FEATURES OF DAMAGES MFA. CLASSIFICATION AND CHARACTERISTICS OF THE CLINICAL COURSE OF SOFT TISSUE DAMAGE face. Aid to the wounded on the battlefield and during medical evacuation, FEATURES AND METHOD OF SURGICAL TREATMENT OF SOFT TISSUE Sciences in maxillofacial area. DAMAGE TO LOWER JAW: classification, clinical course, diagnosis, assistance on the battlefield and during medical evacuation. Surgical treatment of wounds if damaged mandible.
Damage maxillofacial about ranyachoyi divided into nevohnepalni weapons and firearms . The nature of tissue damage , which determine the amount of therapeutic activities , the injury of soft and bone tissues.
Fractures of the bones of the face in peacetime range from 3.2 to 3.8 % of all fractures of the bones of the skeleton . Fracture of the lower jaw found in 70.3 % of the upper jaw – 3.3 %, zygomatic bone – in 9.8%, nasal bones , at 8 %, dental trauma , 3.2 %, gunshot fractures of the bones of the face in peacetime – in 0.7% , multiple facial fractures – in 4.7%.
Distinguish non-productive injury / home -75, 2% , 5 outdoor , 1%, sport- 3, 9 % / production and / Industrial – 8.1 %, -1.2% Agriculture /.
There are the following main types of damage nevohnepalnyh maxillofacial area :
I. Isolated soft tissue damage in violation of the integrity of the skin of face and oral mucosa or without prejudice .
2. Damage to the soft tissues and bones of the face of the violation of the integrity of the skin or oral mucosa or closed injury of bones of the facial skeleton.
3. Damage to the soft tissues and bones of the face / open or closed /, combined with injuries to other parts of the body .
Closed injuries only soft tissue facial / mine / can be accompanied by limited or widespread hemorrhage in the subcutaneous tissue or other weaving, rupture of muscle damage nerve trunks, significant swelling of the soft tissues , especially the first two days after injury. Open facial soft tissue damage is usually accompanied by more or less major bleeding , and the difference ziyannyam wound edges matched to suggest the presence of a real defect tissues. Therefore, in the examination of victims is necessary to distinguish the real from the imaginary defects , surgical technique for treatment of wounds with real fabric defects is significantly different from the treatment of wounds without its defects.
An important indicator of the severity of the damage is primarily the general condition of the victim, and the presence of associated complications such as concussion or brain contusion , fracture of the skull base and others who diagnosed zahalnohirurhichnymy rules.
Closed and open isolated damage to the soft tissues of the face are usually classified as mild complications if they do not entail the destruction of anatomical structures such as the lips and the tip of the wing of the nose , eyelids , branches of the trigeminal and facial nerves.
According to statistics isolated damage to soft tissues of the face that require treatment in a hospital , there are approximately 10 % of patients with facial trauma .
Systematics of isolated lesions of the soft tissues of the face zatrudnen is not. First, one should distinguish between closed and open soft tissue damage face.
Slaughter (contusio) – closed mechanical damage to the soft tissues without apparent anatomical integrity violations . Arise from the impact of a blunt object with a small force. This is accompanied by severe damage hlybshelezhachyh tissue ( subcutaneous tissue , muscle) while maintaining the integrity of the skin. In the deeper lying tissues observed damage small blood vessels , bleeding , leakage ( imbibition ) tissues with blood. Formed krovopidtikannya – bleeding in the thick skin or mucous membrane , and hematoma – limited accumulation of blood in the tissues with the formation of these cavities containing liquid or coagulated blood. The presence of fiber promotes rapid development and spread of edema, krovopidtikan , hematomas. ” Blooming ” krovopidtikan to determine the antiquity of injury.
