes appropriate injuries to the hand and fingers. Proper fusion of bones and the normalization of hand functions are extremely important for humans.
The appearance of edema after a leg injury is a completely natural occurrence. Sometimes swelling occurs immediately, sometimes over time, but there are no fractures without edema. Its formation occurs due to the fact that the normal blood flow in the injured area is sharply disturbed.
A hip fracture is an injury to the integrity of the femur. Trauma is localized in its very thin part, which is called the neck and connects the body of the bone and its head. This diagnosis is perceived by many people as a sentence. Such an attitude towards injury is due to the severity of the recovery and the need for surgery c.
The human body is very fragile, so none of us are really immune from bone fractures, which arise as a result of serious injuries. Unfortunately, the majority of such injuries require not only medical therapy, but also surgery, as well as a certain rehabilitation period after healing.
Folk remedy treatment of fractures. You need to take five lemons, five eggs, fifty grams of brandy, two tablespoons of honey. Cognac can be replaced by Cahors. Mix the raw eggs with honey, and dry the shells from them. Crush this shell and mix with fresh lemon juice. After a couple of days the shell should dissolve in.
What do they come from?
Fractures of the upper jaw can be obtained as a result of impact, compression, emergency situations, road traffic accidents, during sports training, when falling from a height.
The classification of upper jaw fractures includes 3 types of traumatic injury. Consider each of these types separately:
- 1st - is localized under the palatal vault, usually accompanied by breaking off the bottom of the maxillary sinus. It is characterized by the presence of a pronounced facial deformity, bleeding from the mouth and its vestibule.
- 2nd - characterized by a partial separation of the upper jaw and facial bones from the cranial base. This injury is accompanied by intensive drooling, swelling and hematomas, nosebleeds, olfactory dysfunction.
- 3rd - is a complete separation of the upper jaw, zygomatic and nasal bones from the cranial base. Characterized by a distortion of the shape of the face, impaired visual function, the displacement of the eyeballs, the appearance of hematomas under the eye sockets.
In addition, traumatologists distinguish the following types of this fracture:
- Full - with concomitant displacement of jaw fragments,
- Incomplete - without concomitant bias,
- Open - characterized by the presence of damage to the soft facial tissues and skin, bleeding,
- Closed - without concomitant injury to the facial tissues.
Basically, this injury is open. Often, upper jaw fractures are accompanied by the following collateral damage:
- Middle ear injuries
- Damage to the meninges
- Breaks in the muscles and skin of the face,
- Pressing the nasal bones into the anterior cranial fossa,
- Damage to the nasopharynx,
- Injury of the paranasal sinuses.
Such injuries are a serious threat to both the health and the life of the victim, so it is very important to competently provide the patient with the necessary assistance and deliver him to the hospital!
How does it manifest itself?
The main symptom of a fracture of the upper jaw is abnormal mobility of the jaw fragment and a pronounced pain syndrome. Another characteristic feature is a violation of the bite. Also distinguish the following series of symptoms that manifest this traumatic injury:
- Nasal and oral bleeding (may be the main symptom in fractures of the third type),
- Impaired respiratory function
- The formation of extensive hematomas localized under the patient’s eye sockets (spectacle syndrome),
- General weakness
- Speech function disorders
- Impaired chewing function
- Intense drooling
- Puffiness localized in the upper lip.
The painful sensations are aggravated by attempts to close the jaw, by touching the facial points. Quite often, patients have signs such as broken teeth, omission and deformation of the facial areas, impaired visual function, tearing, involuntary contractions of facial muscles. Patients can not speak normally, there are difficulties with chewing food.
Fractures of the upper jaw in childhood are almost always accompanied by a concussion, traumatic brain injury. The little patient turns pale, becomes sluggish, there may be bouts of dizziness, nausea with profuse vomiting, fainting.
