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Bilateral fracture in the chin department
05-09-2009
In clinical practice, such a fracture is quite rare. Fracture line at the same place in the canines. By the middle fragments (smaller) are attached only to the muscles that drive the lower jaw, which is responsible for its shift downwards and backwards, if the oblique angle of the fracture gap in the front is directed inwards and backwards, ie line fracture on the outer compact disc is closer, and on the interior - more towards the middle line. Alveolar part with the teeth on that fragments bends outwards. If the above inverse relationship, the displacement of the average posterior fragments can not happen, because it will be retained angled side (large) fragments. Moreover, shifting to the midline large fragments may in this case to push the average otlomok front. However, to offset it down barriers will not.
If the fracture line runs at right angles to the longitudinal axis of the mandible, and external and internal compact discs are arranged at equal distance from the midline, middle otlomok may infringe upon between the two lateral and posterior displacement of it will not happen. When the removal of smaller fragments of the tongue posteriorly possible and the appearance of signs of respiratory difficulties due to the pressure on the tongue epiglottis (dislocation asphyxia). Both sides fragments will move to the center line due to the reduction of the lateral, to a lesser extent - the medial pterygoid muscles on each fragment. Alveolar part of their lean inward (oral), and the lower edge of the body and the angle of the mandible - outward force due to the prevalence of chewing muscles on the medial wing-reduction and jaw-hyoid muscles. Chewing, temporal and medial pterygoid muscles will turn these fragments up to papulose contact with the teeth-antagonists. On average, fragments of teeth in contact.
Patients complain of pain in the jaw and inability to bite off food because of lack of contact the front of teeth. When opening the mouth, the pain is greatly enhanced. Defined swelling and a hematoma of the lower lip, the chin and anterior Wharton area. The right and left of the midline palpable bony protrusions on the base of the body of the mandible within the boundaries of the chin area. Symptom burden at the pressure on the corners of the mandible positive on both sides of the midline. There is a vast area of hemorrhage in the tissue of the lower body of the arches of the mouth and hyoid area within the small molars. Language somewhat elevated. Perhaps the offset tongue posteriorly. When fractures of the localization of frequent ruptures of the alveolar mucosa, the severity and extent of which depends largely on the impact force and deflection of fragments. Clearly identified the displacement of all three fragments when checking a symptom of their mobility.
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