Dimensions hematoma maxillofacial area may be different – from small to volume ( occupy half of the face of the spread of the neck and upper third of the chest ). Size of hematoma depends on the following factors: the type and size of the damaged vessel, vascular pressure values internally , size defect of coagulation system consistency surrounding tissue. The blood that poured into the cavity undergoes the following changes: it falls with fibrin formennyh elements decay and hemoglobin goes from red blood cells and converted into hemosiderin . The central focus of the hematoma hematoidyn – yellow- brown pigment.
Classification hematomas :
– Depending on the tissue where they are located – subcutaneous , submucosal , pidokistni , intermuscular , subfascial ;
– On location – buccal , pidochnoyi , navkoloochnoyi and other areas;
– The state of the blood that poured – nenahnoyena , infected or suppuration , organized or encapsulated ;
– In relation to the vessel lumen – nepulsuyucha , throbbing, arching .
Hematoma face
Treatment faces and fresh hematoma in the first reduced to the application of cold to the area of injury. Next prescribed thermal treatments. Hematoma that nahnoyilys should open and encapsulated – remove. In most cases of isolated soft tissue contusions victims are treated outpatient , and when combined injuries ( with the bones of the facial skeleton ) – hospitalized in the Department of Maxillofacial Surgery.
Abrasions – mechanical damage to the superficial layers of the skin ( epidermis ) or oral mucosa . The most common areas for the speakers face. Abrasions are often accompanied by soft tissue contusions , at least – the wounds of face and neck. In the healing of abrasions distinguish the following periods: from getting abrasions to crust formation ( 10-12 hours), overgrowth bottom abrasions to the level of intact skin, and then later ( 12-24 hours, and sometimes up to 48 hours), epithelization (up to 4 -5 days), falling peel ( 6-8-10 at night) , the disappearance of traces of abrasion (for 7-14 days) . Healing abrasions occurs without scarring.
Abrasions back of the nose and upper lip
Treatment of abrasions is to process them 1-2 % alcohol solution bryliantovoho green or 3-5% alcoholic solution of iodine.
Among the open lesions distinguish the following types of wounds:
sliced , chopped, torn, slaughter , slaughter – torn, bitten / penetrating or non- penetrating in the mouth and nose /.
Injuries and damage to the soft tissues of the maxillofacial area diagnosed by visible impairment of these organs, resulting injury. Almost all open face soft tissue damage accompanied by more or less severe bleeding , especially during the first hours after injury. If the damage of the lips, especially the lower , as well as rupture of the soft tissues in the corners of the mouth there is a strong salivation . Damage to the tongue and soft tissues of the floor of the mouth dramatically impede eating and drinking, causing speech disorders . Swelling of soft tissues bottom porodnyny mouth or tongue can cause breathing difficulties .
Damage to the soft tissues of the lateral parts of facial injuries are often accompanied by branches of the facial nerve , the parotid salivary glands and vessels. Injury to soft tissue injuries involving areas submaxillary submaxillary salivary glands , blood vessels and nerves of this region with the formation of deep pockets , penetrating to the great vessels of the neck to the larynx and pharynx, and a tendency to suppuration development processes , especially in lesions that penetrate into the cavity mouth. It should also be remembered, and the occasional injury of the oral mucosa and tongue are observed in the work of separation inattentive drives forests . Bleeding that while there may be very strong. In forming the diagnosis of soft tissue damage must specify not only the nature of the wound / cut, torn , slaughter etc / but its size / length , width, depth / and shape / line , oval , irregular shape and al. /.
The wounds of the soft tissues of the maxillofacial area
The main objective of aid at the scene is to prevent imminent danger to the life of the victim and his evacuation to the nearest medical facility or health center . This assistance includes conducting following the steps : Stop bleeding by imposing pressure bandage , providing victim provision that excludes from asphyxia retraction of the tongue. The safest position on the side of the victim . If there are obvious signs of asphyxia / cutting dyspnea, cyanosis of the skin / , especially in the unconscious , you should grab the tongue , its flash silk thread , pull at the mouth slit and fasten the thread on the neck.
