Tires Tigershtedta. For more than 80 years of successfully using bent wire Tooth tires developed further during the First World War, a dentist in Kiev Military Hospital Tigershtedtom S. (1915). They were asked a number of different designs of tires: a simple clamp (now called the smooth tire-clamp), bearing clamp (tire with a hooked pallet hinges), distention clamp (tire with rasporochnym curve), various versions of staples from planes, buses with ramps and hinges , with the levers of different principles of action to move the bone fragments with chronic fractures, fixation plombochki, anchor shackles, etc.

Simple bintovaya (or scarf) parieto-chin bandage. The packs for fractures of the upper and lower jaws. It uses a wide gauze bandage, circular tours that pass through the chin and the parietal bone, bypassing the ears alternately front and rear. Can be used for this purpose mesh sleeve, shawl or a scarf, but it's much worse because it does not provide the necessary rigidity. Apply elastic bandage and superimposing it without tension. Unlike gauze bandage, he does not stretch over 1-2 hours and does not weaken the dressing.

Such change is possible in the place of application of force, when the blow suffered by the lateral division. It should be remembered that at a greater distance between the lines of fracture displacement of the fragments with unilateral double fracture more pronounced. The most significant is the case when the fracture line runs in the chin department and in the molars. In this case, there are three fragments of different sizes. Big is half of the lower jaw with the uninjured side, the second largest - the angle and the branch on the side of the jaw fracture and the third (smaller) - the average otlomok.

Character displacement of fragments is largely determined by the location of the fracture plane and the direction of its slant, depending on the direction and force of impact. In the case of passing the fracture line between the premolar vertically relative to the sagittal axis of the central otlomok could significantly down-down and shift backwards, bend over the alveolar part of the forward and lateral fragments may climb up. Alveolar part of their turns inward, and the base body of the mandible - outwards.

This combination occurs quite often. This results in three fragments: condylar processus on the one hand, the body of the mandible and the branch - on the other, and the average - a branch of a broken jaw condylar process and the body of the mandible.  Clinically prevalent signs of a fracture of the body of the jaw, and therefore its definition is not difficult. It therefore can not be promptly diagnosed condylar fracture of the appendix from the opposite side. It is connected with the fact that the violation of bite, so typical of the condylar fracture of the process, is not observed.

Bilateral fracture of the mandible fracture means two different halves of it. Double fracture of the mandible - were two fractures on one half of the jaw. Multiple fracture of the mandible - a combination of bilateral and double its fractures.  Bilateral condylar fracture of the appendix occurs most frequently when struck on the chin from front to back. In addition to the complaints listed above, with a bilateral fracture patients report pain trestle in front of the ear on both sides. They can not bite the food front teeth.

Damage condylar sprouts in second place in the structure of mandibular fractures. This is due to the fact that when struck on the chin from front to back is broken neck mandibular condylar sprouts, and in case of application of force to the lateral parts of the body, the branches or the chin to the most vulnerable is the base condylar sprouts, along with the angle of the mandible. The mechanism of fracture and in fact and in another case - the bend. Should be recalled that near the base of the appendix condylar cross-sectional area of bone in the lateral (naruzhnovnutrennem) direction is much less than in the anteroposterior.

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).

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.

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.

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.

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.

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.

There are four variants of the mechanism of fracture of the mandible: bend, shear, compression, separation. The lower jaw, having an arched shape, when a mechanical force is experiencing stress of bone tissue in the most crooked, or the most delicate of areas. Established in the limits of the lower jaw are the foundation and condylar neck of the appendix, angle, area openings and canine chin, chin department. It is in these most «weak» ground breaking lower jaw as a result of its inflection.

There are numerous classification neognestrelnyh fractures of the mandible. Conveniently enough for practical purposes is, in our opinion, the classification proposed by BD Kabakov, and VA Malyshev.     Classification of fractures of the mandible on BD Kabakov and VA Malyshev  A. For localization.  I. Fractures body of the mandible:  • the presence of the tooth in the fracture gap;  • in the absence of teeth in the fracture gap.  II. Fractures of the branches of the jaw:  • own branch;  • coronoid process;  • condylar sprouts: base, neck, head.

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.

In practice, the surgeon-dentist found unilateral or sagittal fractures of the upper jaw. They tend to occur when the injuring object has sharp edges and the force is applied downward in an oblique direction, mainly at the side of a single department or zone of the upper jaw of the upper lip with one hand. It breaks down the body of the upper jaw with a wing-offshoot sphenoid bone of the party or without it. In the area of the anterior and infratemporal walls (tuber) of the upper jaw fracture line passes above the bottom of the maxillary sinus, and in the hard palate - lateral of the median suture.

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.

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.

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.