The main task of a dental surgeon during the treatment of a fracture of the upper or lower jaw is to restore the anatomical structure of the broken bone and the correct relationship of the dentition. Many techniques help to achieve this, but the effectiveness of treatment also depends on how correctly and quickly first aid was provided.
Before hospitalization
First aid to the victim includes:
- stopping bleeding (pressing or packing the wound, applying cold);
- if necessary, cardiopulmonary resuscitation;
- pain relief (analgin, revalgin intramuscularly);
- immobilization of the jaw with the help of fixing bandages (contraindicated if the victim is unconscious, since this increases the risk of suffocation from the retraction of the tongue or vomit entering the respiratory tract).
Osteosynthesis
Indispensable for complex, comminuted and multiple fractures with displacement, loose teeth and complete absence of teeth, for periodontal disease and other inflammatory diseases of the gums in the area of injury. Osteosynthesis is also effective in cases of fracture of the condylar process complicated by dislocation of the articular head of the lower jaw.
Fastening materials can be steel knitting needles and rods, pins, nitride-tinan wire with shape memory, quick-hardening plastics, polyamide thread, special glue.
However, osteosynthesis with metal miniplates is considered the most convenient and safe method today. They allow you to cut through the skin and muscles on only one side, which simplifies the operation itself and shortens the recovery period. Another undeniable advantage is the ability to reliably fix fragments in areas with significant dynamic loads.
Discussion
Despite the development of medicine in general and maxillofacial surgery in particular, the problem of providing emergency medical care for fractures of the facial skull remains not fully resolved. Due to the increase in the number of road traffic accidents and domestic conflicts, and the passion of young people for traumatic sports, there has been an increase in the number of victims with injuries to the facial skull, among which fractures of the lower jaw occupy the first place [12].
The difficulty of early diagnosis of fractures of the angle of the mandible is associated with the insufficient information content of routine methods of radiation examination (radiography of the skull in frontal or lateral projection), late referral of victims to specialized maxillofacial hospitals and, as a consequence, the choice of irrational methods of treatment, which in turn leads to development of various kinds of complications, reduction in the quality of treatment and life of patients.
Splinting the jaw
This is the immobilization (fixation) of bone fragments using a special plastic or wire structure.
The technique, created by military doctors at the beginning of the 20th century, is successfully used by dentists today. The materials used to make the splint have changed, and the methods of applying it have been improved.
Today, a specialist has many types of tires in his arsenal:
- from standard Vasiliev tape splints, the simplest and cheapest method of treatment;
- to aluminum Tigerschdedt splints, which are made individually for each patient, due to which they are more effective. In addition, they evenly distribute the load and minimally injure the teeth.
The type of splinting depends on the type of injury and can be unilateral (when one jaw is fractured) or bilateral (when both are damaged).
If the teeth are preserved, it is not difficult to apply a bent dental wire splint. It is bent to the shape of the dental arch and fixed with bronze-aluminum wire ligatures, which, like a hairpin, cover the tooth on both sides. Manipulations are performed under local anesthesia.
When both jaws are fractured, a structure with a more rigid base is installed; in addition to wire, hooks and rings are also used that immobilize the lower jaw.
Osteosynthesis using ultrasound
With the help of metal fasteners, the jaw bones can be fixed quite firmly. But during surgery, it is most often necessary to cut through facial tissue and the salivary glands or branches of the facial nerve can be damaged.
It is less traumatic to perform osteosynthesis using ultrasound. In this case, the bone-fixing devices can be inserted shallowly into the bone and a small amount of scars remains on the patient’s face.
The doctor uses low-frequency ultrasound on a titanium plate with spikes. A plate with holes for the dental bur is placed at the fracture site and adapted to the shape of the jaw. An instrument is then used to make shallow holes in the bone through the plate. After which low-frequency ultrasound vibrations are directed to the base of the spines. In this way, the spikes gradually sink into the bone tissue, reliably fixing bone fragments. In this case, an antiseptic solution is supplied through the instrument, which treats the wound.
The bone tissue around the spines becomes denser under the influence of ultrasound. This occurs due to the large contact area, reducing pressure on the bone due to the use of a spike and the internal compression force of the bone tissue.
Ultrasonic osteosynthesis can reduce the time of surgery and reduce the amount of postoperative trauma. The method gives fewer complications and provides a good cosmetic effect.
Is it possible to do without splinting?
Even if the case is not severe - the fracture is one-sided, closed and without displacement - it is imperative to take measures to prevent the development of such unpleasant complications as:
- accidental displacement of fragments,
- re-injury
- development of inflammation of soft tissues,
- infection of the fracture site.
To do this, it is necessary to immobilize the jaw by any available method. This can be a sling bandage, but it is much more convenient and effective to use a splint. In case of a complicated fracture, splinting is absolutely indispensable, regardless of the location of the injury.
Treatment tactics for displaced fractures
In such cases, before applying a splint, it is necessary to compare the jaw fragments, for which reduction orthopedic devices are used. A broken upper jaw requires traction using special dental splints.
