Fracture of the upper and lower jaw
- What is a fractured jaw?
- Lower jaw fracture
- Upper jaw fracture
- Displaced jaw fracture
- Double fracture of the jaw
- Consequences of a broken jaw
- Jaw fracture treatment
- Jaw fracture nutrition
What is a fractured jaw?
A jaw fracture is an injury to the face, with damage to the integrity of its bones. Occurs when the intensity of the traumatic factor exceeds their strength. This damage is common and can be caused by any kind of injury: strong blows to the face, falling onto a hard surface.
Most often, traumatologists observe a fracture of the articular process, although there are injuries in the area of the angle of the lower jaw, in the middle of the body of the bone of the lower jaw, in the projection of the mental process. The fracture may or may not be complete, open or closed.
The signs of trauma are obvious: a person is not able to open his mouth wide, when he tries to talk he feels pain, the bite changes. Sometimes there may be double vision, numbness of the face, deformation of the cheekbone. The complete list of symptoms will depend on the nature of the injury and where it is located.
Lower jaw fracture
If we talk about a fracture of the lower jaw, then the main types of such an injury should be considered:
- A complete fracture is considered when there is a displacement of fragments, jaw. They can vary in shape and quantity.
- An incomplete fracture is called when no displacement is observed.
- With an open injury, both the mucous membranes of the mouth and the soft tissues of the face are damaged.
- With a closed injury, the bone does not break through adjacent tissues, but remains inside them.
- A comminuted jaw fracture is rare because it requires incredible force to occur. He needs compulsory surgical intervention.
The following symptoms are characteristic of a mandibular fracture:
- Swelling and hemorrhage in the damaged area and the asymmetry of the face caused by these phenomena. The edema is usually severe, with redness and an increase in skin temperature. When the fracture is closed, blood accumulates in the soft tissues and forms a clot. With an open injury, blood more often enters the oral cavity than into the external environment. The greater the blood loss, the larger the vessel was damaged, and the faster first aid is required and the delivery of the victim to a medical facility.
- Sensation of pain when touched. It intensifies when trying to talk, as the periosteum is damaged.
- Displacement of fragments of one degree or another, their mobility.
- Change in bite.
- Increased sensitivity and electrical excitability of teeth.
Depending on where the injury is localized, there are:
- The fracture in the center of the incisors is median.
- The injury between the first and lateral incisors is incisal.
- The canine fracture is located in the canine region.
- The injury to the chin is mental.
- Jaw body trauma, the one located between the 5th and 8th teeth.
- Fracture beyond the 8th tooth is angular.
In the upper third of the jaw - a fracture of the jaw branch.
- Fracture of the base of the condylar process.
- A cervical fracture, that is, one that is located near the process of the jaw (condylar) and a coronary one located near the coronoid process.
First aid, if a person has received a fracture of the lower jaw, is as follows:
- First, the jaw must be fixed. This is done with a bandage. Place an even hard object, such as a ruler, under the teeth. Then the lower jaw is pressed against the upper and immobilized by wrapping it with a bandage. If a person is not conscious, then this cannot be done, since it will be possible to skip swallowing the tongue or getting vomit into the respiratory tract.
- If there is bleeding, then it must be stopped. For this, the wound is pressed or tamped with a clean, preferably sterile material. If you additionally act on the site of injury with cold, then this will help to reduce blood, and also somewhat alleviate the pain symptom.
- It is important to keep the oral cavity clean of possible fillers, in particular: blood clots and vomit.
- Try not to disturb the person before the arrival of the medical team. It is better that he sit, if this is not possible, then you can lay him face down or on his side.
- If you experience severe painful sensations, you need to relieve them. For this, analgin, revalgin, naproxen are used. Since a person with a similar injury will not always be able to swallow a pill, you need to crush it into powder and, dissolving in water, give the victim a drink. Intramuscular injection will be even more effective, but, as a rule, when providing first aid, it rarely succeeds. It will help relieve the condition and cold, which will narrow blood vessels, reduce swelling and pain. But before you apply ice, you need to wrap it in a cloth.
After carrying out these activities, the person must be taken to a medical institution for further therapy by professionals. X-rays are used to diagnose a fracture. Since this is a serious injury, often accompanied by a spinal injury, an additional x-ray of the cervical spine is often prescribed before starting treatment. This is done to exclude damage to the spinal cord. It is also necessary to make sure that the person does not have a concussion and intracavitary cranial bleeding.
Upper jaw fracture
Upper part fractures are less common and account for up to 30% of all cases of jaw damage.
It is classified according to the fracture line:
- The lower line (one lefort), has a direction from the beginning of the pear-shaped aperut to the process of the sphenoid bone (pterygoid).
- The middle line (lefort two) runs along the bones of the nose, with the capture of the bottom of the orbit and the pterygoid process.
- The upper line (lefort three), directed to the cheekbone, through the bones of the nose.
The danger of injury lies in its consequences, which can be expressed in meningitis, concussion and osteomelitis. The higher the break line is, the more often undesirable consequences occur.
