Non-fire damage to the maxillofacial area in elderly and senile people

Emergency medical aid for elderly and elderly patients should be provided by highly qualified maxillofacial surgeons, who can quickly understand the general condition of the victim and decide the need for an intervention depending on the presence of concomitant diseases : atherosclerosis, diabetes, cardiosclerosis, arterial hypertension, emphysema and other chronic diseases.

This task is further complicated by the fact that it is often very difficult to collect an anamnesis for victims of this age, since memory and self-control are weakened, pain sensitivity and temperature reaction to trauma are reduced. All this makes it difficult to establish a diagnosis.

[1], [2], [3], [4], [5]

Symptoms of facial injuries

Reduction of reserve and adaptive capacity, disturbance of the organism's reactivity in the affected elderly and senile age are caused by age-related changes in the structure and function of the cells of organs and systems regulating metabolic processes, as well as by the low level of material and pensions. All this is reflected in the clinical symptoms, course and outcome of trauma in the maxillofacial region. For example, in ruptured-bruised wounds, the formation of extensive hematomas is often observed, due to a decrease in the elasticity of the vessels (sclerotic changes) and an increase in their vulnerability.

The peculiarities of the course of injuries of the maxillofacial region in elderly and senile patients are also the slow resolution of the blood flowing under the skin and the slowing down of the consolidation of jaw fragments due to the decreased regenerative capacity of the bone. However, due to the lack of teeth, fractures of the lower jaw can remain closed, since the mucous membrane of the gum with the periosteum comparatively easily peels off. In such cases, the fracture is determined (by eye and palpation) in the form of a step - like deformation of the toothless gum. If the closed fracture does not become infected, the patient does not develop such possible complications as traumatic osteomyelitis, abscess or phlegmon in surrounding tissues.

However, due to the lack of teeth and the symptom of bite without radiography, it is difficult to diagnose a fracture if it did not cause a significant displacement of the fragments.

When treating jaw fractures in these patients, it is necessary to take into account the presence of concomitant. diseases (circulatory, digestive, respiratory and endocrine systems, periodontal and t. D.), the absence and the instability of existing teeth, the degree of atrophy of the alveolar ridge and offset fragments jaw, the presence in the patient denture (able to perform the role of the tire), the degree of severity osteosclerosis , absence of the alveolar process and partial atrophy of the jaw body, etc.

Treatment of fractures of the lower jaw

Overlapping of tooth wire tires with fractures of the lower jaw in elderly and senile patients is not always possible due to lack or instability of the teeth.

Indications for the removal of teeth from the fracture of the fracture in this contingent of patients should be significantly expanded to prevent "sucking" of infection into the bone marrow from the oral cavity. For example, the absolute indication for the removal of the tooth from the fracture is the presence of periodontitis, pulpitis.

If the displacement of the fragments of the toothless jaw is insignificant (no more than 2-3 mm), and the patient has a removable denture, it can be used as a tire, imposing an extra rigid bandage bandage. To facilitate nutrition, it is possible to connect the upper and lower dentures with a quick-hardening plastic, and in the incisal zone of this "block" drill a hole to facilitate feeding (from an appetizer, a special spoon).

In this case, there is no need to achieve an ideally accurate reposition and fixation of fragments of the toothless jaw, as in the case of the presence of teeth (for an accurate restoration of the occlusion). Inaccuracy in the comparison of toothless fragments, even by 2-3 mm, is not critical for bite, as it can be leveled by the subsequent manufacture of a removable denture.

If toothless fragments are displaced by more than 2-3 mm, it is possible to compare and hold them in the correct position with the help of MM Vankevich's bus in combination with a sling-like bandage. If this method is unsuccessful, osteosynthesis is performed, taking into account the following circumstances.

1. With atrophy of the alveolar process and part of the jawbone against a background of very dense bone tissue (due to sclerosis), it is technically difficult to apply a bone suture and in case of osteosynthesis damage to the neurovascular bundle is possible ; Therefore, the formation of holes, the imposition of the framework or the introduction of knitting need to be done with the utmost care.
2. In cases of obliquely fractured body of the jaw, osteosynthesis should be resorted to by means of a suture seam.
3. The use of osteochondral devices for repositioning and compression osteosynthesis in this category of victims is not always possible, because delayed consolidation requires a longer action of the jaws or spokes on the compact and spongy parts of the bone than in young people; this entails the resorption of the bone under the clamps or around the spokes, their loosening.
4. After the imposition of the immobilizing device (tire, osteosynthesis in one form or another), it is necessary to stimulate the fusion of jaw fragments, using the recommendations of the therapist, endocrinologist, neuropathologist.
5. If the victim has periodontitis, it is preferable to use plastic kappa, as the toothbrush wires and interdental ligatures injure the gum, exacerbating the course of periodontitis; his treatment should be carried out in parallel with the treatment of a fracture in order to accelerate the consolidation, which, with periodontitis, slows down due to the presence of dystrophic and inflammatory changes in the area of trauma.

Yu. F. Grigorchuk, GP Ruzin and others (1997) developed and successfully tested a combined tire for the treatment of jaw fractures with significant defects in dentition in elderly patients.

Treatment of fractures of the upper jaw

For the treatment of upper jaw fractures in elderly and senile people, plastic tires with extraoral rods - "whiskers", fixed to a plaster bandage or a standard cloth or bandage cap can be used. If the survivor retains the upper removable prosthesis, it can be used as a tire by welding to him (fast-hardening plastic) extraoral rods "whiskers" or by connecting this prosthesis with a lower removable prosthesis with the same fast-hardening plastic. Such improvised bus Port complemented chin sling bandage.

With regard to osteosynthesis, which suspends the upper jaw (according to the type of operation Adams, Federspil, T. Chernyatina, etc.), then, in my opinion, this type of immobilization in patients of elderly and senile age should not be applied to them additional injury.