Such injuries are very dangerous because they can cause asphyxia. But correctly provided first aid will prevent suffocation. Clear the oral cavity of foreign bodies or blood, lay the victim face down, placing a cushion rolled up from clothes, blankets, etc. up to the chest.
Metal Kirschner spokes
This type of wire was first used to treat fractures of the lower jaw in 1933. Intraosseous insertion of these wires can be carried out both percutaneously (without incisions) and with soft tissue incisions.
In 1975 V.V. Donskoy used an original technique, with which he inserted a wire into the branch of the lower jaw through the mucosa without an incision, then carried out a reposition, and fixed it like a splint to the teeth or to a splint. Later, in 1988, Deryabin E.I. and Osipov V.Yu., and Yu.G. Kononenko and G.P. Ruzin proposed modifications of this method in 1991. Today there are many techniques where the wire suture is combined with knitting needles, staples, surrounding wire ligatures, etc.
Rehabilitation after a jaw fracture
For successful treatment of a jaw fracture, anti-inflammatory and restorative therapy, physiotherapy, mechanotherapy and special oral hygiene are also important.
- Within 3-4 days after the injury, antibiotics must be prescribed to prevent inflammation, which are injected directly into the area of injury.
- General strengthening therapy is taking vitamins C, P, D and group B, drugs that stimulate tissue regeneration and restore the level of leukocytes in the blood.
- Among the effective physical procedures, we note UHF therapy, general ultraviolet irradiation, and magnetic therapy. After the third procedure, swelling and pain are noticeably reduced, swelling subsides. For better healing of fragments, 2 weeks after a jaw fracture, electrophoresis is performed using a two to five percent solution of calcium chloride.
- Mechanotherapy, or physical therapy, accelerates the restoration of jaw function and helps if, after an injury, the mouth opens poorly or does not open at all. It can also be practiced at home, starting 4-5 weeks after the fracture, when the splints are removed and a callus has formed.
- Special hygiene involves irrigation at least 8-10 times a day. For unconscious victims, their teeth and mucous membranes are treated with a special solution at least twice a day.
Fracture of the lower jaw - symptoms and treatment
Diagnosis of patients with fractures of the lower jaw is carried out in order to establish the location, number of fractures, as well as to determine injuries to nearby tissues, vessels and nerves.
Diagnostic methods are basic and additional (instrumental).
Basic diagnostic methods are carried out with a standard set of instruments in the emergency room, dental office or dressing room. The doctor finds out the patient’s complaints, learns about previous diseases and previous operations. At this stage, it is very important to establish the time of injury, since the duration of the injury plays a big role in further treatment tactics.
During the investigation, the doctor will find out whether the injury was sustained at home, at work, or during a fight, and whether it is of a criminal nature. In case of injury during violent acts, the doctor is obliged to report the incident to the police. After that, an internal affairs officer talks with the victim, finding out the details of what happened. In this regard, there is often a concealment of the real reasons for the injury, and the patient sometimes invents very ridiculous and implausible stories.
Sometimes collecting complaints and medical history is difficult or impossible due to the patient’s serious condition or alcohol/drug intoxication.
A clinical study begins with an external examination; post-traumatic swelling, changes in skin color, the presence of abrasions, hematomas, and bleeding are detected. Next, palpation is carried out, during which the nature of the swelling is revealed, inflammatory infiltrate, hematoma, and subcutaneous emphysema are excluded. Palpation of the lower jaw is carried out symmetrically, starting from the branch of the lower jaw and ending in the chin. The presence of a bony step indicates a fracture of the mandible. The degree of mobility of the fragments and the direction of their displacement are also determined.
When examining the oral cavity, special attention is paid to the mucous membrane of the alveolar part of the lower jaw, identifying violations of integrity and bleeding. The relationship of the dentition and the displacement of the central line of the lower jaw when opening and closing the mouth are determined. The landmarks are the labial frenulum, the line between the central incisors of the upper and lower jaw.
Often, the opening of the mouth with jaw fractures is limited. When rocking the lower jaw, relying on the chewing teeth and the basal edge, you can determine the degree of pathological mobility of the lower jaw and the location of the fracture.
Additional diagnostic methods:
- X-ray : an X-ray of the skull is taken in a direct projection in order to exclude fractures of other parts of the face and an X-ray of the lower jaw in lateral projections, the number of fractures, the presence or absence of displacement, diastasis (gap) and the presence of teeth in the fracture line are analyzed.
- An orthopantomogram is a more modern method, with functionality similar to an x-ray. One detailed image is taken, and it is possible to view it on the monitor screen using various programs.
- Computed tomography allows you to most accurately identify fractures of the lower jaw, measure the distance of displacement of fragments, diastasis, determine the size and number of fragments, and the presence of foreign bodies. Using certain setting modes, you can determine the violation of soft tissues (muscles, blood vessels, nerves) and the presence of hematomas.
- Assessment of the general condition of the body - examination of organs and systems of the body, identification of viral and chronic diseases. For this purpose, a physical examination, digital chest x-ray, ultrasound examination, and laboratory diagnostic methods are used. If necessary, consultations with related specialists are carried out. All this helps to select the most effective therapy for the patient, taking into account the characteristics of a particular clinical case.
