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Fracture of the upper jaw of Le Fort II (medium type) on the one hand, and Le Fort III (bottom type) on the other
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.3.14).
Patients may complain of pain in the upper jaw, with the increasing interdigitation and try chewing food; wrong interdigitation, foreign body sensation in the throat, retch, numbness, skin infraorbital area, lower eyelid and skin of the wing of the nasal septum on the left; numbness of the teeth and the mucous membrane of the gums within these teeth on the right, numbness, or reduced pain sensitivity in the area of incisors, canines and premolars on the left and the gum tissue within these teeth double vision when looking sideways.
On examination, determined by the deformation of the face due to swelling of tissues: left - mainly in the infraorbital, zygomatic, buccal area, on the right - in the buccal area and upper lip. Left can be bleeding into the tissues infraorbital area, upper and lower eyelids, inner corner of the orbit, the root of the nose, conjunctiva and sclera of the eyeball. Pronounced hemorrhage in retrobulbarno fiber - exophthalmos. However, possible unilateral enophthalmos on the left, if the fracture has passed through the slit of the zygomatic bone and broke off all the bottom of the orbit. There may be abrasions, wounds, bruises of different localization both the left and right.
On palpation the left infraorbital region and the root of the nose can determine bone protrusion or zapadenie tissues. In some patients, the fracture line is determined (palpable bony step) in the lower-outside corner of the orbit, ie it passes through the zygoma and the bottom of the orbit and, together with the upper jaw and eyeball moves down. This leads to a violation of alignment of the eyeballs, which is manifested in patients with diplopia. When applying painful stimuli needle there is a lack or reduction of pain sensitivity of skin infraorbital area, lower eyelid skin of the wing and the nasal septum. When the displacement of bone fragments posteriorly possible unilateral flattening of the face (left), but less pronounced than in symmetric turn of the average type. On the upper arch of the arches of the mouth is bleeding within the limits of all the teeth on the right and left molars. The bite usually open, but may be direct. Pain sensitivity of the mucous membrane Gums reduced or absent in the area of all the teeth and right incisors, canines and premolars on the left. Palpation determined bone step within the infratemporal and the front wall of the upper jaw and right infratemporal wall of the left. Especially it can be clearly felt in the area skuloalveolyarnogo crest of both the left and right. Soft palate somewhat shifted posteriorly in the upper sections krylochelyustnyh folds (left and right) may be hemorrhage. When you try to offset the bone fragment is determined by the mobility of skuloalveolyarnogo crest on the left and right and left infraorbital region and the root of the nose. In addition, skinfold can be formed in the root of the nose and skin of partitioning it. Symptom load positive and manifests painful sensations on the left and right sides are not symmetrical, and in accordance with the location of the fracture gap. For percussion of teeth, both the left and right, there is a dull sound. With this type of fracture are frequent signs of a skull fracture and brain injury.
On radiographs of the upper jaw in front poluaksialnoy projection shows decrease the transparency of the maxillary sinuses on the left and right, violations of the integrity skuloalveolyarnogo ridge on both sides and the left infraorbital region.
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Articles for theme "fracture of the jaw":
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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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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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