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Classification of fractures of the mandible
05-09-2009
There are numerous classification neognestrelnyh fractures of the mandible. Conveniently enough for practical purposes is, in our opinion, the classification proposed by BD Kabakov, and VA Malyshev.
Classification of fractures of the mandible on BD Kabakov and VA Malyshev
A. For localization.
I. Fractures body of the mandible:
• the presence of the tooth in the fracture gap;
• in the absence of teeth in the fracture gap.
II. Fractures of the branches of the jaw:
• own branch;
• coronoid process;
• condylar sprouts: base, neck, head.
B. The nature of the fracture.
I. No displacement of bone fragments, with displacement of bone fragments. P. Linear, comminuted.
Fracture of the mandible may occur because of the impact force, which exceeds the physical capacity of bone tissue. This change is called traumatic. However, the jaw can break down and a force no greater than the physiological (eg, chewing food). This usually happens in the case of a significant decrease in the strength of bone tissue due to its thinning in certain diseases (malignant tumor, cystic tumor, dysplasia, chronic osteomyelitis, etc.). In this situation, defined as a pathological fracture;
The change may be in the place of the applied force (direct) or at some distance from this place and even on the opposite side (indirect or reflected). . Often occur simultaneously direct and indirect fractures, especially when the location of fracture lines on both sides of the midline. Depending on the direction of crack fracture and its forms fractures are divided into longitudinal, transverse, oblique, zigzag. In addition, they can be large and melkooskolchatymi. By number of fracture lines emit single, double (two fractures on one side of the jaw), bilateral (one fracture on different sides of the jaw), multiple fractures. They can be located on one side of the jaw (unilateral) or both sides (bilateral). According to the literature, single fractures are more common than double, multiple - less than the single and double.
From the clinical considerations of mandibular body fractures are subdivided into fractures chin division (ranging from canine to canine), the lateral division (ranging from canine to second molar); field angle (the section between the second and the third hole of the third molars and molars). In the angle fracture often goes through the eighth hole of the tooth.
Fractures of the body of the mandible within the dentition is always open. This is due to the fact that the mucous membrane of the alveolar part of the fixed and displacement of bone fragments can be torn along with the periosteum. Slot fracture at the same time will be communicated with the oral cavity. The change can take place and through the hole of the tooth, which is accompanied by periodontal injury, and sometimes dislocated or fractured tooth. This in turn determines the message of the bone wounds of the oral cavity through the periodontal crevice. In the frontal section of chin department fractures observed in 4,9%, in the canine - in 12,9%, premolars - at 11,8%, the angle of the jaw - in 37,4% of cases. Thus, the share of the body of the mandible accounted for 67% of the fractures. In the area of branch fractures account for 33%: condylar processus - 23,3%, actually a branch of - 6,1%, coronary process - 3,6% [Lurie, TM, 1975]. At the turn of condylar fractures of the appendix are distinguished, neck and head it. Fracture of the zygomatic arch is sometimes accompanied by a fracture of coronoid process. Fractures of the branches of the mandible are usually closed, but in the case of rupture of surrounding bone, soft tissue and skin may be open. Most often it is observed in the case of injury or accident.
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Articles for theme "fracture of the jaw":
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03-09-2009
When combined craniocerebral trauma (CoN ™) as a result of mechanical impact damage occur simultaneously, the facial skeleton, bones of the cranial trauma and brain. Possible closed craniocerebral trauma (CCT), without damage to the bones of the skull, combined with fractures of the face. Fractures of facial bones, combined with head injury is diagnosed in 6.3% [Fraerman AP, YE Gelman, 1977], or 7,5% of victims [Lebedev VV, 1980]. Enough high frequency of craniofacial injuries caused not only by their anatomical proximity, but also the fact that some of the facial bones of the skeleton are involved in the formation of the skull base.
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03-09-2009
In practice, the surgeon-dentist found unilateral or sagittal fractures of the upper jaw. They tend to occur when the injuring object has sharp edges and the force is applied downward in an oblique direction, mainly at the side of a single department or zone of the upper jaw of the upper lip with one hand. It breaks down the body of the upper jaw with a wing-offshoot sphenoid bone of the party or without it. In the area of the anterior and infratemporal walls (tuber) of the upper jaw fracture line passes above the bottom of the maxillary sinus, and in the hard palate - lateral of the median suture.
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03-09-2009
Assume that the left is fractured along the middle and the right - the bottom type. Fracture line runs from the junction point of the frontal sprouts upper jaw with the nasal part of frontal bone on the left, extends on the inner wall of the orbit and beyond - in accordance with a fracture in Le Fort II, but with only one left. Nasal septum is broken at different levels depending on the transmission line fracture of nasal bones. The right line of the fracture begins at the pear-shaped holes, and further extends the type characteristic of a fracture in Le Fort III (ris.
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03-09-2009
For convenience of presentation, suppose that the left fissure fracture runs along the upper type, and the right - on average. The line is a fracture in the frontal connections sprouts upper jaw with the nasal part of frontal bone. Left it extends characteristic of Le Fort I (ris.3.12), and the right - for the Le Fort II (see the relevant section, as outlined above). Patients may complain of pain in the upper jaw, with the increasing interdigitation or attempted biting or chewing food, improper closing of the teeth, foreign body sensation in the throat, choke and retch, insufficient opening of the mouth, double vision.
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03-09-2009
Fracture of the upper jaw of Le Fort III (bottom type)
Fracture line passes through the edge of pear-shaped holes, backwards and slightly above the bottom of the maxillary sinus. It crosses skuloalveolyarny ridge, goes through the hill of the upper jaw and extends to the lower third of the pterygium sprouts sphenoid bone (see 3.10). Sometimes pterygoid bone is not broken off with the upper jaw, and is separated from her mound at their place of seam. In these cases, pressure on the hook pterygium the process, as described above, is not accompanied by pain and may complicate diagnosis.
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