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Fractures of the upper jaw and brain injury
03-09-2009
When combined craniocerebral trauma (CoN ™) as a result of mechanical impact damage occur simultaneously, the facial skeleton, bones of the cranial trauma and brain. Possible closed craniocerebral trauma (CCT), without damage to the bones of the skull, combined with fractures of the face. Fractures of facial bones, combined with head injury is diagnosed in 6.3% [Fraerman AP, YE Gelman, 1977], or 7,5% of victims [Lebedev VV, 1980]. Enough high frequency of craniofacial injuries caused not only by their anatomical proximity, but also the fact that some of the facial bones of the skeleton are involved in the formation of the skull base. The basis of characteristics CoN ™ posited relations between the two defining moments: 1) the localization of extracranial injuries, 2) the ratio of cerebral and extracranial injuries on their degree of severity.
More than '/ 3 of cases CoN ™ is accompanied by a shock. Erectile phase of its considerably lengthened in time and can take place against a background of impaired consciousness (as opposed to classical), accompanied by bradycardia, gross violations of external respiration, hyperthermia, meningeal signs, focal neurologic symptoms. Furthermore, the anatomical features of the relationship of the facial bones of the skull and brain lead to the fact that fractures of facial bones (eg, maxilla, zygomatic bone), usually beyond the anatomical boundaries of what has been said above. This otlomlenny bone fragment often includes the bones of the skull base, and therefore should be reminded of anatomic data relevant to the subject.
Anterior cranial fossa (fossa cranii anterior) is separated from the middle rear edge of the small wings of sphenoid bone. It consists of the orbital surface of the frontal, ethmoid, sphenoid (small wings and part of her body) bone. It is known that they are involved in the formation of the upper, inner and outer walls of the orbit, along which the line of fracture of the upper jaw to the middle and upper type (Le Fort II, Le Fort I). Middle cranial fossa (fossa cranii media) form the front surface of the pyramid and the scales of the temporal bone, the body and great wing of sphenoid bone, which are involved in the formation of the inner and outer walls of the orbit.
Between small, large wings and body of sphenoid bone is verhneglaznichnaya slit. The orbital surface of the upper jaw, together with the orbital edge of large wings sphenoid restricts the lower orbital fissure.
Fractures of the upper jaw may be accompanied not only a skull fracture and concussion or contusion of the brain, the formation of intracranial hematoma. To determine the correct tactics of examination and treatment of patients with maxillofacial surgeon should be aware of the main clinical features of these injuries. It is known that the associated trauma to the pathophysiological point of view is different in its content pathological process, as equivalent to the damage of a single vital organ (eg brain). It can not be regarded as a simple sum of traumatic injuries of two or more anatomic areas. Combined injury is severe on the overall reaction of the organism, although not heavy damage on each of the bodies concerned. Possible violations of respiration, blood circulation and likvorodinamiki characteristic of CCT, can lead to insufficient cerebral circulation. Hypoxia of the brain, a violation of its share rise to swelling of the brain, central respiratory failure, which contributes to further brain edema. Thus, a vicious circle: the damage to the brain causes a violation of all types of exchange, and damage to other areas (maxillofacial, chest, etc.) reinforces such changes and creates the preconditions for the suppression of brain activity. With a decrease in systolic blood pressure below 70-60 mm Hg. Art. self-regulation of cerebral blood flow is disturbed, accompanied by a first functional, and then morphological changes in the brain.
Breathing disorder is a severe complication, a threat to the life of the victim. When combined injuries, it can be of three types: respiratory disorder of the central, peripheral and mixed type. The disorder of the central type of breathing caused by brain trauma, more precisely the respiratory centers located in the brain stem. This peripheral airway patency is not broken. Clinically, it manifests itself a violation of rhythm, the frequency of the amplitude of respiration: bradypnea, tachypnea, periodic rhythms of Cheyne-Stokes and Biota, spontaneous stop him. Need help - intubating a patient and supportive breathing.
Respiratory disorders in the peripheral type may be due not only to brain injury, but damage to the maxillofacial region. They arise due to obturation of the upper respiratory tract, as well as the trachea and bronchi vomitus, mucus, blood from the mouth, nose and throat secretions (especially at the turn of the jaws), the tongue or soft tissue flap, performing the role of the valve, which prevents the passage of air into the lungs. Assistance: reorganization of the tracheobronchial tree, removal of foreign body from the mouth, oropharynx. Respiratory disorders are more common in the mixed type, due to those and other reasons. It should be remembered that the occlusion of the tracheobronchial tree leads to hypercapnia. Restoring airway is accompanied by a reduction of CO in the blood, which can lead to a cessation of breathing. In this clinical situation shown artificial respiration until recovery of spontaneous breathing.
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