Features of splinting for a jaw fracture: the procedure for installing and removing splints, nutrition and care. Proper and healthy nutrition in case of a jaw fracture Oral care after jaw splinting

Post date: 17.11.2013 21:47

Hello, Alexey!
Splinting must be done, otherwise the fragments simply will not heal. The tooth is usually removed from the fracture line, but of course everything is done at the discretion of the attending physician.

Post date: 25.11.2013 07:27

Anton M

Hello! I visited this site and decided to get splinted. I have a fracture of the lower jaw on the right. They removed two teeth on Saturday, as they cracked along the fracture line, and splinted on Monday. The mouth does not open at all, the gums ache very strongly, I drink painkillers "NEMESIL" I don't know how to eat, the tube will not crawl anywhere. I only drink milk, yogurt and broth. I think I will lose 10 kilograms.

Post date: 25.11.2013 09:33

Alas, Anton, these problems arise not only for you, and only time can help here. You cannot open your mouth, otherwise the fragments may shift and the fracture will not heal. Search the Internet about the "jaw table" you can find something useful for yourself. By the way, you can try baby food or nutrition for athletes. And after eating, do not forget to brush your teeth and rinse your mouth.
Ps: besides nimesil, were you prescribed any other medications?

Post date: 25.11.2013 11:45

Anton M

They prescribed: 1. Lincomycin 3 times a day (drink for seven days) 2. Nimisil 2 times a day (drink for three days) 3. Cetrin 1 tablet a day (drink for five days) 4. Chlorhexidine Bigluconate rinse 5 times a day

Post date: 25.11.2013 13:21

Guest

Is it possible to drink anything else so that my teeth don’t ache? Thank you

Post date: 25.11.2013 22:24

The choice of analgesics in our pharmacies is simply gigantic.
As for the prescribed treatment, I disagree a little with the choice of an antibiotic, but if you are already taking it, then it’s too late to slow down. Lincomycin was very fond of treating about 10 years ago. Why don't you completely agree? This drug has a narrow spectrum of action. Its benefits are mainly due to its ability to accumulate in bone tissue.

Post date: 27.11.2013 18:47

Alexander

My rubber bands were removed today. A month passed with tires. While eating, the jaw at the fracture site moves up and down. Should it be so?

Post date: 28.12.2013 03:23

Artyom

hello, I’ll say right away it’s not as painful as they say, it’s quite tolerable if your teeth are not knocked out or removed at the same time. I’m wearing it for the 5th day, one question, if you can, describe as widely as possible, all the ways, and nuances - how to brush your teeth? monitor hygiene in the mouth, let's say so (let's divide the teeth in half, the left side is sensitive due to damaged teeth to such an extent that I only eat on the right side)

Oh, and another question, how much will the restoration of teeth and gums cost on average?

Post date: 29.12.2013 08:25

Restoration of teeth and gums depends on how damaged they are, from 0 rubles if the tooth is healthy, to 3-6 thousand if it is destroyed. As for hygiene, type in Yandex: “oral hygiene for jaw fractures” and you will be happy.

Post date: 05.01.2014 17:01

Victor

Hello! I had splinting done a day ago. The edge of my tongue and the inner parts of my lips are very sore. Tell me, is this normal?

Post date: 05.01.2014 17:45

As for the tongue, go to the doctor, maybe somewhere the sharp edge of the ligature.
As for the lips, ask the doctor to bend the hooks inward. In addition, gluing orthodontic wax on the hooks helps.

Post date: 07.01.2014 14:02

Daniyar

Hello broken lower jaw double fracture without mixing. The course of seven days, the tumor passed gently. I'm afraid to splint. I pray that it will heal like this. Tell me what to do

Post date: 10.01.2014 03:05

Ksenia

hello, fracture of the lower jaw, left process.. joint.. I don’t remember exactly what it’s called, I’ve been walking for almost 3 weeks, I’m already used to it, it doesn’t hurt me, as soon as they take it to a good dentist, I’ll cure everything, but a friend told me that her friend had a broken jaw , and he went to his doctor every week, who fitted him with splints, and he constantly tightens them, adjusts them, etc. But I can’t go to my doctor, he lives 1000 km from me. the jaw doesn’t wobble, the bite remains as it was, nothing gnaws at me other than the feeling of hunger) So what will happen if they don’t adjust my tires every week

Post date: 10.01.2014 09:31

Hello, Ksenia! The main thing is that the tires perform their function well, i.e. securely fixed the jaw and prevented it from accidentally moving. In general, the adjustment consists of strengthening the ligatures and changing the rubber rods, because they stretch over time.