The first medical aid at the scene includes stop bleeding, ensure normal breathing protyshokovi measures warming victim of cardiac input , etc.
In order to stop the profuse bleeding using finger pressing the common carotid artery to the transverse processes of the cervical vertebrae in front kyvalnoho muscle. Further to temporarily stop bleeding should be used Arzhantsev clamp which is placed upon the neck. To temporarily stop bleeding from wounds wounds apply tamponade with subsequent overlay on top of the pressure bandage pads .
Key measures to provide emergency medical dopomody victim with closed injuries in the early hours after injury are enclosed in the local application of cold / ice / and imposing pressure bandage .
The nature of specialized medical care and subsequent treatment depends entirely on the nature and location of the damage , general condition of the victim. Thus, with only minor isolated soft tissue injuries / without tissue defects / outpatient treatment can be carried out .
Treatment of open lesions / wounds / soft tissue maxillofacial area lies in the surgical treatment of wounds with suture and proper conduct of the postoperative period. During the surgical treatment of wounds apply various elements of sculpture, the nature of which depends on the location , shape and size of existing tissue defect .
Wounds of the upper lip without loss of tissue after stopping bleeding and pain relief sewn layers. First sew m’yazevyy layer, reduced line red border of lips, sew the skin and then placing sutures on the mucosa , from the red border to consistently transitional fold . Sometimes should first restore the integrity of the mucous membrane , then stitches the muscles and skin. When wound of the upper lip with partial loss of tissue in the center or on the sides of fabric defects zamishayut by moving the local tissues.
In the surgical treatment of wounds lower lip and corners of the mouth in cases of minor loss of tissue used this method as the upper lip . In wounded tissue defects of the corner of his mouth , mucous membranes and skin requires mobilization of the wound edges or moving flaps followed by suturing the mucous membrane and skin.
If the damage does not penetrate the cheek in the mouth after revision wounds impose catgut sutures to the muscles , skin – seams streak . Important not to overlook the damage ductless parotid gland and stitched it. If the damage cheeks , penetrating in the mouth , it is necessary to carefully examine the wound , including its relationship to the duct cancer, and initially catgut stitches on the mucous membrane and muscles. If the damaged ducts, both sides should be a mouth to take the rubber duct tape as drainage and fix it. Then the skin with silk sutures impose .
If the damage of the upper lip , combined with the trauma of the nose wings , or partitions initially placing the lining of the joints and tissues of the upper lip by vyvyschevkazanoyu method, and then carry out surgical treatment of wounds wings and nose . Regardless of the time elapsed since the injury, wound edges and tip of the nose wings , and ever shall be accurately mapped and linked seams.
Wounds pidboridochnoyi area in most cases combined with damage to the mandible. Debridement of wounds begin processing chin bone wound and fixing fragments and complete suturing the wound skin.
Dislocations and fractures of teeth.
The most commonly damaged front teeth of the upper and lower jaw. This agent is directed from front to back . Sometimes dental trauma occurs when struck in the vertical direction – from the bottom up or top down. Often dislocation or fracture of the tooth occurs when careless removal of a number placed tooth.
Dislocation of a tooth.
During tooth dislocation understand it forced displacement in the hole , accompanied by rupture of tissues surrounding the tooth / periodontium , clear , circular ligament /. There are complete, incomplete , and vkolochenyy dislocated tooth.
When complete dislocation of the root of the tooth is completely removed from the hole,
whereby partially retained its relationship to the surrounding tissues . In these cases, it is located in a transverse position with respect to the alveolar ridge – there bare- root of the tooth.
Incomplete / partial / dislocation of the tooth seen its displacement relative to adjacent teeth , most often – in the tongue or palate side. Sometimes he stands above the adjacent teeth. Patients complain of tooth mobility and pain in it. Sometimes – the inability to close the jaw , pain when eating.