The particular danger of this injury is that at the first time since the moment of injury, the symptoms may not be clearly expressed. Often, patients are slow to appeal to a specialist, trying to self-medicate, which already carries a threat to life!
Therefore, when at least some of the symptoms described above appear after the traumatic situation, it is necessary to urgently take the patient to a hospital, undergo diagnosis and start treatment promptly.
What is the danger?
In the absence of adequate, timely carried out therapeutic measures, fractures of the upper jaw bone can lead to the development of highly undesirable complications:
- Abscess formation,
- Maxillary deformity
This type of fracture is very often accompanied by craniocerebral injuries and other very dangerous injuries requiring urgent medical attention! Self-treatment and the lack of adequate reactions can cause the most disastrous consequences, even the death of the patient!
How to help?
At the first signs characteristic of this damage, it is necessary to call the doctors and competently provide the victim with first aid. The first thing the patient laid on his side, to prevent the overlap of the respiratory tract. It is important to provide the person with absolute peace, since any movement in this case is absolutely contraindicated!
Then you need to stop the bleeding by using tampons, applying sterile wipes. In order to immobilize and prevent possible displacement under the region of the patient's upper teeth, a ruler or a special plate can be laid, securing it to the head with a fixing bandage. If there were no improvised means or damage to the dentition is observed, the upper jaw is simply carefully aligned with the lower jaw and fixed with a bandage.
It is recommended to apply an ice compress to the injured area, something cold - in order to reduce swelling and pain. If the patient sank tongue, it must be fixed.
Jaw injuries in most cases are accompanied by very strong painful sensations, up to the development of a pain shock. A little to alleviate the condition of the victim can be with the help of analgesic drugs, if possible, it is better to introduce an anesthetic by injection. After that, the patient must be taken to the clinic, always in the supine position! In this case, the victim must lie face down or on his side.
Features of the diagnostic process
Diagnosis of maxillary fractures is complicated by layering of the maxillary bones. Therefore, for making an accurate diagnosis, determining the type and severity of damage, a radiographic survey is performed in different projections.
In addition, studies such as computed tomography and magnetic resonance imaging may be indicated. Accurate, detailed diagnosis can reduce the duration of treatment and reduce the risk of developing characteristic complications, even after several days from the moment of injury.
The whole complex of therapeutic measures used for fractures of the upper jaw bones can be divided into several successive stages:
- Comparison and fixation of displaced mandibular debris.
- Stimulation of regenerative processes.
- Therapy aimed at preventing the development of possible complications and accelerated, full recovery of damaged bone tissue.
If upper jaw fractures are diagnosed, treatment begins with a reorganization, treatment of the damaged area. It is important to normalize the respiratory function of the victim, which, as a rule, requires a tracheotomy.
At the next stage, the doctor combines fragments of the jaw bone. This procedure is quite complicated and painful, and therefore should be carried out exclusively by a qualified specialist, in the clinic, under the influence of local anesthesia!
After immobilization is carried out using the splinting method. In the most difficult clinical cases, patients require surgery, in which bone jaw debris is fixed by using special plates and structures.
It is mandatory for patients to prescribe a course of antibiotic therapy in order to prevent the development of infectious, inflammatory complications. Drug treatment also includes the use of painkillers, immunomodulatory drugs, vitamin-mineral complexes.
The rehabilitation process after fractures of the upper jaw can last from 1 to 2.5 months, depending on the type of damage and the severity of the injury, the individual characteristics of the patient, the time of initiation of therapy. One of the important elements of the rehabilitation course is physiotherapy. The following physiotherapy procedures may be recommended for patients:
- Ultraviolet irradiation - promotes the active production of vitamin D, which is necessary for the formation of calcium and accelerated recovery of bone tissue.
- Magnetic therapy - allows you to eliminate puffiness, pain, manifestations of inflammatory processes.
- UHF-therapy is aimed at improving blood circulation in the area of damage, elimination of edema, inflammation.
