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Bilateral fracture of the lateral part of the body of the mandible
05-09-2009
Character displacement of fragments is largely determined by the location of the fracture plane and the direction of its slant, depending on the direction and force of impact. In the case of passing the fracture line between the premolar vertically relative to the sagittal axis of the central otlomok could significantly down-down and shift backwards, bend over the alveolar part of the forward and lateral fragments may climb up. Alveolar part of their turns inward, and the base body of the mandible - outwards. Teeth are not antagoniruyut secondary fragments with teeth of the upper jaw. Dentition it can be tilted forward so that the visible surface of the cutting bits cutting tools. On the lateral teeth, bone fragments in contact with the buccal knolls knolls palatal teeth-antagonists. The mechanism of displacement of bone fragments is the same as that of a bilateral fracture in the chin department. Clinically fragments are active, marked discontinuities mucosa of the alveolar process. If the plane of the fracture is oblique direction inwards in front and behind (on the outside of a compact plate fracture line is located closer to the midline than on the inside), and fragments may be offset in the horizontal plane, ie napolzanie fragments to each other on the surface of the bone fracture. Offset secondary fragments backwards to be more pronounced, and the reverse side of the alveolar bone fragments inside - the more significant. This creates prerequisites for the dislocation asphyxia.
In the case of the location of the bevel plane fracture of the posterior lateral bone fragments anteriorly and inward (on the outside of a compact plate fracture line is located posteriorly, and on the inside - anterior to the midline), the average otlomok can be kept side by retrusion. Moreover, with a significant lateral displacement of bone fragments to the midline and turning them into part of the alveolar perhaps even pushing the average fragments anteriorly. Dental arch and considerably narrowed.
At the bilateral mandibular fractures in the middle otlomok angles, being very large and heavy, lacking connection with the muscle lifting the lower jaw, and prone traction of muscles, lowering the lower jaw considerably shifted down and back, more than in the previous case. In these patients, when expressed by the displacement of bone fragments may be the tongue, especially in the horizontal position of the body of the patient. The branches of the lower jaw are displaced in accordance with the laid down laws, and depending on the location and bevel plane fracture that detailed in the section on mandibular fractures in the corner.
The patient complains of pain and swelling of soft tissues in the corners of the lower jaw, the sharp malocclusion, inability to close his teeth and his lips, numbness of the skin of the chin and lower lip entire, sharply painful swallowing, excessive salivation, and sometimes the selection of blood from his mouth.
On examination, there has been substantial traumatic edema of the lower third of the face, especially pronounced in the corners of the lower jaw. Lips are often difficult to merge or not merge at all, and the mouth stands viscous saliva, sometimes tinged with blood. In such cases, often in considerable bleeding from the fracture gap and surrounding soft tissue soaked with blood. As evidenced «bruises» on the skin.
When the feeling of the mandible after lung prodavli-tion edematous tissues can feel the sharp protrusions or step into the angle of the mandible. The skin of the chin and lower lip is defined by loss of pain sensitivity. Even slight pressure on the chin from front to back (symptom load) causes considerable pain in the field change.
Inspection of the mouth allows you to set the threshold of a material breach of the bite. If a crack fracture is located between the second and third molars, the latter will be in contact with the antagonists, if fracture occurred behind the wisdom teeth, smaller fragments move forward, upward and inward. When exposing the surface of bone fracture. Sometimes the shift is so great that these fragments run into the upper molars. Average otlomok, ie whole body of the mandible together with the muscles attach to it and the language that has more weight, significantly shifted downwards. Muscle contraction, lowering the lower jaw, not only contributes to this shift, but also upsets the frontal division of the fragments anteriorly. At the same time it lifted the rear end, and the teeth are inclined forward, so that they become visible surface of the front cutting teeth. The distance between the front teeth on both jaws can sometimes reach up to 2 cm
The mucous membrane of the lower lip and gums with the vestibular side throughout devoid of pain sensitivity. In the lower arch of the arches of the mouth may arise from saliva, stained with blood, or blood clots. The patient had difficulty opening his mouth because of severe pain. In the field of fracture depends on the magnitude of the displacement of bone fragments may appear swollen mucous membranes, bleeding in her, often extending to the anterior palatal arc, and sometimes found with a lacerated wound oozing blood. Even a day later, when a wound has stopped, the language can see traces of blood. Palpation for painful fractures. Able to feel the sharp edges and steps. Capturing the fingers of his right hand front Front jaw for the teeth and chin, gently shake the average otlomok, and fingers of his left hand placed on the place of alleged fractures, feel the movement of bone fragments. If there is a wound, you can see the movement of bone fragments.
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