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Fracture of the jaw
Last reviewed: 23.04.2024
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Dull injury to the face can cause fracture of the jaw and other bones of the facial skeleton.
Fracture of the jaw is suspected in patients with newly developed bite anomalies or local edema and tenderness over the site of the mandible. When palpation, the instability of some fractures is noted. For a fracture of the condyle of the lower jaw are characterized by: great pain in the ear, swelling and restriction of the opening of the mouth. With a one-sided fracture of the condyle of the lower jaw, the latter, when opening the mouth, deviates to the damaged side.
Fractures of the middle part of the face, including the area from the upper edge of the orbit to the teeth of the upper jaw, can break the contours of the cheeks, cheekbones, zygomatic arch and the edges of the orbit and numbness in the infraorbital region. Enophthalmos and diplopia indicate a fracture of the bottom of the orbit. To describe the fractures of the upper jaw, you can use the classification of Le Fort (Le Fort). With a rather serious injury with a fracture of the bones of the face, possible head trauma and fractures of the cervical spine. With large depressed fractures of the facial area, due to edema and hemorrhages, the patency of the respiratory tract may be impaired.
With an isolated fracture of the lower jaw, a panoramic radiography of the teeth should be performed. Standard radiographs (anteroposterior, oblique, occlusal, Waters and Tawne projections) are informative if a fracture of the facial skull is suspected, but, if possible, CT scans should be used, which is appropriate, even if the fracture is clearly visible on conventional radiographs.
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Treatment of jaw fracture
To maintain patency of the airway to a patient with a hemorrhage, edema or extensive tissue damage, intubation of the trachea through the mouth may be required. The final treatment of facial fractures is a laborious process and may involve osteosynthesis.
Jaw fractures passing through the denticles are considered open. In these cases, antibiotic prophylaxis is indicated, inward or parenterally.
In fractures of the lower jaw, intermaxillary or rigid open fixation is used. If fixation is possible within the first hour after the injury, suture any wounds of the lips and mouth should be postponed until it ends. For intermaxillary fixation use special arched tires that fix on the teeth of each jaw, then restore the bite and connect the tires with wire. The patient should always have a clipper in case of vomiting. Food is limited to liquid, puree and food additives. Since only the outer surface of the teeth is cleansed, to prevent plaque, infection and bad breath, the patient is recommended to rinse 30 ml of a 0.12% chlorhexidine solution 60 s daily in the morning and evening. Exercises to open the mouth usually help to restore the function after removing the latches.
The condylar fractures require external fixation for no more than 2 weeks.
However, with bilateral fractures of condyles with pronounced displacement, open reposition and fixation may be required. In condylar fractures in children, rigid external fixation should not be used because of the threat of ankylosis of the mandibular joints and anomalies of facial development. Elastic fixation for 5 days is usually sufficient.