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Clinical signs of mandibular fractures
05-09-2009
Based on the requirements of clinical practice, the body of the mandible conventionally divided into chin (between the moon-kami 3 1 3), the side sections (3 | 3 to 7 | 7), region of the angle (between 8 7 | 7 8 or recess 8 | 8 ).
When fractures of the mandible complaints of patients are diverse and largely dependent on the localization of the fracture and its nature. Typically, patients concerned about the swelling in admaxillary tissues, pain in a certain sector of the mandible, increasing when opening and closing the mouth, poor interdigitation. Biting and chewing food, especially hard, sharply painful, sometimes impossible. Some patients noted numbness of the skin of the chin and lower lip. May cause dizziness, headache, nausea. The physician must determine when, where and under what circumstances were injured. Are there any features characteristic of a skull fracture, brain damage. On clinical grounds (maintenance or lack of awareness, contact the patient, the nature of respiration, heart rate, blood pressure, muscular defense or pain during palpation of the abdominal cavity) evaluate the overall condition of the patient. Necessary to exclude traumatic injuries of other anatomical areas. On examination, the person is often determined by a violation of its configuration due to swelling of soft tissues, hematoma, displacement of the chin to the side of the midline. On the skin of the face may be scratches, bruises, wounds. Important data can be identified by palpation contours of the mandible, which is carried out in symmetrical points.
The doctor moves the fingers on the trailing edge of the branches of the jaw and the base of her body in the direction of condylar the appendix to the midline, or vice versa. This can be determined by the finger bone protrusion, bone defect or painful point often in the most severe soft tissue swelling or hematoma. Following this, check the symptoms of stress (pain symptom) - reveal the painful point corresponding to the place of the alleged change. In the case of fracture of the mandible was some movement of bone fragments under the influence of the attached physician at a distance from the fracture is accompanied by the efforts of moderate pain at the site of fracture. Previously the patient explain the essence of the ongoing investigation. One finger at the patient shows a projection of pain points on the skin. It usually coincides with the previously identified bone protrusion and swelling (hematoma) in the field of soft tissue. This symptom check as follows: A. physician records on the chin section of the body of the mandible patient thumb and index fingers of his right hand and produces a moderate pressure from front to back. It is possible to establish the intended line of fracture in the branches and the body of the mandible;
▲ doctor has his fingers on the outer surface of the angle of the mandible on the left and right and produces a pressure toward the midline (toward each other) - both show a fracture in the body of the mandible;
▲ physician moderately presses his thumbs up at the bottom edge of the angle of the jaw on both sides (toward the head of the lower jaw). This technique determines fracture in the branches of the mandible.
This symptom is very important for topical diagnosis of fracture, especially in those cases when you can not probe the bone step (no displacement of bone fragments, expressed traumatic edema, inflammatory infiltration, etc.).
Not using X-rays, clinical technique can determine the direction and configuration of the fracture gap. This move II finger along the base of the jaw and every 5 mm have a slight pressure on the bone. In the most painful point advance proinstruktiruemy patient signaled voice. Specified location physician designates paint. Slide your finger up about 1 cm, repeat the procedure for examination and also mark the place of greatest pain. Raising his finger still at 1 cm, conduct a similar survey. To improve the accuracy of the study procedure is repeated. Combining the three identified points are curve corresponding to the direction and configuration of the fracture gap.
With a sharp needle can determine a violation of pain sensitivity of the skin of the lower lip and chin on the left and right. If a ruptured inferior alveolar nerve, then on the side of a fracture pain completely absent.
To exclude or confirm the condylar fracture of the appendix should determine the range of motion of his head in the glenoid cavity. This physician II or V finger enters the outer ear canal from both sides and pressed it to the front wall of the passage. When shifting the jaw down and to the side according to palpation can judge the presence or absence of synchrony and the adequacy of the amplitude of motion condylar head spike. In the case of a fracture myschel-arms sprouts move the head of the mandible can be absent or its amplitude will be significantly less than on the healthy side. The data can be confirmed palpiruya head of the mandible trestle in front of the ear. Then inspect the oral cavity. The patient was offered to open and close the mouth. Reduced range of motion of the lower jaw may be a sign of change, because when you open your mouth fully appear expressed pain due to displacement of bone fragments. When opening the mouth, the chin is often shifted away from the midline (in the direction of the fracture).
An examination of the mouth especially pay attention to the contact dentitions. The most common bite is broken. When unilateral fracture usually formed raznovelikie fragments of the mandible. At large fragments are attached nearly all the muscles that drive the jaw. By his strength they surpass the muscles that are asking this otlomok. Besides affecting the gravity of large fragments and the bottom of the mouth muscles that attach to it. Therefore, greater otlomok always moves down, and the youngest - up. It is for this reason, small fragments of teeth in contact with the antagonists, and fragments of larger contact of teeth with antagonists are missing from almost all over, except for molars. It may be painful percussion of the tooth posterior to the fracture gap.
In the case of a fracture within the tooth row in anticipation of the mouth is determined by the hematoma, which is located to the vestibular and lingual sides of the alveolar part. When injuries to the soft tissue is formed only from the vestibular side. Localization of hematoma in the mouth coincides with the localization of admaxillary soft tissues and corresponds to the place of fracture. Sometimes you can find, as already mentioned above, ragged wound of the mucous membrane of the alveolar part, which is distributed in the interdental gap. In this case, with some confidence can be assumed that the fracture line passes exactly between the teeth. If the gap mucosa not, correlate the fracture line with teeth can be according to the percussion. Usually percussion of the tooth located posterior to the fracture gap, usually painful. Can respond to the percussion and tooth, located anterior to the fracture gap. Reliable clinical sign, allowing not only to establish the fracture, but also clarified its localization, is a symptom of the mobility of fragments of the jaw.
Fracture within the dentition determined as follows: II finger of his right hand have the teeth of one of the alleged fragments, II finger of his left hand - on the teeth the other fragments. The thumbs of the skin is fixed body of the mandible in its lower edge, ie bottom. By making a slight movement in different directions (up and down, back and forth, «at the break»), you can set the altitude change the location of the adjacent teeth, an increase in interdental spaces, or the wounds of the mucous membrane of the alveolar part. This is due to the displacement of bone fragments under the influence of the efforts of a doctor. In the case of a fracture in the angle of the mandible is more convenient to record a smaller otlomok not within the tooth (third molar, if it exists), and in the branches of the lower jaw, placing the I finger of his left hand from the mouth at its forefront, and the rest of the fingers ( from the skin) - on the back edge. Fingers of right hand grasp the big otlomok and shift it as described above.
Clinical assumptions should be confirmed by X-ray study. X-rays allow to specify the location and nature of the fracture, the severity of displacement of bone fragments and the presence of bone fragments, the ratio of the roots of teeth to crack fracture. It should take two x-rays - in the direct and lateral projections. If possible, make Orthopantomogram, where you can track changes throughout the lower jaw, caused by a traumatic impact. When condylar fractures of the appendix provides valuable additional information tomogram temporomandibular joint. Based on clinical and radiological data doctor makes the diagnosis and determine a plan of treatment.
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