ICD-10 code: S02.6 A fracture is a damage to the lower jaw with a violation of its integrity. In peacetime, the causes of fractures of the lower jaw are most often blows and bruises received during a fall, compression, in a fight, etc. Fractures of the mandible are the most common of all facial fractures.

Symptoms of a mandibular fracture

There are a number of signs that suggest a fracture of the lower jaw. This is swelling of the soft tissues around the jaw, pain in the lower jaw, which intensifies when opening and closing the mouth, and improper closure of the teeth. Biting and chewing food is severely painful or impossible. Often there is a feeling of numbness of the skin in the chin and lower lip, bleeding from the mouth. Also, quite often a fracture of the lower jaw is accompanied by a concussion. In this case, there may be dizziness, headache, nausea, vomiting; the victim may partially or completely not remember the circumstances of the injury.

  Collecting anamnesis, the doctor must find out when, where and under what circumstances the injury occurred. Based on clinical signs (preservation of consciousness, contact, breathing pattern, pulse, blood pressure level), the general condition of the patient is assessed. Damage to other anatomical areas must be excluded.

During the examination, a violation of the facial configuration is determined due to post-traumatic swelling of soft tissues, hematoma, and displacement of the chin away from the midline. There may be abrasions, bruises, and wounds on the skin of the face.

  Palpation of the lower jaw reveals a bony protrusion, a bone defect or a painful point, often in the area of ​​the most pronounced soft tissue swelling or hematoma. An important diagnostic criterion is a positive symptom of stress(pain symptom): when pressing on a obviously undamaged area of ​​the lower jaw in the area of ​​the fracture, a sharp pain appears due to the displacement of fragments and irritation of the damaged periosteum.

If one or more of the listed signs appears, you must immediately seek medical help and call an ambulance. The sooner specialized medical care is provided for a fracture of the lower jaw, the less likely there are complications, including very serious ones.
  Such complications include: osteomyelitis, phlegmon, neuritis, neuralgia, malunion of fragments, the occurrence of a false joint, etc. Often the complications that arise cause serious health consequences and require long-term treatment with repeated surgical interventions.

Diagnosis of a mandibular fracture

  Clinical picture data must be confirmed by results x-ray examination. Radiographs make it possible to clarify the topical diagnosis of the fracture, the severity of displacement of fragments, the presence of bone fragments, and the relationship of the roots of the teeth to the fracture gap. Usually two x-rays are taken: in frontal and lateral projections, or an orthopantomogram. For fractures of the condylar process, additional information is provided by special placements for the TMJ.

Treatment of a mandibular fracture

Treatment of victims with fractures of the lower jaw is carried out in a specialized medical institution in a hospital setting.
  The essence of the treatment is to compare the fragments and stabilize them in the correct position for the period necessary for the formation of a bone callus (about four weeks). The correctness of the comparison of fragments is controlled using control radiography.
  There are surgical and orthopedic (conservative) treatment methods, each of which has certain advantages and disadvantages. Most orthopedic techniques come down to applying to the upper and lower dentition splinting structures, which are fastened together, providing fixation of fragments of the lower jaw to the fixed upper jaw. The advantage of orthopedic (conservative) methods is that they are less traumatic and there is no threat of surgical complications (damage to large vessels or nerve trunks during surgery).
  Significant disadvantages are the forced immobility of the lower jaw during the entire period of fixation, poor oral hygiene (which may result in the development of inflammatory complications), and injury to the ligamentous apparatus of the teeth. In addition, stable fixation of fragments using splinting is not possible in all clinical situations. Currently, as a rule, orthopedic treatment methods are used for fractures of the lower jaw within the dentition without significant displacement of the fragments.

"Gold standard" surgical methods of treatment are currently considered to be the fastening of fragments using bone titanium mini plates. This technique allows to achieve the most accurate comparison and stable fixation of bone fragments. In the postoperative period, as a rule, the patient immediately has the opportunity to open his mouth, oral care is simplified, there is the possibility of early use of physiotherapy exercises, which prevents the development of cicatricial changes in the masticatory muscles; shortening the recovery period.