When vkolochenomu dislocation of the tooth you can see that it is below the adjacent teeth / mandibular / or above them / in the upper jaw /. On radiographs periodontal no line throughout.
Treatment.
Incomplete dislocation should dislocate fingers vpravyty tooth fix it with smooth tires with aluminum wire staples or tires with self-curing plastic. Sometimes it is possible to make a tire- kapu . Engraftment tooth takes 3-4 weeks. When vkolochenyh dislocations reposition the tooth is usually not performed. In complete dislocations do surgery tooth replantation .
Given that the dental pulp may die at dislocations , exploring elektrozbudlyvist pulp after engraftment / 3-4 weeks / trepanuyut tooth , remove gangrenous pulp and root canal fastened under his treating .
Fracture of the tooth.
There crown fracture without damaging their organs, vidlomy crown with the opening of the cavity of the tooth, the tooth root transverse fractures at different levels and longitudinal tooth fractures . At the turn of the crown without opening the oral tooth pain arising from mechanical and thermal stimuli .
When vidlomah crown with pulp vskryttyam patients experience severe spontaneous pain, which intensified at any irritation when hit in the mouth cold air. Patients unable to speak and eat normally .
On examination in place of vidlomlenoyi crown is observed naked bleeding pulp .
At the turn of the tooth root in its middle and upper mobility of patients complain of pain in the tooth and nakushuvanni . Palpation mixed vidlomlena only part of the tooth mobility without the second part. To clarify the diagnosis must determine elektrozbudlyvist dental pulp. On radiographs well observed fracture line that passes through the tooth root .
At the turn in the area of the root apex of the tooth mobility tooth often vychnachayetsya and is a pain with percussion .
Treatment.
At the opening of the pulp under local anesthesia tooth depulpuyut , channel fastened .
If there was a turning point in the middle or upper part of the root and pulp viable , then spend fixing the tooth using a smooth tire- staples or mouth guard . In such cases, the fragments grow by laying a layer of cement and dentin. In case of death of the pulp may compound fragments by introducing a metal rod into the root canal of the tooth after trepanation and removal of the pulp. At the turn of the apical part of the root of the tooth can be removed vidlomanu of root / transaction -type root apex resection / from canal filling of tooth cement.
In case of storing the tooth / multiple fracture longitudinal fracture of the tooth / teeth or roots removed.
Dislocation of the temporomandibular joint.
There are anterior and posterior dislocation of the mandible , anterior dislocation often occurs when the head of the mandible moves anteriorly and slides on the front slope of the articular buhorka . Rarely occurs posterior dislocation . Anterior dislocation of the mandible can result from excessive mouth opening / if zivanni during tooth extraction when the doctor does not support the lower jaw / injuries inflicted on the area of the chin down.
There are one-sided and two-sided , and habitual dislocation of the mandible.
When habitual dislocation patients will easily reduce a it by moving the lower jaw.
At the front bidirectional dislocation in patients with pain in the joints : the mouth is not closed , it’s not expressive, chewing food possible. On examination, the patient’s original appearance : mouth open, pidbo – riddya put forward forward , the front teeth do not merge , mouth saliva flowing . Palpation anteriorly from the tragus ear marked retraction / absence of the head, which is easily palpable, normal / and under skulovoyu arc in the anterior , marked swelling / offset head /.
In unilateral dislocation is determined by a similar pattern . Is marked midline shift chin in a healthy way. Palpation in the area of the projection head / ear tragus anteriorly from / to the side of dislocation marked depression. On the opposite side of the head is very palpable.
Treatment.
Reduction of dislocation of the mandible is carried out manually. When dislocations that arose a few days or weeks ago , it is best to use general anesthesia in order to weaken the tone of masticatory muscles.
