Symptoms of a fracture of the orbit and zygomatic bone. Symptoms of a fracture of the orbit and zygomatic bone Fracture of the zygomatic bone ICD code
The human skull differs from other parts of the body in the complexity of its structure. It consists of the brain and facial sections, which are formed by numerous paired and single bones. The zygomatic bone, spongy in structure, is paired and the strongest.
It consists of the maxillary branch, the mandibular branch, which serve as a connection between the parts of the skull and the place of formation of facial tissue. It has three surfaces that pass near the temple, capturing the edge under the eye socket.
Injuries to the lower part of the face are a common phenomenon in traumatology. In terms of frequency of cases, fracture of the zygomatic bone ranks second after. Fractures come in varying degrees of severity, displaced and not. Single, can be combined with others.
Possibly mechanical destruction of the integrity of the zygomatic arch and processive ossicles. The pathology is classified as craniofacial trauma, where the slightest bone deformation becomes dangerous. The anomaly is aggravated by a concussion and causes serious harm to health.
Classification
Fractures of the zygomatic bone are determined by the location of the injury, time, and severity. By time of fracture:
- early, 10 days ago;
- old, about a month;
- incorrectly, jaws not completely fused for more than a month.
Species:
- open form;
- closed;
- linear view;
- splintered.
The jaw bone includes three surfaces: buccal, near temporal, forming the orbit.
Classification by fracture site:
- A fracture of the zygomatic arch occurs with or without displacement. Damage to the upper vault of the oral vestibule, disruption of the walls of the maxillary sinus.
- When the temporal process of the zygomatic bone is destroyed. It may have a closed or open form, where the jaw moves or remains in place.
- Displaced fracture of the zygomatic-orbital complex with possible destruction of the jaw sinuses.
Trauma code according to ICD 10
The 2016 International Classification of Diseases, after the 10th revision, established a specific designation for mechanical damage to the skull skeleton.
Trauma codes according to ICD 10: floor of the orbit (SO 2.8), upper part (SO 2.4), lower (SO 2.6).
Etiology
The cause of such injuries is a household or work-related factor. Victims seek help with a cheekbone fracture with consistent regularity. Fragments of the zygomatic bone may appear due to the following reasons:
- falling from a height;
- accidents on the highway;
- after an accident;
- being hit with a fist or a hard object during an argument;
- when playing sports;
- non-compliance with safety regulations at work.
The manifestation of the pathology is quite obvious, well defined visually. Therefore, timely consultation with a doctor will help to avoid unwanted consequences, including facial surgery.
Symptoms
A fracture of the zygomatic bone is combined with a concussion to varying degrees. Symptoms will include not only visual identification, but also a deterioration in general well-being. The main symptom is the displacement of the bone plate, which puts pressure on the walls of the orbit, touching the nerve endings. The main signs of the anomaly:
- irritation of the nervous system of the cheek (loss of sensitivity, sensation of goosebumps);
- the broken fragment forms a deformity of the integrity and a bony protrusion on the cheek.
- limitation of mouth opening, accompanied by pain;
- loss of sensitivity in the area of the wings of the nose, lower eyelid, on the cheekbone on the side of the injury;
- when the fragment is displaced into the zygomatic-alvelar region, a bony protrusion appears, which is well determined by palpation.
- due to concussion, complaints of ripples in the eyes;
- swelling of the tissues under the eyes, the face on the side of the fracture, the eyelid is drooping and closed, extensive hematomas at the site of the injury;
- bleeding from the sinuses;
- sores in the mouth.
If you do not contact a traumatologist in a timely manner, symptoms of Purtscher syndrome (retinal detachment) appear within two days.
First aid
In case of a fracture of the zygomatic bone and zygomatic arch, it is necessary to take the victim to a nearby medical center for assistance. If this is not possible, then you can help the person in the following way:
- Give a pain reliever.
- In case of bleeding, it is necessary for the victim to compress the artery, for example, a fracture on the left, which means with his left hand. Follow the same scheme if the injury is on the right.