- Calcium electrophoresis - the procedure allows to intensify the processes of calcium in the cellular structure of damaged bone tissue.
Of great importance for the successful treatment and rehabilitation is the provision of proper care and oral hygiene of the patient. This process is complicated by the presence of tires in the patient's mouth, metal structures in which small pieces of writing get stuck.
Therefore, after each meal, it is necessary to irrigate and rinse the oral cavity, using for these purposes special solutions that have antiseptic and anti-inflammatory properties. Tires are cleaned with the help of toothpicks, tweezers, ordinary toothbrushes with soap.
Several times during the day, the oral cavity must be rinsed with antiseptic solutions. Compliance with these simple recommendations will speed up recovery processes, improve the condition of the oral cavity, and most importantly, prevent a number of dangerous infectious complications.
A full, balanced diet is a prerequisite for recovery of the patient. In jaw injuries, this task is complicated by the violation of the chewing function. The victim can not eat solid food. As a rule, patients are fed through a tube or special drinking bowls.
When the patient's condition is somewhat stabilized, you can begin to feed him with liquid food, through a bottle, a straw. The following foods should be included in the patient's diet:
- Pureed vegetable soups,
- Vegetable puree,
- Pureed porridge,
- Dairy products,
- Vegetable, fruit juices with pulp,
- Raw eggs
- Vegetable oils,
- Meat puree.
It is important that all food be at room temperature. Too hot or cold dishes with such injuries are strictly contraindicated. Nutrition is recommended fractional - often in small portions.
Gradually, as you recover, you must begin to develop a chewing function, including in the diet more solid food. This process should be carried out under the strict supervision of the attending physician. Until the patient is completely cured, the use of crackers, hard fruits, and other solid foods is contraindicated.
Fractures of the upper jaw in children and adults - the injury is very dangerous, with associated injuries. Therefore, in order to avoid undesirable consequences, it is important to timely consult a specialist, comprehensive treatment and rehabilitation in compliance with all medical recommendations!
General information about the fracture of the upper jaw
Fracture of the upper jaw is a varying degree of severity of the integrity of the bone of the upper jaw for one reason or another.
In more than half of cases of such injuries, a fracture of the upper jaw results from a mechanical impact on the maxillofacial region (shock, accident, sports, falling, a gunshot wound, etc.).
The higher the fracture line passes, and the larger the part of the upper jaw bone separates from the skull bone, the more severe the condition of the injured and the greater the likelihood of possible complications.
Fracture of the upper jaw is a rather dangerous injury that can lead to the development of complications such as concussion, meningitis, osteomyelitis, etc.
Types, forms and signs of fracture of the upper jaw
By analogy with any other fractures, the following types of upper jaw fractures are distinguished:
- Complete fracture of the upper jaw - with the displacement of fragments of the jaw (down, inward or to the sides), which by their nature can be transverse, oblique and zigzag
- Incomplete fracture of the upper jaw - without displacement of jaw fragments
- Open upper jaw fracture - with damage and violation of the integrity of the soft tissues of the face in the area of the fracture, accompanied by injuries of the skin of the face and bleeding
- Closed upper jaw fracture - without violating the integrity of the soft tissues of the face
Specific classification based on the structure of the upper jaw and the nature of the injury divides the upper jaw fractures into three types.
Symptoms of a fracture of the upper jaw
For any type of upper jaw fracture characteristic common symptoms:
- Severe pain in the area of injury, especially when closing teeth
- The mobility of the jaw fragment and strong pain when probing the area of injury
- Hemorrhages and hematomas in the orbital area
- Violation of a number of important functions: respiratory, speech, chewing
- General malaise and nausea
In addition, many fractures of the upper jaw are accompanied by complications such as brain concussion.
Fracture of the upper jaw
Fracture of the upper jaw is usually diagnosed by a number of external signs, as well as by palpation in the area of injury.