When you reposition a patient dislocation seat in a chair or on a low stool so that his jaw was at Loktev joint hairy hands physician. The doctor is in front of the patient, enters the thumbs of both hands wrapped in gauze diaper mouth and puts them on the chewing surfaces of large molars . The remaining fingers zahvachuye lower edge of the body nyzhnoi jaw outside. Then, shaking thumbs for large molars , or posterior alveolar ridge , placed down the lower jaw. Simultaneously, other fingers placed at the edge of the body of the mandible ; prypidnimayut her previous department. Gradually, the head of the mandible moved downward and skolznuvshy on the back slope of the articular buhorka , enters the hollow joints . Reduction is accompanied by a characteristic head luskannyam , with interdigitation is free . To prevent prykushuvannya fingers physician should quickly move them out of the alveolar ridge .
After reduction of dislocation of the mandible is recommended to put a bandage soft praschevydnu 1 – 2 weeks. The patient should take a liquid or semi-liquid food.
Fractures of the alveolar process .
Isolated fractures of the alveolar ridge is most commonly found in its anterior part . When applying the injury front to back there is an excess alveolar ridge and there is arch- shaped fracture. Perelamu line is above the tops of the roots of teeth / in maxilla / or below / on the lower jaw /. Often alveolar ridge fractures combined with fractures of roots or crowns of individual teeth with damage to the pulp. Vidlomok alveolar ridge is shifted toward the palate or tongue . Patients complain of pain, tooth mobility and inability to chew food, reported the injury and its cause of bleeding from the mouth.
On examination, the patient is marked swelling of the lips , the teeth in the area of injury shifted downward breaks observed plum shell or bleeding in it, and often – Scalping areas of bone. When you break the mucous membrane over the top of the arch vidlomanoyi areas alveolar ridge is sometimes seeude top tooth roots. Palpation can install mobility broken areas of alveolar ridge with teeth.
Fractures of the mandible.
There are numerous nevohnepalnyh classification of fractures of the mandible. Very convenient is the classification proposed B.D.Kabakovym , V.A.Malyshevym .
A). Localization :
1. Fractures of the body of the jaw :
– The presence of teeth in the cleft of the fracture ;
– The absence of teeth in the cleft of the fracture.
2. Fractures of the branches of the jaw :
– The actual branches ;
– Coronary process ;
– Condylar process : fundamentals , neck , head.
3. The nature of the fracture :
– Without displacement of fragments ;
– Displacement of the fragments ;
– Linear oskolchati .
Fracture of the lower jaw can occur as a result of force that exceeds the physical properties of bone. This change is called traumatic. However, the jaw can break down under the action of forces, not to exceed physiological (eg, chewing food ). Most of this occurs in the case of a significant decrease in bone density due to its refinement in certain diseases ( malignant tumor , cystic neoplasms, dysplasia, chronic osteomyelitis , etc.). . This classification is defined as pathologic fracture . Fracture may be in place application of force (direct ) or far away from this place , and even on the opposite side (indirect ). Often at the same time there are direct and indirect fractures , especially at the location of the fracture lines on either side of the midline. Depending on the direction of the fracture gap and its forms of fractures are divided into longitudinal , transverse , oblique , zigzag . In addition, they can be large and dribnoskolchatymy . The number of lines of fracture distinguish single, double (two fractures on one side of the jaw) , bilateral (one fracture on both sides of the jaw) , multiple fractures. They can be placed on one side of the jaw ( unilateral ) or both sides (bilateral ). According to the literature , single fractures are more common than double , multiple – less than a single and twins. From the clinical views fractured body of mandible fractures are divided into pidboridkovoho department ( ranging from canine to canine ), lateral ( ranging from canine to second molar ) in the area of corner (area between the second and third molar and third molar hole ). In the area of corner fracture often passes through the eighth hole of the tooth.
