Injuries of jaws and teeth in children: causes, symptoms, diagnosis, treatment

In peacetime, damage to the maxillofacial area in children is 6-13% of the total number of injuries. Between 1984 and 1988, children with injuries accounted for 4.1%. Almost half of them (47%) were taken by ambulance; 5.5% were sent by medical institutions, and 46.8% addressed themselves. The urban population was 96.6%, rural - 2.5%, nonresident - 0.9%. Boys were injured more often than girls - an average of 2.2 times. In 59.1% of cases there was a domestic trauma, in 31.8% - street, in 2.4% - road, in 3.2% - school, in 3.5% - sports. Children with bitten wounds were 1.2%. Damage by nature was distributed as follows: soft tissue injuries were observed in 93.2% of cases, dental injuries in 5.7%, facial skeleton fractures in 0.6%, temporomandibular joint injuries in 0.5%.

As the analysis of the work of the emergency department in recent years has shown, the flow of injured Kiev children tends to decrease: if in 1993 it was delivered to 2574 children, in 1994 it was 2364, and in 1995 - only 1985 children. This encouraging trend is due in part to the fact that among the women-women there are more unemployed mothers and grandmothers, fathers and grandfathers who can stay at home more and pay more attention to their children and grandchildren.

All lesions of the maxillofacial area in children can be divided into the following groups:

1. damage to soft tissues (bruises, abrasions, skin tears, facial and tongue muscles, mucous membrane, nerves, salivary glands and their ducts);
2. damage to the teeth (violation of the integrity of their crown, root, dislocation of the tooth from the alveoli);
3. damage to the jaws (fracture of the body or processes of the upper and lower jaws, fracture of both jaws);
4. fracture of the malar bone, zygomatic arch;
5. damage to soft tissues, bones of the face and teeth;
6. Combination of injuries of the maxillofacial area with closed craniocerebral trauma;
7. damage to the temporomandibular joints;
8. a combination of damage to the maxillofacial area with injuries of the limbs, chest, abdominal cavity, pelvis and spine. Fractures in the jaws and teeth in children occur mainly as a result of accidental falls and bruises (when running fast, playing sports, playing with hoofed animals or horned animals), when getting under street transport.

In early childhood, children fall more often and hurt, however, fractures of their bones are relatively rare; in older children, fractures of the jaws and bones of the nose occur more often, which is due to a decrease in the layer of subcutaneous tissue in the face, an increase in the impact force when falling (due to increased growth and more rapid movement), a decrease in the elasticity of bones (due to a gradual increase in their inorganic component) a decrease in the resistance of bones to traumatic influences, since in connection with the resorption of milk teeth and the eruption of constants, the bone plate of compact bone is reduced.

To properly assist children with a trauma to the maxillofacial area, it is necessary to take into account its anatomical and topographic features.

Anatomico-physiological and radiological features of the maxillofacial region in children, affecting the nature and outcome of damage

1. Continuous, but spasmodic growth of the children's skeleton and adjacent soft tissues (during periods of temporary growth slowdown, there is an intensive differentiation of tissues and organs and their formation).
2. Significant differences in the anatomical structure of the face and jaws (especially in newborns and young children).
3. Presence on the face of the expressed subcutaneous fat of a large mass (especially the fatty body of the cheek).
4. More superficial, than in adults, the location of the facial nerve, especially between the stylophyllum aperture and the parotid gland.
5. Low location of the parotid duct, its indirect course.
6. The absence of the upper and lower jaw gum closure in newborns and young children, which is caused by underdevelopment of the alveolar processes and prolapse into the gap between the gums of the mucous membrane and the fatty body of the cheek. Over time, with teething, this inconsistency of the jaws is gradually eliminated.
7. Weak development of the upper jaw along the vertical (horizontally it grows according to the rate of development of the base of the skull), as a result of which the oral cavity borders on the bottom wall of the orbit.
8. The relatively weak development of the lower jaw (a kind of physiological microgeny), because of which it does not seem to keep pace with the development of the cerebral part of the skull and the closely connected upper jaw.
9. The flat form of the palate, insignificance of the volume of the oral cavity, flattened and elongated form of the tongue, not yet involved in "labor activity" (breast sucking, sound production).
10. Gradual eruption of infant teeth, beginning in the middle of the first year, and then changing their permanent. Due to this, the volume and height of the alveolar processes gradually increase.
11. Frequent inflammation of the gums in connection with teething (hyperemia, swelling, infiltration), which in themselves can sometimes complicate the trauma.

In addition to the listed anatomical and topographical features, one should also take into account the features of the x-ray characterization of the maxillofacial region in children.

1. The alveolar process of the upper jaw in newborns and children of early childhood is projected on a par with the palatine processes.
2. The rudiments of the upper teeth in infants are located on the roentgenogram directly under the eye sockets, and as the upper jaw grows vertically, they are gradually projected lower.
3. The upper contour of the maxillary sinuses in children under 3 years of age is defined as a narrow slit, and the lower contour is lost against the background of dental rudiments and incised teeth. Up to 8-9 years the bottom of the sinuses is projected at the level of the bottom of the nasal cavity, i.e. The lower edge of the pear-shaped aperture.
4. The size of the shadow of the milk teeth is small, the pulp chamber is relatively large and clearly delineated; enamel, dentin and cement, not having such a density, as in adults, cause a less intense shadow than for permanent teeth. In the region of the apex of the still unformed root of the milk tooth, a defect filled with the remainder of the "growth granuloma", i.e., the dental sac, is clearly visible .
5. Given that the tooth rudiment is capable of moving not only vertically, horizontally, but also around its longitudinal axis, it should not be regarded as a permanent and pathological position found on the roentgenogram.

Concerning the rate of change in the x-ray characterization of teeth in children, EA Abakumova (1955) distinguishes two stages: the unformed apex of the tooth and the uncovered tip. The first is characterized by the fact that the picture clearly shows the parallel walls of the canal of the root of the tooth, which at the apex are thinned and diverge in the form of a funnel, forming a funnel-shaped widening of the already wide opening of the apex of the tooth. In the second stage, the walls of the canal of the tooth root, although completely formed along their length, are not yet closed at the apex, so in such cases a fairly wide opening of the apex of the tooth is clearly visible.

At the age of 6-7 years on the roentgenogram, the child can see both the generation of teeth (20 dairy and 28 permanent), located in 3 rows (the first - the cut dairy, the second - uncut permanent teeth, the third - fangs).

The process of changing dairy teeth is constant at the age of 12-13 years, however, the radiographic image of permanent teeth for a long time differs in the unformed apex of the root of the tooth or with the opening of the apex of the tooth.

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