In the process of treating patients with fractures of the lower jaw, it is mandatory to prescribe antibiotics, given that the bone wound in such fractures in most cases is obviously infected with the aggressive microbial flora of the oral cavity. In addition, preparations of vitamins A, C, D, E, calcium preparations, some hormones (parathyroidin, calcitrin, retabolil), immunomodulators (thymalin, thymarin, timazine, etc.) play an important role in drug treatment. It is important to remember that self-medication is unacceptable. Only a doctor can prescribe medication.

In addition to fixing fragments and prescribing medications, it is necessary to use various techniques physiotherapy and exercise therapy. Timely use of these methods helps to optimize the process of bone formation and prevent the development of complications such as muscle contracture, false joint, delayed fusion of fragments, and the osteomyelitic process.

Treatment of a fracture of the lower jaw in a hospital

Treatment in a hospital is carried out in within 1-2 weeks, after which the patient is discharged for outpatient observation by a dental surgeon at his place of residence. During this period, calcium and vitamin D supplements, physiotherapeutic treatment, and physical therapy continue.
  When using orthopedic treatment methods, the outpatient doctor carries out, if necessary, correction of splints, fixing ligatures, and elastic traction. On days 7-10, the sutures are removed.
  After 4 weeks from the start of treatment in an outpatient setting, the external fixation structures are removed, after which, in the absence of complications, the patient has the opportunity to begin his full work duties, if they do not involve heavy physical labor. You should refrain from heavy physical activity for another 2-3 weeks.

It is important to remember that the success of the treatment depends not least on the patient himself, on how conscientiously he follows the doctor’s recommendations. Thus, an important condition for the success of treatment is careful adherence to oral hygiene, especially when choosing orthopedic treatment methods. Dental splints, wire fixing ligatures, and lack of movement of the lower jaw cause deterioration in the self-cleaning of the oral cavity and teeth with the help of saliva and solid food. Food residues are retained on splints and ligatures, which are a fertile basis for the proliferation of aggressive microorganisms that cause a variety of complications from periodontal damage to supporting teeth to the development of phlegmon and osteomyelitis.

It is necessary to rinse the mouth with antiseptic solutions (furacilin, chlorhexidine) not only after each meal, but also in the intervals between meals and before bedtime. Irrigation of the oral cavity can be done, for example, using a rubber bulb. In addition, be sure to brush your teeth with toothpaste and a toothbrush, remove leftover food with a toothpick, and massage your gums with your index finger several times a day.

An important component of treatment is proper nutrition. In this case, patients with fractures of the lower jaw cannot eat solid food. For such patients, a special diet has been developed - a jaw table, which differs in consistency and its components, depending on the severity of the general condition of the victim and the method of fixing the fragments. The first jaw table has the consistency of cream. It is prescribed for orthopedic fixation of fragments for the entire duration of treatment. The second jaw table (the consistency of thick sour cream) is prescribed more often to patients after surgical treatment, as well as after removal of elastic traction and in the first two days after removal of splints. This diet is transitional to the general table. In a hospital setting, the diet is prescribed by a doctor; the hospital cafeteria has a special menu and daily layout.

In an outpatient setting, after discharge from the hospital, the patient must take care of preparing appropriate food. It should be taken into account that food should be liquid and high-calorie, include proteins, fats, carbohydrates and vitamins. We can recommend three liquids that can be used to dilute (dilute) any food. This is milk, vegetable or meat broth. They are used to dilute boiled pureed vegetables (potatoes, carrots, beets, herbs, tomatoes, sweet peppers, etc.), pureed pasta and well-cooked cereals (buckwheat and oatmeal are especially useful), cottage cheese and other products. To obtain a sufficient amount of proteins, boiled meat that has been minced twice, and sometimes also mashed through a sieve, is diluted in meat broth.

In addition, you can use ready-to-eat products: sour cream, cream, milk, kefir, juices, fruit and vegetable purees (preferably from fresh fruits and vegetables).

Be sure to use vegetable oil in all dishes, as it contains many unsaturated fatty acids, which have a beneficial effect on bone tissue regeneration.

Food is taken warm 5-6 times a day. When the teeth are in close contact (double-jaw splints), food is introduced with a sippy cup with a rubber tube into the gap behind the last tooth. If there is a defect in the dentition (a tooth or several are missing), it is used to introduce food through a sippy cup tube or using a spoon. With surgical treatment methods, when the lower jaw is not fixed to the upper jaw, it is possible to eat with a regular spoon.