Lines of mandible fractures are more common
Fractures of the body of the mandible within the dentition is always open. This is due to the fact that the mucous membrane of the alveolar fixed in the case of displacement of bone fragments may rupture with the periosteum. Fracture gap thus be combined with oral . Fracture and can pass through the hole of the tooth, followed by periodontal trauma and sometimes dislocation or fracture of the tooth. This in turn causes the combination of bone wounds of the oral cavity through the periodontal crevice . At the turn of the articular process fractures distinguish its base, neck and head . Fracture of zygomatic arch fracture is sometimes accompanied by coronary process. Fractures of the mandibular branches are usually closed , but in the case of rupture of the soft tissues that are around the bones, the skin may be open. This often occurs in the case of home injury or accident .
The mechanism of fracture of the mandible.
There are 4 versions of the mechanism of fractures of the mandible : bend , shift, textures , lead . Mandible , having an arched shape when subjected to mechanical stress tensions bone in the most bent or the thinnest of plots. Those within the lower jaw and the neck is the basis of articular process , angle, area pidboridochnoho hole and fangs pidboridkovyy department.
When attacking a broad pidboridku its area towards the front to back greatest tension occurs in the zone of articular processes . Possible indirect fracture in the region of the neck on one side or both sides , but not its base. This is due to the fact that in the anteroposterior directioeck articular process three times thinner than at its base.
If applying force in a small area of the lateral body of the mandible , can direct change in the place of its application : most often in the region of the angle of the jaw ( bone vytonshena wells in the area of the third molar ) pidboridkovoho hole (zone premolars is one of those areas of the mandible ) in the area of canine ( weakened bone fangs deep hole ).
If applying force in a small area of the lateral branches of the jaw (in the frontal area), possible direct fracture of the base of the articular process, since its thickness is much smaller than the area of the neck .
In the case of the attack on the wide side of the plane of the body of the mandible possible indirect fracture on the opposite side from the application of force in the region of the angle and base of the articular process.
If the force application on a wide area of the angle of the mandible on one side , that is unbalanced, there will be a change in the area of direct and indirect angle – in the area pidboridkovoho side of the body of the mandible.
Thus, in the case of inflection mandibular fracture often occurs at the site of application of force to a narrow area, and indirectly when applying power to a large area of the jaw.
Causes of displacement of bone fragments.
Displacement of fragments of the mandible is due to the application of force , under the influence of its own weight fragments and force reductions attached to these fragments muscles. The last factor is remarkable. As already noted , the lower jaw peremischyetsya influenced by two muscle groups: climbing ( posterior group ) and lowering (front group) the lower jaw. All muscles are paired and attached to symmetric points . They operate on the entire lower jaw and enhance the action of each other. Muscles lower jaw , – weaker muscles that lift it .
Character displacement of fragments of the mandible :
– Displacement of the mandible upwards ( jaw closing ): temporal , chewing , medial alary muscles ;
– Lowering of the mandible : dvocherevtsevyy , oral hypoglossal , hypoglossal – pidboridkovo muscles ;
– Displacement of the mandible back, still lifted anteriorly : temporal ( tail pieces ) and dvocherevtsevyy pidboridkovo – hypoglossal muscles ;
– Shift of the mandible to the left : right lateral and medial alary muscle, left dvocherevtsevyy , temporal , oral and pidboridkovo hypoglossal – hypoglossal muscles.
So anterior muscle group shifts the end of a large fragment down. Oral and hypoglossal muscle deploys along its longitudinal axis, tilting the teeth in the oral direction. Lateral to a lesser extent the medial alary muscle shift towards large fragment fracture , chewing and temporal muscles – lower piece top. In addition, the chewing muscles shifts the basis of small fragment outward tilting orally – alveolar portion of the tooth. The lateral alary muscle on the side of a small fragment displaces it slightly inward. Based on clinical experience, we can assume that the displacement of fragments of lower jaw is up, down, inside and out. It is possible to shift them horizontally (lengthwise ) when the end of the fragments overlap each other, z’yednyuyutsya with their side surfaces .
Examination of patients with mandibular fractures
Single fractured body of the mandible in ITS
Central Division .