How to eat?
Since during intensive therapy and during the recovery period the jaws are rigidly fixed and habitual chewing of food is out of the question, correction of the diet is necessary during this period.
Food should have the consistency of low-fat sour cream. These are broths, pureed soups, carefully chopped vegetables and fruits, milk drinks, liquid cereals. Spices are excluded, salt consumption is limited. The temperature of the dish should not be higher than 45-50 °C. The most convenient way to eat food is through a straw.
You need to gradually switch to your usual diet after removing the splint. This is important not only for restoring chewing functions, but also for preventing disorders in the gastrointestinal tract.
How much does it cost to treat a broken jaw?
The price depends on the nature of the injury, whether osteosynthesis was performed, what splints were used, and whether the patient attended physical therapy procedures. But let's say for sure that the service is not cheap. Osteosynthesis alone will cost from 14,000 to 55,000 rubles.
It is also necessary to consider the cost of subsequent dental treatment to restore lost teeth or damaged teeth after splinting. Our service will help you choose a competent specialist and not waste your money. Compare prices and services of different clinics, read reviews from real patients.
The husband got into a fight, broke his jaw and received Art. 112 of the Criminal Code of the Russian Federation. What's the threat? No previous convictions.
Hello. The husband got into a fight, broke his jaw and received Art. 112 of the Criminal Code of the Russian Federation. What's the threat? No previous convictions.
Lawyer Antonov A.P.
Good afternoon
According to Part 1 of Art. 112 of the Criminal Code, intentional infliction of moderate harm to health, not dangerous to human life and not entailing the consequences specified in Article 111 of this Code, but causing long-term health disorder or significant permanent loss of general working capacity of less than one third, is punishable by restriction of freedom for a term of up to three years, or forced labor for a term of up to three years, or arrest for a term of up to six months, or imprisonment for a term of up to three years. According to Article 15 of the Criminal Code, depending on the nature and degree of public danger, the acts provided for by this Code are divided into crimes of minor gravity, crimes of medium gravity, serious crimes and especially serious crimes. Crimes of minor gravity are recognized as intentional and careless acts, for the commission of which the maximum punishment provided for by this Code does not exceed three years of imprisonment. Crimes of average gravity are recognized as intentional acts, for the commission of which the maximum penalty provided for by this Code does not exceed five years of imprisonment, and careless acts, for the commission of which the maximum penalty provided for by this Code does not exceed ten years of imprisonment. Grave crimes are intentional acts, for the commission of which the maximum penalty provided for by this Code does not exceed ten years of imprisonment, and careless acts, for the commission of which the maximum penalty provided for by this Code does not exceed fifteen years of imprisonment. Particularly serious crimes are intentional acts, the commission of which is punishable by this Code in the form of imprisonment for a term of over ten years or a more severe punishment. Taking into account the actual circumstances of the crime and the degree of its public danger, the court has the right, in the presence of mitigating circumstances and in the absence of aggravating circumstances, to change the category of the crime to a less serious one, but not more than one category of crime, provided that for committing the crime specified in part three of this article, the convicted person is sentenced to a sentence not exceeding three years of imprisonment, or another more lenient punishment; for committing a crime specified in part four of this article, the convicted person is sentenced to a punishment not exceeding five years of imprisonment, or another more lenient punishment; for committing a crime specified in part five of this article, the convicted person is sentenced to a punishment not exceeding seven years of imprisonment.. According to Art. 56 of the Criminal Code, deprivation of liberty consists of isolating a convicted person from society by sending him to a penal colony, placement in an educational colony, a medical correctional institution, a correctional colony of general, strict or special regime, or in prison. Punishment in the form of imprisonment may be imposed on a convicted person who has committed a crime of minor gravity for the first time, only in the presence of aggravating circumstances provided for in Article 63 of this Code, with the exception of crimes provided for in part one of Article 228, part one of Article 231 and Article 233 of this Code, or only if the relevant article of the Special Part of this Code provides for deprivation of liberty as the only type of punishment. Imprisonment is set for a term of two months to twenty years. With the exception of the cases provided for in part five of this article, in case of partial or full addition of terms of imprisonment when imposing penalties for a set of crimes, the maximum term of imprisonment cannot be more than twenty-five years, and for a set of sentences - more than thirty years. In case of commission of at least one of the crimes provided for in Articles 205, 205.1, 205.2, 205.3, 205.4, 205.5, parts three and four of Article 206, part four of Article 210, Article 210.1, part four of Article 211, articles 277, 278, 279, 353, 356, 357, 358, 360 and 361 of this Code, in case of partial or full addition of terms of imprisonment when imposing penalties for a set of crimes, the maximum term of imprisonment cannot be more than thirty years, and for a set of sentences - more than thirty-five years. Thus, since you committed a crime for the first time, the court cannot assign you imprisonment, even a suspended one. He can only assign you restriction of freedom and forced labor.
Sincerely, lawyer Anatoly Antonov, managing partner of the law firm Antonov and Partners.