- If the patient is unable to do so, stop the bleeding with an antiseptic bandage.
- It is necessary to hold the lower jaw; a bandage or any clean piece of fabric that is suitable in size can be used as a bandage. This method will not only reduce pain, but also fix the fragments.
- During the first two hours, it is recommended to apply ice to the problem area. In this way, the appearance of edema will be reduced.
Afterwards, the victim must be taken to a trauma center for subsequent hospitalization.
Diagnostic methods
First of all, the medical history is determined, under what circumstances the injury was sustained. And also the examination of a broken zygomatic bone is based on asking the patient about chronic diseases, the presence or absence of pain. Then the damaged area is examined and examined by palpation.
Making a diagnosis in this case is not difficult; the fracture has characteristic signs. Considering that the damage affects the volume of the orbit, consultation with an ophthalmologist is necessary. To clarify the full picture, a number of diagnostic measures are prescribed:
- computed tomography;
- magnetic resonance imaging (MRI);
- radiography;
- orthopantomography.
Based on the medical history and diagnostic examinations, conservative therapy or surgical intervention is prescribed.
Treatment method
Treatment for a fracture of the zygomatic bone directly depends on the severity, form and duration of the injury. Without displacement, the pathology is classified as a mild form and therapy is prescribed taking into account bed rest and a liquid diet. To remove the hematoma, an incision is made under the lower eyelid and medications are prescribed to treat a patient with a fracture:
- anti-inflammatory drugs that do not contain steroids;
- painkillers orally (by mouth) or intramuscular injection;
Ice is applied to the injured area. Then physiotherapy procedures, a visit to the dentist and ophthalmologist are prescribed.
Surgical treatment
The operation is indicated if the zygomatic bone is damaged with displacement and conservative therapy does not produce results. The main goal of surgical intervention is the reposition of bone fragments. The operation is done inside the oral area and externally.
A zygomatic arch fracture is treated as follows:
- In mild cases, victims are treated using the Limberg method. It is carried out with a hook, which pries up the broken, depressed bone, returning it to its normal appearance.
- For old fractures, it is advisable to use the Malarchuk method; a special instrument is placed under the bottom of the cheekbone, and adjustments are made.
- For mild fractures, the problematic bone is replaced with forceps. This method was first used by Duchant.
- The Dubov method is used for surgical treatment of fractures of the zygomatic region if the sinuses are affected.
The choice of surgical intervention is determined by the severity of the course, duration and nature of the injury.
Rehabilitation
If zygomatic bone fractures require surgery to place plates, the healing process will be long. Adaptation of tissues to foreign material plays a role. Rejection manifests itself in the form of an inflammatory process and poor regeneration.
In the case of a non-displaced injury, the recovery process will last no more than one and a half months. Healing, as indeed of all fractures, depends on timely treatment and a rational attitude to the therapy prescribed by the doctor.
Physiotherapy
Procedures are prescribed if there is a fracture of the zygomatic bone without displacement and include:
- electrophoresis;
- pulse therapy;
- magnetic therapy;
- ultrasound (phonophoresis);
- UHF (ultraviolet radiation).
Physiotherapy affects the body at the molecular and cellular level. Promotes rapid regeneration of bone tissue.
Complications and consequences
What harm to health can a facial injury cause in any form of injury if measures are not taken in time:
- facial asymmetry as a consequence of deformation;
- Chronic sinusitis may become a complication;
- meningitis;
- osteomyelitis.
Without adequate therapy or surgery, the health damage is quite serious. Improperly fused jaw bones can impair respiratory function. The act of swallowing and chewing is difficult. Speech diction changes for the worse.
Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)
Multiple fractures of the skull and facial bones (S02.7)
General information
Brief description
Violation of the integrity of the bone tissue of the facial skeleton as a result of trauma.
Combined injury - damage to at least two anatomical areas by one or more damaging factors.
