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Fracture of the upper jaw of Le Fort III (bottom type)
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. Therefore, we believe that a more informative pressure on the hard palate or molars. However, it should be remembered that in the latter case, this feature can be determined and when the turn of the lateral part of the alveolar process of maxilla. Rarely fracture line ends at the third molars and does not pass on the pterygoid bone. At the turn of the lower type of breaking the nasal septum in the horizontal plane (in the anteroposterior direction), broken off the bottom of the nose and maxillary sinuses. Most are torn all or part of the nerve Stalks going deep in the bony wall of the upper jaw and taking part in the formation of the upper dental plexus, which is manifested in the clinical features of this type of fracture violation of pain sensitivity in the area of innervated tissues. Sometimes there is a fracture of the upper jaw, with the fracture line must pass through the hard palate in the sagittal plane.
At the bottom type of fracture, patients may complain of diffuse pain in the upper jaw, with the increasing interdigitation or try chewing of food, inability to bite the food front teeth; «numb» of all the teeth and the mucous membrane of the gums, often the mucous membrane of hard and soft palate (if injured nerves going to the pterygopalatine canal); wrong interdigitation; labored nasal breathing, sensation of a foreign body in the throat, choke, and sometimes periodic retch (due to the displacement of the soft palate posteriorly and a little tongue irritation of mucous membrane posterior wall of the pharynx, violations of the innervation of the soft palate ).
Configuration of the face is altered due to swelling of soft tissues of the lower third of the face (upper lip, cheek, malar region), hemorrhage, and sometimes subcutaneous emphysema. Nasolabial folds smoothed. On the skin of the face may be scratches, bruises, torn-contused wound. In the event of a significant shift of fragments down the vertical position of the patient lengthens lower part of the face. Sometimes it may be noted movement of the skin of the nasal septum from the horizontal to the obliquity of the bone due to displacement of the nasal septum (and its associated soft tissues), together with a broken upper jaw down. But set this clinical sign is difficult because of the severe deformation of the tissues of the upper lip and nose due to swelling.
When interdigitation at the base of the nasal septum is formed barely visible skinfold, and the skin of the nasal septum has a tendency to move up. In the upper arch of the arches of the mouth is determined by bleeding all along the tooth row, extending to the buccal region and upper lip. Bite violated in accordance with the degree of displacement of fragments backwards and downwards. It may be open (usually), direct, progenicheskim (if pre-injury was orthognathic), can not change if otlomok not shifted. In the oral cavity often can be noted hemorrhage in the upper Pterygopalatine mandibular fold, while unilateral fracture - on the mucous membrane of the hard palate. Seems an elongated soft palate and uvula can relate a little tongue or posterior wall of the pharynx.
On palpation anterior and infratemporal surfaces of the body of the upper jaw bone can be defined step (projection) within the visible hemorrhage, ie around the perimeter of the body of the mandible. However, with a slight displacement of fragments in a situation where periosteum is not broken along the fracture gap, and with the express swelling and bruising palpated step can be difficult. More significantly, this feature can be defined in skuloalveolyarnogo crest as its profile well konturiruet, and it extends slightly towards the body of the jaw. Therefore, even with a slight displacement of the bone fragments can not palpated protrusion in this place, despite the above circumstances. Pain symptom burden positive: pressure on the pterygoid bone sphenoid bone on both sides, the last molars or the hard palate accompanied by painful sensations along the lines of fracture. Sometimes, while the frontal part of fragments fall down. This feature is of great diagnostic value, since it is positive even in the absence of clearly defined bony protrusions in the typical places.
To assess the pathologic mobility of fragments should be fingers of his right hand gently (no more than 1-2 mm) several times to remove (shake) the alleged otlomok back and forth, applying effort to the front unit of the alveolar process. Index finger and thumb of his left hand, left and right in the zone of the alleged line of fracture (better in skuloalveolyarnyh ridges, where the bone is palpated projection), we can determine the mobility of fragments of simultaneous displacement ( «stirring») to the left and right. At the same time on the skin of the nasal septum is often wrinkled or changes color of the skin at this point due to changes in the degree of tension of soft tissues. By moving the index finger of the pear-shaped holes in the upper jaw and hillock wing-spikes and shifting the broken upper jaw, can determine the course of clinical fractures throughout. When applying sterile injection needle pricks on the mucous membrane of the gums establish a violation of pain sensitivity, lack of or decrease throughout the upper jaw. This is due to rupture (injury), front, rear and secondary alveolar branches of infraorbital nerve, passing in the thickness of the walls of the upper jaw. For percussion teeth is determined by the low percussion sound.
Fracture of the upper jaw on the bottom type should be differentiated from a fracture lateral part of the alveolar process of maxilla. Pain symptom load, carried out by the method described above (pressure on the pterygoid bone) at the turn of the alveolar process is negative, and the load on large molars is accompanied by pain in his zone. Hemorrhage in the upper body of a unilateral vestibular cavity, and the mobility of the upper jaw with a shaking her upper teeth missing.
On radiographs of the facial bones of the skeleton in the front poluaksialnoy projection in the vertical position of a patient is determined by the violation of the integrity of the walls of the pear-shaped holes and skuloalveolyarnogo crest on the left and right, and the level of fluid in the maxillary sinus due to haemorrhage in them.
Timing of treatment using the victim did not significantly alter the classic signs of a fracture of the upper jaw, if not develop complications of inflammatory nature. Then align the signs of acute inflammatory disease admaxillary soft tissues (pyosis hematoma, abscess) or traumatic sinusitis.
In addition, swelling of soft tissues may have to disappear, stop bleeding, and bruising zone have different colors or absent, depending on the old injury. In these circumstances, palpation more clearly defined bony protrusions of the lack of swelling of soft tissues and the arches of the mouth.
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Articles for theme "fracture of the jaw":
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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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