Fracture in the midline / between the central incisors / no defect bone fracture gap , starting at the alveolar ridge, going almost vertically down / in the sagittal plane / the bottom of the jaw. Jaw fragments are in a state of ” balance ” under the influence placed upon them muscular groups. With this median fracture possibly a slight shift fragments , which sometimes can be accompanied vazhkozahoplyuyuchymy malocclusion . Offset fragments occur in the frontal plane , leading to malocclusion , characterized by the so-called buhorkovym contact – inclination of posterior teeth Yazykovo side. This is a result of the termination of the overall arc of the mandible when each half of her tougher chewing muscle of the medial and alary like ” gut-wrenching ” lower edge of the jaw from the outside. As a result of the lower edge of the jaw is the difference fragments , while the crown as the central incisors even more tightly spivstavlyuyutsya aproksymalnymy their surfaces. This shift can be observed fragments and with a slight inclination of the fracture gap from the midline in the region of the lower edge of the jaw in cases where the thrust left and right muscle groups that lower jaw , separated by a slit , about equal.
But in most cases , since the central incisors, the fracture gap , moving to the lower edge deviates from the midline on either side and ends in the region of the lateral incisor , canine , or even the first indigenous small tooth. As a result of the fact that one of the fragments attached most muscular fibers, lower jaw , there is a vertical displacement of large fragments down. If the crack is perpendicular to the fracture pidboridkovomu department, midline shift may not occur . However, often fracture line on the outer cortical plate does not match the line on the lingual surface of the jaw. The location of fracture gap occurs in most cases, fractures in the area of the lateral incisor socket . Crack fracture is placed obliquely in the direction from the outer to the lingual cortical plate , and the fracture line on the inner surface separated further from the midline than on the outer surface . With the passage of change in the slanting plane with respect to the vertical axis of the mandible of further observed pattern: the closer the fracture line on the outer surface of the bone is coming to the midline , the further / lateral / from it is the line of fracture on the lingual compact plate.
With this placing fissure fracture fragments shift is not only vertically , but also horizontally because ” napovzannya ” fragments to each other under the action of reducing lateral alary muscles. Midline shifts toward fracture due to narrowing of the dental arch is broken bite. Character displacement of fragments of mandible fracture depends on the location , placement and distribution of crack fracture.
Fractures of the mandible on lateral section often occur at the site of application of force . Offset fragments increases with increasing distance from the fracture plane pidboridkovoho midline of the mandible. Most common is the placement of fissure fracture when she starting to alveolar ridge, crosses the horizontal plane at an angle and ends in the region of the lower edge of the jaw backwards . Line fracture on the outside of a compact plate passes behind the line displayed on the lingual surface. With this placing fissure fracture displacement of fragments , tends to be significant. Great vidlomok in front moves down through the contraction of muscles that lower jaw and the side of fracture under lateral alary muscle. Less vidlomok shifted up / by reducing muscle that raises the lower jaw / to the front and side Yazykovo . The angle of the jaw by chewing muscle traction ” twisted ” out, and vidlomok in the area of tooth has a slope of Yazykovo side. Midline / between the central incisors / shifts toward fracture fragments come one after another, leading to a narrowing of the dental arch and malocclusion almost all over. Very rarely observed displacement of small fragments in the buccal strontium . This is possible only in cases where the fracture line pa compact outer plate is placed closer to the center than the line that runs along the inner surface of the jaw.
Radiographs . Mental articular fracture and fracture of the stem.
In the study of clinical and radiological pattern of fractures seen that the sharper the angle between the planes of fracture and the lower edge of the jaw , the more pronounced displacement of fragments . Very rarely there is a fissure fractures accommodation option when it from alveolar vidrosthu , persikaye horizontal plane at an angle and ends near the midline . In such cases, reduce the fragments fails or it is minimal.
If the damage of the lateral areas of the body most jaw fracture takes place in the area pidboridkovoho hole , often fissure fracture , Being located close to the hole, ” outranked him.”