Protocol code: H-S-024 "Facial bone fractures"
Profile: surgical
Stage: hospital
ICD-10 code(s): S02 fracture of the skull and facial bones
Excluded - eye sockets:
Top wall (S02.1);
Dna (S02.3).
Classification
1. Fracture of the zygomatic bone and upper jaw.
2. Tooth fracture.
3. Fracture of the lower jaw.
4. Multiple fractures of the skull and facial bones.
Risk factors and groups
1. Detraining.
2. Careless sudden movements.
3. Old age.
Diagnostics
Diagnostic criteria
A) Fractures of the lower jaw:
1. Statistical data - the most typical fractures of the angle of the mandible (usually left-sided).
2. Examination - palpation of the lower jaw. Usually the fracture line can be palpated before swelling develops. It is also necessary to examine the oral cavity. The presence of a hematoma in the floor of the mouth almost always indicates a fracture. You should pay attention to bleeding from the gums when bending the lower jaw. Your teeth should be examined. A “step” on the line of the teeth is a reliable sign of a fracture. The bite needs to be assessed. Usually the patient himself notices a change in the bite. Assess sensitivity in the lower jaw area. Its change or loss indicates a displaced fracture and the possible need for surgery.
3. Fractures of the lower jaw branch can be combined with ruptures of the auditory canal and bleeding from the external auditory canal, not associated with a fracture of the base of the skull.
B) Lateral fractures of the facial skull:
1. Examination: it is necessary to pay attention to the location of the cheekbone and the limitation of the range of movements of the lower jaw. Loss of sensation in the area of the wing of the nose, upper lip or cheekbone is characteristic of a displaced fracture; in such cases, surgical treatment is necessary. It is necessary to determine the presence of diplopia. Sometimes the injury causes vision loss. Typically there is a raised hematoma on the side of the eye (bruising) and hematoma around the eye.
IN) Lefort fracture P: swelling in the middle third of the face and under the eye socket, bruising on both sides, nosebleeds (very common). The patient sometimes notes diplopia.
Lefort III fracture: in addition to the signs listed above, pathological mobility of the entire middle third of the face is detected. There may be loss of sensation in the cheekbone and upper jaw. It is necessary to pay attention to possible leakage of cerebrospinal fluid. When injuries occur as a result of exposure to significant force, the entire middle third of the face is wedged back, and severe malocclusion occurs.
List of main diagnostic measures:
1. X-ray of the facial skull in direct projection.
2. X-ray of the facial skull in lateral projection.
3. X-ray of the facial skull in axial and semi-axial projections.
4. General blood test (6 parameters).
5. General urine analysis.
6. Examination of stool for worm eggs.
7. Microreaction.
8. Determination of capillary blood clotting time.
9. Determination of blood group and Rh factor.
10. Consultation with an anesthesiologist.
12. Fluorography.
13. HbsAg, Anti-HCV.
List of additional diagnostic measures:
1. Computed tomography of the facial skull.
2. Orthopantomography.
3. Determination of bilirubin.
4. Determination of glucose.
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Treatment
Treatment tactics
Treatment goals: elimination of pain in the jaw, reposition, fixation of fragments, restoration of bite.
Treatment
A) Basic principles of treatment of mandibular fractures:
Conservative treatment (installation of an arched bar, support of the dentition) is indicated if the fracture is stable, the occlusion is normal and the sensitivity of the lower lip is preserved;
You should visit your doctor again in a week. At this time, the fracture is much easier to see on x-ray;
Insensitivity of the lower jaw indicates dislocation and the need for surgical treatment. If in a displaced fracture it is not possible to compare the lines of fragments in another way, then surgical intervention is necessary. Operation - reposition and fixation of jaw fragments using an orthopedic method;
Typically the fracture needs to be reduced and immobilized for 4-5 weeks;
Osteosynthesis with a miniplate and shape memory clamps in combination with stable fixation can be used. Fixation using the wire osteosynthesis method is not stable enough, so it must be supplemented with intermaxillary splinting for a period of 4-5 weeks.