Signs of a fracture of the upper jaw, depending on its type:
- If there is a break under the palatine arch, with a fracture of the maxillary sinus and a fracture of the nose, the victim has swelling of the cheeks, nose and lips, with severe bleeding between the lip and teeth.
- If a part of the upper jaw is torn off from the base of the skull, and the fracture line crosses the orbit and the bridge of the nose, then there is numbness in the area under the eyes, and pronounced hematomas in the same place. Blood flows from the nose, it is often impossible to stop the drooling. The sense of smell is either completely absent or significantly impaired.
- If the separation of the jaw is complemented by a fracture of the base of the skull, then the function of vision will be impaired, the mouth will not be able to open. The face will be asymmetrical, hematomas resemble glasses, the eyeballs are down.
Regardless of the type of fracture, a person often experiences nausea, vomiting may occur, the bite will be broken, and pain is pronounced. All other functions are difficult, such as respiratory, chewing and speech. A concussion almost always accompanies this injury.
First aid, in addition to the basic measures in the form of immobilization, anesthesia and stopping bleeding, should be supplemented by the restoration of respiratory function. To do this, it is necessary to remove all foreign objects from the mouth, in particular, fragments of teeth and vomit. If a person is nauseous, then immediately put it on its side, or face down.
Displaced jaw fracture
With a fracture of the jaw, displacement of fragments can be observed in three directions: sagittal, vertical and transversal. They play a decisive role in determining the tactics of treatment and the choice of the apparatus that will be used for their reduction.
The most commonly used splints made of wire, with fixation by the teeth. The bones are collected by the surgeon manually, the patient at this time can be under both local and general anesthesia. Fragment fixation can also be carried out using a nylon vein. Then the jaw is fixed with metal knitting needles or plates, which are superimposed on the outside.
When the fixation is carried out, the patient is recommended to rest, with the implementation of antimicrobial measures.
Double fracture of the jaw
A double jaw fracture is characterized by the fact that it diverges in three directions:
- The middle part of the jaw is directed downward.
- The side ones go inward and upward.
This injury is dangerous in that after receiving it, a person may die from asphyxiation, which will occur as a result of the tongue sinking. Therefore, it is necessary to especially carefully monitor its condition.
Consequences of a broken jaw
In order to avoid the consequences of a jaw fracture, do not self-medicate, but seek medical help as soon as possible. As complications, there are:
- Displacement of one dentition.
- The formation of pronounced gaps between the teeth, which will be located at the site of the fracture.
- Strong displacement of fragments with deformation of the face, due to muscle strength.
- Displacement of teeth with the occurrence of an abnormal bite.
Jaw fracture treatment
Jaw fracture treatment is the prerogative of the doctor. The sooner it is started, the better for the patient.
Basically, the activities are reduced to the following actions:
- Treatment of an existing wound, its disinfection.
- If there is a displacement of the nasal septum, then its alignment.
- Comparison of possible fragments, and alignment of whole bones.
- Reliable fixation of the jaw with a special splint. It must be completely immobilized. A splint is applied for up to 1.5 months, until the jaw bones heal. Sometimes doctors, through surgery, implant metal plates into the jaw. They are fixed with screws.
- Anti-inflammatory therapy.
When the main course is completed and the splint is removed, then it will be possible to proceed to the rehabilitation stage. It should be aimed at restoring several vital functions: chewing, swallowing, speech, vision.
Jaw fracture splinting
Splinting is one of the main treatments for jaw injury. The procedure is the fixation of fragments using a construction consisting of plastic or wire.
The type of splinting depends on the nature of the injury:
- It is applied on one side, when the fracture is unilateral, for this, a wire is used that fixes the damaged areas.
- It is applied on both sides, while the structure has a more rigid base. In addition, there are hooks and rings.
- When both the upper and lower jaws are broken and there is a displacement, then it is advisable to use a two-jaw splint. For fixation, copper wire is used, with fastening by the teeth and fixing the jaws with rings.
If the plastic version is used, then it should be placed under the chin and fixed with a bandage around the head. But this method is indicated in the case when assistance must be provided in a short time in order to deliver the victim to the traumatology department.
When the fracture is complicated and there is a significant displacement of the fragments, then before splinting, it is necessary to compare them.
On the subject: 12 popular ways for home treatment
Jaw fracture nutrition
Correction of the diet for such injuries is a necessity. This is due to the fact that during intensive therapy and during recovery, the jaws will be in a fixed state, which means that a person will not be able to fully control them.
The minimum bone healing time is a month, which means that during this time the victim will have to consume only liquid food. Its consistency should be equal to that of sour cream. Therefore, it is advisable to feed the patient with broths and soups, vegetables and fruits passed through a meat grinder or blender, boiled cereals. It is imperative to include milk drinks in the menu.
Learn more: Do's and don'ts for a fracture?
When the tire is removed, do not immediately switch to solid food. It must be introduced gradually. This is important not only for the normal restoration of the functioning of the jaw, but also for the prevention of malfunctions in the digestive tract.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.