Fractures of the lower scheleyy on the side section that passes through the hole pidboridkovyy or placed behind him, in the presence of a significant shift fragments often accompanied by damage to the neurovascular bundle , which not only causes severe pain or loss of sensation in the area of the corresponding half of the lower lip , but accompanied by significant bleeding freely .
Single fractures in the area of mandibular angle
In single fractures of the mandible in between dentition most common injury in the region of the angle.
Isolated fracture of the branches of the mandible
In the first place the frequency is damaged articular sprout , then own branch and lastly the coronal germ . It certainly damaged articular fractures with displacement of the arc fragments , although isolated fractures observed in single coronary stem FAULT mandible. Mechanism of isolated fractures of the coronary stem is still not clarified . There were doubts about the possibility of an isolated fracture of coronary sprout without broken links to skulovoyi arcs or other areas of the mandible. A.Ya.Rauder / I947 / and S.I.Kahanovych / 1964 / consider that possible , though rare , fractures coronary stem to rupture when applied to a severe blow to pidboridku down with jaws clenched tight and temporal muscle .
In such cases where the fracture plane passes below the attachment of the temporalis muscle fragments is offset upwards in till the temporal area . In patients with fractures of the coronary stem mouth opening is limited to 1.5 cm -I , the bite is not broken , but when lowering the lower jaw it changes the way of damage. Palpation on the front edge of branch determined by a sharp pain in the area of coronary stem bases . Radiography of the mandible in lateral projection at maximum mouth opening facilitates diagnosis of such fractures.
Fractures of the mandible in the area of own branches occur more frequently than coronary sprout damage . They occur on the side of application of force and often have oskolchatyy character. Such fractures are accompanied by sharp fragments displacement and malocclusion . The examination is marked limitation of mouth opening , and midline shift towards damage when lowering the mandible. Determined by palpation tenderness in the region of the posterior surface of the branches, with a load on the chin is increased local pain at the site of the fracture. Clarify the diagnosis by radiological examination.
As noted , when individual fractures often damaged articular branches sprout , and areas damaged by its uneven. The most frequently observed fractures foundation process, arising as a result of force – bending . The point of application of force often is the lateral region of the chin and jaw lateral parts of the body . In such a mechanism of injury force accounted for the most vulnerable part of the articular germ – its base. If the impact point of application of force appeared pidboridok performance and power multiplied in perednozadnomu direction , often there is a fracture in the region of the neck of the mandible. Why, when attacking the side and slightly below breaks down more articulate petiole base , while perednozadnomu direction of impact – neck . The explanation must be sought in the anatomical structure of these departments articular stem. In the area of the base stem thickness articular bone – the size of the plane in the direction of foreign domestic considerably smaller in perednozadnomu direction. In the cervical region is diametrically opposed to these relationships .
If the damage petiole bases articular fracture gap , from venous cut , is usually inThey and backwards . In most cases, this damage localization fracture line on the outer and inner plates do not match. Depending on the kind of fracture lines above – on the outer or inner surface of the articular stem , there is a different offset fragments.
If the fracture line in the area of the base of the articular stem is placed on the outer plate is below the line, which is located on the inner surface / crack fracture takes place outside inwards and upwards / , the most commonly observed following the shift : the peripheral end of the small fragments shifted dozovni and slightly back, while the head remains in the jaw articular hollow , although it may be in a state of subluxation when contact with the base of the skull is only the lateral joint. Directly involved in the displacement of small and large fragments accepts that stirred upwards and backwards / under proper chewing , and medial temporal alary muscles / pushes peryferychnyy end dozovni small chips and a little backwards . Thus, in most cases, these situations are not all mixed dozovni vidlomok small , but its peripheral end. In such fractures can achieve improvements of small fragments orthopedic techniques without reducing branch jaw with mizhschelepovoho flexible extraction and interdental laying on the damaged side.