When the coronoid process is fractured, there is usually no need for osteosynthesis.
Complications:
Approximately 6% of cases of fractures of the lower jaw are complicated by more or less pronounced disturbances in the sensitivity of the lower lip;
In the area of the damaged nerve, neuralgic pain is possible, which is difficult to treat;
To restore sensitivity in the area of the zygomatic bone, the most appropriate operation is suturing the infraorbital nerve (it can be performed even 6 months after the injury).
B) Methods for restoring the normal position of the zygomatic bone: reduction using a Limberg hook. If the zygomatic bone cannot be kept in the reduced position, plates, wires, or external fixators with shape memory metal are used to secure it.
IN) Lefort fracture P. Lefort fracture III: the bones of the middle third of the face are fixed directly to the skull or to the lower jaw. It is necessary to try to restore the bite. Often it is necessary to carry out osteosynthesis using a miniplate, shape memory clamps, knitting needles, or bone suture.
Complications: the flow of cerebrospinal fluid from the nose usually stops spontaneously after a few days. Sometimes the upper jaw remains displaced back, which leads to a decrease in the size of the face and a malocclusion.
G) Fractures of the bones forming the walls of the orbit: Surgical treatment is carried out during the first (at the latest, second) week after the injury. Correction of diplopia is most important, but the cosmetic effect is also important. If vision is lost, surgery is performed for cosmetic purposes, as well as to restore the sensitivity of the facial skin.
Methods: the lower wall of the orbit can be strengthened from the side of the maxillary sinus using a tampon or balloon. Currently, correction is carried out by direct examination and lifting of bone fragments. If necessary, the lower wall of the orbit is strengthened using synthetic materials, bone or cartilage autografts.
Restoration of sensitivity can continue for 6 months. Moderate diplopia usually resolves gradually after surgery (probably due to the activation of compensatory mechanisms in one or both eyes).
Complications: due to changes in the volume of the orbit, enophthalmos may occur, and diplopia is also possible. For prophylactic purposes, antibiotics must be prescribed.
List of essential medications:
Information
List of developers: Malik B.K., Scientific Research Institute of Orthopedics, Ministry of Health of the Republic of Kazakhstan
Attached files
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ICD-10 code: S02.1 - fracture of the upper wall of the orbit
ICD-10 code: S02.3 - fracture of the orbital floor
ICD-10 code: S02.8 - orbital fracture not otherwise specified (NOS)
ICD-10 code: S02.4 - fracture of the zygomatic bone (arch)
Combined fractures of the zygomatic bone with the zygomatic arch, as well as the orbital margin with the floor of the orbit (lateral fracture of the middle part of the facial skeleton) are often observed. Isolated burst fractures of the orbital floor and isolated fracture of the zygomatic arch are also possible.
Fractures zygomatic bone And eye sockets may also be part of severe midfacial or frontobasal fractures. The maxillary sinus is almost always damaged. The mechanism of fractures consists of a blunt forceful blow to the side of the face, such as a blow from a fist or a blow received in a traffic accident or a fall from a ladder. Fractures of this location are almost always depressed.
Displacement of bone fragments may be minimal, but there are also cases of comminuted fracture, in which it is difficult to reduce numerous bone fragments.
Fractures of the zygomatic bone:a Side view. 1 - zygomatic arch; 2 - lower jaw; 3 - coronoid process;
4 - head of the lower jaw; 5 - body of the zygomatic bone.
b Front view. 1 - zygomatic arch; 2 - lower jaw; 5 - body of the zygomatic bone; 6 - medial ligament of the eyelid.
The inset schematically shows damage to the orbit, maxillary sinus, and ethmoidal labyrinth.
A) Signs of a fracture of the orbit and zygomatic bone. Includes hematoma of the orbit, swelling of the eyelids, asymmetry of the middle third of the face with retraction of the contour of the cheek on the side of the fracture, downward displacement, as well as enophthalmos on the side of the fracture, the formation of a step on the lower or lateral wall of the orbit, occasionally on the upper edge of the orbit, and in some cases trismus.
