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Fractures of the actual branches of the mandible and the coronoid process
05-09-2009
There are actually branches of fractures of the mandible, coronoid and condylar processes it. Fracture of the actual branches of the mandible in the horizontal direction is more often localized in the middle section and it is caused by compression. Small otlomok under the influence of temporal and to a lesser degree lateral muscles pterygium rotary motion in the joint moves upward inside and a few front. However, when expressed by a slant fracture cracks in the direction upwards and inwards (the turn of the outer compact disc is much lower than on the inside), the displacement of small fragments medially may not occur as a result of holding it on the big fragments (it rests against the inner compact disc of large fragments). Big otlomok shifts to fracture, ie posteriorly under the influence of lateral and to a lesser extent the medial pterygium of muscles on the side opposite the fracture, and up - under the influence of occlusal and medial pterygium of muscles on the side of the fracture. The middle line will move in the direction of fracture. On the side of a fracture as a result of shortening of the branches of the jaw contact of teeth will be rather solid, but also incorrect (Bugorkov). On the healthy side teeth can not touch or contact them will be incomplete (loose) and wrong (Bugorkov).
Fracture of the actual branches of the mandible in the vertical direction is caused by the shift. The displacement of bone fragments will be largely determined by the magnitude of the applied force and the degree of damage to the chewing muscles and the medial pterygium in the place of attachment to a branch of the mandible, the presence or absence of molars on the upper and lower jaw. The displacement of large fragments more pronounced. He can move up and some under the influence of anterior traction of the temporal and masticatory muscle on the side of the fracture. However, this may counteract the lateral and medial webbed muscles on the side opposite the fracture. Reducing, they have shifted a large otlomok toward fracture, ie posteriorly. Therefore more likely to mean the line will move in the direction of the fracture, but the bite would be consistent with that of transverse fracture. Small otlomok or does not move, or more deflected medially under the influence of the lateral muscles of pterygium on the side of the fracture.
During examination the patient is determined by swelling in the parotid or pozadichelyustnoy area. Can propalpi-ment bone protrusion, irregularity or to identify the sore spots on the back edge of the branches of the mandible (transverse fracture) or at the bottom of the angle of the jaw (in the case of longitudinal fracture). Mouth opening is limited and often accompanied by severe pain reaction. When lowering the mandible is determined by the displacement of the midline in the direction of fracture. Symptom burden is accompanied by pain in the area of damaged branches. Violation ratio of dentitions above.
Isolated fracture of the coronoid process is possible as a result of separation [Rauer, AE, 1947; Kaganovich SI., 1964]. Other authors do not share this view, believing that coronary process can be broken with the zygomatic arch. We observed fracture (broke off), coronoid process, together with the front edge of the branches of the jaw when removing the third molars of the lower corner elevator. At the turn of the coronoid process is noted pain when opening the mouth, the restriction of opening the mouth to 1.5 cm in the feeling the front edge of the branches of the mandible from the oral cavity at the base of coronoid process has been a sharp pain. Broken coronary process under the influence of the temporal muscle is displaced upwards. If the fracture is within the tendon attachment of the temporalis muscle and the latter is not broken, then otlomok may not shift or shift it will be negligible because of the retention piece of muscle-tendon sheath. Since the continuity of the mandibular arch is not violated, the ratio of tooth-rows is not changed, but a symptom of stress will be negative.
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Articles for theme "fracture of the jaw":
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05-09-2009
If the fracture line passes between the central incisors vertically down to the bottom of the chin department formed almost the same size fragments, which is attached to the same number of muscles. These fragments are in a state of dynamic equilibrium, the displacement of crude is not observed. However, due to the dominance of power over the chewing muscles medial wing-in the presence of a movable fulcrum of each fragments (articular head) there is a slight shift in the bottom of the body of the mandible outwards.
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05-09-2009
Mandibular fractures most often occur in the region of its angle. This fracture is more often direct, sometimes - as reflected, ie at some distance from the place of the applied force. Ignoring this fact is often the cause of diagnostic errors, especially at the turn without bias. For the displacement of fragments of considerable importance is the localization of the fracture gap. If it passes anterior to the chewing muscles and the medial pterygium, or more precisely - within only a quarter of the front of their plane, the displacement of fragments more often than significant.
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05-09-2009
These fractures tend to occur at the site of application of force, ie direct. The clinical manifestation of a unilateral fracture of the lower jaw of any location, including the lateral part of the body of the jaw, is largely predetermined by the direction of the plane of the fracture and its location relative to the median line: the farther from it is a fracture plane, the greater the displacement of bone fragments. Before talking about the nature of the displacement of fragments of the mandible in its turn, it should be recalled that represent the plane and axis.
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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.
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05-09-2009
Causes of displacement of bone fragments in mandibular fractures
The displacement of fragments of the mandible is due to the action of the applied force, under the influence of its own weight and strength reduction of bone fragments attached to the fragments of the muscles. The last factor is decisive. As already noted, the lower jaw is moved under the influence of two muscle groups: to raise (rear group) and down (front group) the lower jaw. All the muscles are attached in pairs and symmetrical points.
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