A more accurate diagnosis and clinical picture can only show a radiograph, which is necessarily carried out in the case of such injuries.
Before a patient with an upper jaw injury gets qualified help in a medical facility, he must be provided with first aidwhich is as follows:
- Eliminate respiratory failure in case of respiratory failure, for which, if necessary, release the oral cavity from foreign bodies that interfere with breathing
- Immobilize the jaw with a parietal chin dressing
- Stop possible bleeding
- Put a cold compress to the place of injury
- To fix the tongue if it is observed
- If possible, conduct anesthesia using available drugs.
- Provide a state of rest for the future transportation of the victim to the hospital
After receiving first aid, an injured person with a fracture of the upper jaw should be transported to the nearest hospital as soon as possible, where he will receive qualified medical assistance.
The victim is transported either lying on its side or face down.
Qualified medical assistance in a hospital with a fracture of the upper jaw includes the following procedures:
- Injury area treatment
- Ensuring the normal performance of respiratory functions (for which, if necessary, a tracheotomy is performed)
- Combination of fragments of jaw bones under local anesthesia
- Reliable fixation of fragments of the jaw bones by splinting, as well as (if necessary) using special structures (spokes, plates, extraoral structures)
- Antimicrobial and fortifying therapy to prevent various complications in the area of fracture
After the end of treatment, a course of mechanotherapy and therapeutic gymnastics is carried out to restore the normal functioning of the masticatory muscles and temporomandibular joint.
All materials are checked by doctors. Articles are advisory in nature and can not replace the advice of a specialist.
Symptoms of upper jaw fractures
In patients with type 3 fractures of the upper jaw, swelling of the upper lip, violation of nasal breathing is detected. The main complaints are reduced to pain in the area of the injured jaw, the increase in pain during the closing of the teeth. If there is no displacement of the fragment at the fracture of the upper jaw - the fissure-bumprock contact is normal. As a result of the downward movement of the damaged distal area, the patient indicates the presence of an extraneous body in the throat. Depending on the trajectory of the fragment displacement, a violation of the closure of the teeth in the sagittal, transverse or vertical planes can be observed.
In case of fracture of the upper jaw in type 2, hemorrhage is localized in the tissues around the orbit, resulting in chemosis, exophthalmos. The horizontal parameters of the face flatten, the vertical lengthened. Compression of teeth increases pain. With type 2 fracture of the upper jaw, the sense of smell is reduced, tearing appears. The tongue of the soft palate is located down.
Le Fort 1 fracture of the upper jaw is combined with damage to the bones of the skull base. Patients have pronounced tissue edema. The conjunctiva, sclera, and tissues of the periorbital region are soaked with blood. The displacement of the uvula of the soft palate downwards causes sore throat, nausea. The dislocation of the posterior maxilla can lead to mechanical asphyxiation due to overlap of the airways. When damage to the optic and oculomotor nerves, vision is impaired, strabismus may develop.
An extraoral examination of patients with type 3 fractures of the upper jaw reveals a violation of the integrity of the chuloalveolar ridges: tissue swelling, abrasions, an increase in the vertical parameters of the face. At the border of the transition of the fixed mucous membrane of the alveolar process to the mobile, and also on the hard palate, hemorrhages are diagnosed. The displacement of the damaged sections at the turn of the upper jaw leads to rupture of the mucous membrane. The dislocation of the posterior fragment downward causes a lengthening of the soft palate.
In the course of palpation examination on the alveolar process, irregularities and depressions are determined. When pressing on the hooks of the pterygoid processes, the patient feels pain in the area corresponding to the line of the upper jaw fracture. Dysocclusion is more often observed in the anterior segment, biliary pathologies along the transversal and sagittal are less commonly diagnosed. The patient does not feel that the patient touches the tip of the probe of the mucous membrane of the alveolar process, which indicates a loss of pain sensitivity. At CT scan, a fracture of the upper jaw of type 3 reveals areas of integrity in the zones of the pear-shaped aperture and sculoalveolar crests, reducing the transparency of the maxillary sinuses.