The soft tissues in the zygomatic area quickly swell, but the contours of the zygomatic bone are flattened. There may be loss of sensitivity in the area of innervation of the infraorbital nerve. With a burst fracture, the movement of the eyeball is partially limited, and diplopia appears due to pinching of the inferior rectus or inferior oblique muscle.
b) Diagnostics is based on anamnestic data that allows us to determine the nature and direction of the blow, the results of examination and bimanual palpation, which allows us to identify asymmetry of the facial skeleton, the presence of a step in the wall of the orbit and limitation of movements of the lower jaw. X-ray examination is performed in standard projections, as in pathology of the paranasal sinuses, and in a special projection for visualizing the zygomatic arch; X-ray tomography is also performed. An ophthalmological examination is necessary.
P.S. Fractures of the zygomatic bone are observed relatively frequently. During the initial examination, they often go unnoticed due to the pronounced swelling of the soft tissues of the cheek and lateral part of the face and are therefore diagnosed later, when improper fusion of bone fragments occurs.
Even after relatively mild trauma to the middle third of the face as a result of a blow from the front or side, it is always necessary to check for asymmetry of the facial skeleton, a step on the wall of the orbit, or loss of sensitivity in the area of innervation of the infraorbital nerve; palpated simultaneously with both hands so that both sides of the face can be compared.
a Incision of soft tissues for reposition of fragments and their elevation.
b Condition after reposition of zygomatic bone fragments and their fixation using microplates.
V) Treatment of orbital and zygomatic bone fractures. A number of approaches have been proposed for open reduction and fixation of bone fragments in fractures of the zygomatic bone:
1. Access through the vestibule of the mouth and through the maxillary sinus.
2. Through the temporal region.
3. Direct access through the soft tissue covering the zygomatic bone.
Method for stabilizing bone fragments after their reduction (eg, with a miniplate or wire) using single-prong retractors depends on the type of fracture and its severity. If sensory loss is noted in the area of innervation of the infraorbital nerve, it should be isolated and decompressed.
Jaw fracture is a severe pathological situation in which the linear integrity of the bones that form the lower jaw is disrupted. This occurs under the influence of some traumatic factor, the intensity of which exceeds the strength of the bone. A fracture of the lower jaw is a fairly common pathology that occurs among all age categories, but most often it affects young men aged 21 to 40 years. This is due to several factors, which are determined by both socio-economic status and lifestyle, as well as anatomical and physiological characteristics. Tooth fracture is a tooth injury caused by mechanical force. When a fracture occurs, the anatomical integrity of the tooth root or its crown is disrupted. The causes of tooth fracture are mechanical injuries resulting from an impact, a fall, or during chewing when there are solid foreign bodies in food. The frontal teeth of the upper jaw are more susceptible to fractures than the teeth of the lower jaw; often tooth fractures are combined with their incomplete dislocations. 
