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Fracture of the upper jaw of Le Fort I on one hand and Le Fort II on the other
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. Right may numb the skin of the lower eyelid, infraorbital area, a wing of the nose, incisors, canines, premolars and gingival mucosa to the vestibular side of these teeth. Left - numbness of the skin of the upper eyelid, forehead, external and internal angle of the optic fissure (in case of damage to the orbital nerve in the verhneglaznichnoy gap).
Person deformed due to swelling and subcutaneous emphysema on the right. When transferring the patient in the upright position readily visible process of lengthening the person, the expansion of the optic fissure left enophthalmos (only left) becomes more pronounced. When transferring a patient in a horizontal position visible shortening and flattening of the face. Possible bilateral exophthalmos due to hemorrhage in retrobulbarno fiber. Determined hemorrhage in periorbital soft tissue zone: left - typical for the upper, right - for the average type (ris.3.13). When interdigitation eyeball on the left can be shifted upward, Ophthalmic slit - taper. Double vision it may decrease, in the root of the nose appears skinfold. On palpation of the facial skeleton is determined by bone protrusion of verhnenaruzhnogo angle of the orbit and zygomatic arch on the left and right infraorbital region, as well as bone projection at the bow of the frontal bone, or you feel provalivaniya tissues under the finger in this area (with the express removal of bone fragments). In determining the symptom of mobility of the bone fragments under the fingers of your left hand can determine the mobility ( «stirring») otlomlennogo fragment in the right infraorbital region, verhnenaruzhnogo angle of the orbit and zygomatic arch on the left, as well as the root of the nose. Opening mouth somewhat limited.
Open bite (or direct). In the absence of displacement ratio of teeth can not be changed. Right to transition the crease of the upper jaw within the premolars and molars clearly visible hemorrhage, extending to the mucous membrane of the cheek. On palpation anterior and infratemporal surfaces of the body determine the upper jaw bone protrusion in skuloalveolyarnogo ridge on the right and behind him. To the left of these features can be found. Reduced pain sensitivity mucosa of the gums, respectively, the front group of teeth on the right. In the upper division krylochelyustnoy folds on the right can be bleeding, but the left side it is not. Soft palate is displaced posteriorly, and a little tongue can touch the back wall of the pharynx or tongue. For percussion teeth is determined by the low percussion sound.
X-rays - Reduced transparency maxillary sinus, destroying the integrity of bone tissue: the left - at the root of the nose, verhnenaruzhnogo edge of orbit and zygomatic arch, right - in the infraorbital region and the cheekbones, the alveolar ridge. Under this option, a fracture of the upper jaw can fracture at the base of the skull with no less likely than with a symmetric turn of the upper or middle type. In this case, the radiograph may be visible to a step or a fracture line, located in the Turkish saddle, or more anteriorly from it.
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Articles for theme "fracture of the jaw":
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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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03-09-2009
Fracture line passes through the place of the frontal sprouts upper jaw with the nasal part of frontal bone on the inner wall of the orbit to the infraorbital fissure. Further extends anteriorly on the lower wall of the orbit to the infraorbital region, crossing his or skuloverhnechelyust Board the seam, or close to it. Then comes down and backwards on the front surface of the upper jaw, extending to the pterygoid bone sphenoid bone (sometimes on the border of the upper and middle third) (ris.3.7).
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03-09-2009
The line is a fracture at the junction of the frontal sprouts upper jaw with the nasal part of frontal bone in her lattice notch. The front edge of the latter is connected to the nasal bones, and the rear - with the front edge of the plate perforated ethmoid bone, which is involved in the formation of the skull base in front of his pit. Rear bow sections of the frontal bone contains cells in contact with the ethmoid bone and forming the roof of its cells. Then the fracture line passes through the inner wall of the eye socket to the junction of the upper-and infraorbital slits, passes to the outer wall of the orbit, extending to her up and anterior to verhnenaruzhnogo its corner.
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