If the upper jaw is fractured in type 2, the symptom of glasses is positive - the periorbital zone is soaked with blood immediately after the injury. Observed chemosis, exophthalmos, lacrimation. Pain sensitivity of the skin in areas corresponding to the level of damage is reduced. In the frontal section, as a rule, diesel occlusion. During a palpation examination, a dentist determines the mobility of the maxillary bone at the border with the orbit, in the region of the malarialisolar ridge, and also in the area of the suture connecting the frontal bone with the upper jaw. The same changes can be diagnosed during the radiographic examination.
In case of fracture of the upper jaw of type 1, diplopia, chemosis, exophthalmos, subconjunctival hemorrhages, and eyelid edema are observed. If the patient is lying down, enophthalmos is detected. In the sitting position, the diplopia is enhanced, with the closing of the teeth decreases. Palpation with the upper fracture of the upper jaw can identify irregularities in areas of the maxillary, as well as the skulbone sutures, zygomatic arch. Sample load is positive. Computed tomography reveals a breach of integrity in the area of the root of the nose, zygomatic arch, frontal-zygomatic suture, sphenoid bone. The diagnostic test that determines the presence of rhinorrhea is a handkerchief sample. After drying, the structure of the fabric impregnated with liquor remains unchanged. If the handkerchief has become rigid, it means that there is no liquorrhea, serous contents are released from the nasal passages.
It is necessary to differentiate a fracture of the upper jaw with other injuries of the bones of the maxillofacial skeleton. All patients should be examined by a maxillofacial surgeon, as well as by a neurologist. In case of damage to the maxillary sinuses, optic nerve, skull bones, treatment is carried out in conjunction with a neurosurgeon, resuscitator, ophthalmologist, otorhinolaryngologist.
Treatment of upper jaw fractures
Treatment of upper jaw fractures consists of reposition, fixation of bone fragments, bone immobilization. When transporting a patient to a specialized institution, bandage bandages are applied to the frontal bone and chin to ensure temporary fixation of the maxillofacial complex. Craniofascial fastening in case of fracture of the upper jaw implies the use of tooth-splints along with a horseshoe-shaped brace, which is placed in the region of the frontal bone.
In the surgical method of treatment of fractures of the upper jaw, reposition of the damaged fragments is performed with their subsequent fixation to the healthy bones of the facial skeleton. The most common method of osteosynthesis is the use of wire sutures and titanium miniplates connecting the damaged and immobile bones of the maxillofacial area. For fractures of the upper jaw in 2 and 3 types, the titanium screw is inserted into the zygomatic bone, since it is this bone that is the nearby support for the damaged fragment.
Access produced by the transitional fold in the projection of a fracture of the upper jaw. Exfoliate mucoperiosteal flap, skeletonizing bone fragments. The titanium screws are screwed into the zygomatic bone and into the alveolar process between large molars at an angle of 90 degrees to the fracture line. After reposition of the fragments is completed, the screws are interconnected with a titanium wire, the ends of which are twisted. After laying the mucoperiosteal flap, the wound is sutured.
In case of fracture of the upper jaw in type 3, an incision is made along the line of the outer edge of the orbit. The flap is peeled off at the site of the zygomatic process of the frontal bone, a titanium screw is inserted. The ligature is carried out around the head of the miniplate and under the zygomatic bone, taken out on the threshold of the oral cavity between the molars, where it is fixed to the head of the second twisted screw. With timely treatment of the upper jaw fracture, the prognosis is favorable. The formation of callus occurs within 2 months. Post-traumatic edema resolves over 7 days, subconjunctival hemorrhages are held for several weeks. Late circulation causes an abnormal fusion of fragments. In this case, you need to reposition bone fragments after the resumption of the upper jaw fracture line.