Reasons
Fractures of the lower jaw occur as a result of exposure to some traumatic factor, the force of which exceeds the strength of the bone. In most cases, this occurs as a result of falls, impacts, road traffic accidents, sports and professional accidents. However, the consequences of traumatic exposure are not the same in all cases and depend not only on the intensity, but also on a number of other factors, among which the physiological and structural state of the bone before the injury is of particular importance. In medical practice, it is customary to distinguish two main types of fractures, in which the integrity of bone structures is disrupted, but which are the result of slightly different cause-and-effect relationships. Depending on the type of fracture, corresponding to the classification based on the initial cause of the fracture, the most adequate therapeutic and preventive tactics are selected. The following types of fractures are distinguished:
Basically, in clinical practice there are traumatic fractures, which, due to the shape and anatomy of the jaw, differ from fractures of other skeletal bones. First, due to the arched shape of the bone, when pressure is applied in front, in the chin area, the resulting force is applied to the areas of the arch that are located laterally. This is due to the rigid attachment of the jaw in the temporomandibular joint, which does not allow it to move and thereby absorb the impact energy. Thus, under the influence of one traumatic factor, multiple jaw fractures quite often develop ( usually in the area of the mandibular symphysis and angle of the jaw). Secondly, the jaw is a fairly strong bone that requires a lot of force to break. From a physical point of view, to fracture a jaw in the area of the corner, it is necessary to apply energy corresponding to 70 accelerations of free fall ( 70g), and for a fracture in the symphysis area, this figure must be increased to 100. However, it should be understood that under pathological conditions and with disorders of bone development, the force of the required blow is significantly reduced. According to statistical data, the cause of trauma to the lower jaw largely determines the location of the fracture. This is most likely due to the fact that in certain types of injuries the impact mechanism and the location of maximum energy absorption are similar. In car accidents, fractures usually occur in the area of the symphysis of the mandible and the condylar process ( on both sides), in motorcycle accidents - in the area of the symphysis and dental alveoli ( that is, at the level of the jaw body), and for injuries received as a result of an act of physical violence - in the area of the condylar process, body and angle of the jaw. Typical places for the formation of a jaw fracture line are:
Fractures of the lower jaw, like fractures of other bones of the body, are divided into open and closed depending on the contact of bone fragments with the external environment. However, unlike other bones, jaw fractures have their own characteristics, which are associated with the close location of the oral cavity. Fractures of the lower jaw are of the following types:
Depending on the displacement of bone fragments, the following types of jaw fractures are distinguished:
- Displaced fracture. A fracture with displacement of fragments occurs when bone fragments lose their normal relationship and are displaced under the influence of some internal ( bone heaviness, muscle pull) or external ( direction and force of impact, displacement during movement) factors.
- Fracture without displacement of fragments. In a fracture without displacement, there is a pathological defect between the bone fragments ( fissure or fracture line), however the fragments are correlated correctly. A similar situation is typical for incomplete fractures, in which part of the bone tissue retains its integrity, as well as for fractures that developed under the influence of a low-intensity traumatic factor.
- Comminuted fracture. A comminuted fracture of the lower jaw is quite rare, but it is characterized by the presence of many bone fragments that are displaced to one degree or another. The peculiarity of this fracture is that, firstly, for its occurrence it is necessary to apply a large force to a small area of the bone ( for example, when hit with a hammer), and secondly, comminuted fractures require surgical treatment, as they significantly destabilize the bone.
In osteomyelitis of the lower jaw, the developed infectious process stimulates an inflammatory reaction, under the influence of which the environment and local metabolism change. In addition, thrombus formation increases, local blockage of blood vessels occurs, and necrosis occurs ( dying off) bone tissue. Pus forms in the cavity under the tooth, dental ligaments weaken, the causative tooth and adjacent teeth acquire pathological mobility and begin to wobble. Due to malnutrition of the bone, it becomes more fragile and loses its original strength. This is especially pronounced in total osteomyelitis, that is, in cases where the pathological infectious-inflammatory process covers the entire lower jaw. Odontogenic osteomyelitis is one of the most common causes of pathological fractures of the mandible. This disease is accompanied by severe pain in the affected area, aggravated by chewing, putrid breath, bleeding from the mouth, redness and swelling of the skin over the lesion. Symptoms
The symptoms of a jaw fracture are quite varied. In most cases, this pathology is combined with a number of external manifestations, as well as a number of subjective sensations. However, since quite often a fracture of the jaw is combined with traumatic brain injuries, in which the victim may be unconscious, those clinical manifestations that the doctor can see during examination are of greatest importance. A fracture of the lower jaw is accompanied by the following symptoms:
Among other symptoms of a jaw fracture, bleeding from the nose or ears deserves special attention, since cerebrospinal fluid may leak along with the blood through the damaged base of the skull. Such bleeding can be distinguished by placing a clean napkin. With normal bleeding, one reddish spot remains on the napkin, while with bleeding combined with loss of cerebrospinal fluid, a yellowish spot appears on the napkin, diverging to the periphery. Tooth fracture
Tooth fracture- traumatic damage to a tooth, accompanied by a violation of the integrity of its root or crown. There are different types of tooth fracture: fracture of enamel, dentin and tooth root. They manifest themselves as sudden mobility and displacement of the injured tooth, and intense pain. If the crown is fractured, the tooth can be saved with subsequent cosmetic restoration; if the root is fractured, its removal is required. In case of root injury, there is a high risk of developing periostitis, osteomyelitis and other complications.Tooth fracture
Tooth fracture is a tooth injury caused by mechanical force. When a fracture occurs, the anatomical integrity of the tooth root or its crown is disrupted. The causes of tooth fracture are mechanical injuries resulting from an impact, a fall, or during chewing when there are solid foreign bodies in food. The frontal teeth of the upper jaw are more susceptible to fractures than the teeth of the lower jaw; often tooth fractures are combined with their incomplete dislocations.Clinical manifestations of tooth fracture
When a tooth is fractured, severe unbearable pain occurs, the victim experiences difficulty opening the mouth and closing the teeth. In addition, a tooth fracture is preceded by some kind of trauma, bleeding gums and pathological loosening of the tooth are noted. Painful sensations from mechanical and thermal irritation depend on the type and location of the fracture, as well as on tooth mobility. During the examination, swelling of the soft tissues of the oral cavity and pinpoint hemorrhages in the skin and mucous membranes are detected. A fracture of the tooth crown is clinically manifested as a defect; often such a fracture is accompanied by an opening of the pulp chamber. When the root of a tooth is fractured, the tooth becomes mobile, its percussion is sharply painful, and the crown sometimes acquires a pink tint. A tooth fracture can be minor in the form of a chipping of the tooth enamel, or significant when there is a dentin fracture with or without exposure of the pulp and a fracture of the tooth root. Fractures with pulp exposure are called complete, and fractures without pulp exposure are incomplete.Diagnostics
A jaw fracture can be suspected based on a patient interview, examination data and clinical examination. However, in most cases, for a final diagnosis, additional instrumental studies are required to diagnose both the fracture itself and a number of existing and potential complications of this phenomenon. It should be noted that with pathological fractures, the diagnostic process is not limited only to identifying the location and type of fracture, but also involves a number of additional radiographic and laboratory studies aimed at identifying the initial bone pathology. However, since the vast majority of people admitted to hospital trauma departments with a jaw fracture have suffered in various traumatic circumstances, their examination is considered routine and includes an examination and a number of additional procedures. A jaw fracture is detected using the following methods: During a clinical examination, the doctor identifies the main objective ( visible or felt by an outside observer) and subjective ( perceived exclusively by the patient) symptoms, and also finds out the circumstances of the incident. Objective symptoms of a jaw fracture include:- unilateral displacement of the jaw due to shortening of the body on one side;
- pathological jaw mobility;
- visualization of bone fragments deep in the wound;
- violation of the bone relief;
- asymmetry when opening the mouth;
- spasm of the masticatory muscles;
- crepitus ( crunch) bone fragments during movement.
If a fracture of the lower jaw is suspected, radiography of both the upper and lower jaw is performed in direct and lateral projection, which also covers the area of the facial skeleton, the vault and base of the skull, and several cervical vertebrae. As a result, diagnosis is not limited to just one bone, but covers the entire anatomical formation. In case of a fracture of the lower jaw, radiography allows one to determine the location of the fracture gap, the number of fractures, the presence or absence of fragments, and the degree of their displacement. In case of a fracture of the upper jaw, the involvement of adjacent bone structures is assessed by radiograph, and darkening of the maxillary sinuses is also noted ( as a result of hemorrhage in them). It should be noted that, despite its advantages, radiography has a number of significant disadvantages, among which the most significant is the need to irradiate the patient. From an environmental health perspective, one of the objectives of which is the assessment of radiological background and its effects on the body, performing several radiographic procedures increases the dose of radiation to a person, but the overall health impact is relatively small. However, since the effects of ionizing radiation can accumulate, it is highly discouraged to expose yourself to unnecessary radiation. Orthopantomography Orthopantomography is an X-ray examination method that allows you to obtain a panoramic image of the dental system. It is performed using a special device - an orthopantomograph, in which the image is obtained by rotating the X-ray source and film around the fixed head of the patient being examined. As a result, the film produces a panoramic image of the dentition, as well as the upper and lower jaw and nearby bone formations. This research method allows you to determine the presence and number of jaw bone fractures, damage to the temporomandibular joint and teeth. The entire procedure takes no more than five minutes and is relatively harmless. Computed tomography (CT
)
Today, computed tomography is the preferred method for diagnosing jaw fractures, as it provides more accurate and detailed information. The method is also based on X-ray radiation - the patient is placed in a special computed tomograph, and an X-ray machine rotating around him takes many pictures. After computer processing, a clear layer-by-layer image of the area under study is obtained, and if necessary, you can even create a three-dimensional image of the facial skeleton. CT provides clear information about the presence and number of fractures, the location of the fracture gap, allows you to identify small fractures of the upper and lower jaw, fractures and cracks of nearby bone structures, and visualize small fragments that may not be visible on a simple x-ray. Computed tomography is indicated in the following situations:
- in the presence of two or more fractures determined by x-ray;
- jaw fractures involving the dentition;
- suspicion of fractures of adjacent bone formations;
- before surgical treatment of jaw fractures.
Treatment
Surgical treatment of jaw fractures
Surgical treatment of a jaw fracture, which is indicated for most patients, and which in medicine is called osteosynthesis, is the main effective method of restoring bone integrity. The following types of osteosynthesis are used to treat fractures:
In addition to the listed methods used to fix fracture fragments, other methods are used in traumatology practice, the choice of which depends on the severity of the patient’s condition, the type and complexity of the fracture, as well as the skills of the surgeon. Indications for osteosynthesis are:
- the presence of large and small bone fragments;
- strong displacement of fragments and, as a consequence, the impossibility of their comparison without surgical intervention;
- fractures behind the dentition;
- pathological inflammatory or neoplastic process in the fracture area;
- reconstructive operations;
- a small number of healthy, stable teeth on bone fragments.
Bone suture
To apply a bone suture, the fracture area is exposed from soft tissue on the lateral and internal sides. Holes are made in the fragments, through which, after comparison, a wire is passed, which is used to fix the fragments. The wire can be made of stainless steel or titanium. In some cases, synthetic threads are used instead of wire, however, due to their lower strength, this method has limited use. This method of osteosynthesis is indicated in all cases of fresh fractures of the lower and upper jaw, in which there is no significant displacement of bone fragments. Contraindications to this method are:- inflammatory process in the fracture zone;
- the presence of many small bone fragments;
- osteomyelitis;
- gunshot wounds in the area;
- presence of bone defects.
Bony metal plates
Bony metal plates are widely used in maxillofacial surgery because, firstly, they reduce soft tissue trauma during surgery ( it is necessary to dissect the skin and muscles on only one side, the lateral side), which has a positive effect on the recovery period and the time of bone fusion, and secondly, they allow better fixation of fragments in areas subject to strong dynamic loads. To fix bone fragments, small narrow plates made of titanium or stainless steel are used, which are screwed into the fracture area so that the fracture line is firmly fixed.
Also, fast-hardening plastics and special glue ( resorcinol epoxy resins), metal staples with memory, Kirschner knitting needles. For closed osteosynthesis, various extraoral wires and staples can be used. These include S-shaped and unified hooks, Kirschner wires, static and dynamic extraoral devices for immobilization, etc. The choice of fixation method is individual and is largely determined by the characteristics of the fracture.