Medicines in the form of tablets or dragees are ground to a powder and dissolved in a tablespoon of warm water, after which they are administered using a sippy cup or spoon.

During the treatment period, it is strictly prohibited to consume alcohol, which, with such a meager diet, is quickly absorbed and causes severe intoxication, even to the point of poisoning. Alcohol can provoke vomiting, which, with double-jaw fixation of fragments, is life-threatening, since the patient, being unable to open his mouth on his own, may choke on his own vomit.

Attention! the information on the site does not constitute a medical diagnosis or a guide to action and is intended for informational purposes only.

Fighting oral contamination (oral care)

Oral care for soft tissue injuries and bone fractures should continue throughout the entire period of treatment of jaw wounds, starting from the moment of first emergency care, and during all subsequent periods of observation of the wounded person during transport and inpatient treatment. This is the most time-consuming part of caring for a jaw wound. In case of a fracture of the upper or lower jaw, as well as damage to the soft tissues of the face, an important function of the masticatory apparatus is disrupted - physiological cleaning of the oral cavity. Even in an intact oral cavity, microbial flora constantly exists, which nests in carious teeth, in the interdental spaces, on the surface of the tongue, and penetrates here from the tonsils, from the nasopharynx, and when coughing up from the respiratory tract. However, when chewing, drinking, rinsing the mouth, brushing teeth, the microbial flora in the oral cavity is constantly changing and does not linger unless there are carious teeth, fistulas and other pathological phenomena.

The cessation of chewing function in case of fractures and damage to the soft tissues of the oral cavity, as well as a decrease in this function at high temperatures, in infectious diseases and phlegmon of the tonsils and submandibular region, etc., is affected by the rapid increase in the microbial flora of the oral cavity, increasing its virulence and pathogenicity depending on from the predominance of one or another type of infection.

The best method of combating oral contamination and oral infection is systematically rinsing the mouth with weak solutions of disinfectants.

Oral care at the first examination begins with mechanical cleaning. The edges of the wound and cheek pockets are pulled apart with blunt hooks and all the bays and folds of the oral mucosa are examined; Remnants of food, blood clots, particles of dead tissue, completely free bone fragments, fragments of teeth and foreign bodies lingering here are carefully removed with tweezers, damp soft cotton wool swabs wrapped on a strong wooden stick. Wipe your gums and teeth thoroughly. The oral cavity is well cleaned with a strong stream of a weak disinfectant solution from a rubber balloon or an irrigator with a straight glass tip, which washes all the coves, folds and crevices between fragments and surfaces covered with plaque and cellular decay. Washing here plays the role of mechanical, most gentle cleaning. For washing, it is best to use a copious amount of potassium permanganate solution (1:1,000 - 1:2,000), a solution of hydrogen peroxide with boric acid, etc.

The first rinsing, along with examining the wound, should be done by a doctor, and then it can be entrusted to the nursing staff. In the future, rinsing should be done at least 3-4 times a day, after each meal and at night, to avoid the absorption of infected saliva and pus into the respiratory tract.

Rinsing is done with a glass tip (not thin), holding the patient's head over a wide tray or basin; the walking wounded subsequently rinse their mouths themselves by sitting in front of a stand on which is mounted a bottle or large Esmarch mug, equipped with several rubber tubes to serve several wounded at the same time. The tips are boiling.

With good care, bad breath soon disappears, dirty deposits are cleared; the secretion of pus and saliva decreases; the wounded feel significant relief; their general condition improves.

Already during rinsing of the oral cavity, the whole picture of the damage becomes clear - deep tears and pockets of the oral mucosa; thrombosed or bleeding vessels, areas of bone devoid of periosteum, the number of remaining teeth on the fragments; broken teeth and completely toothless fragments. Deep bleeding pockets are tamponed, bleeding vessels are ligated; exposed bones are covered with folded and sutured periosteum; Completely loose bone fragments and knocked out teeth are also removed. To avoid fusion, the cheek pockets or folds under the tongue, exposed from the mucosa, are lined with strips of iodoform gauze; free bone defects between the fragments are tamponed with iodoform gauze. The open edges of the wound help to thoroughly prepare the teeth for the application of fixing splints; it consists of removing completely loose teeth and tartar with tweezers with an experienced hand and appropriate instruments, especially near the necks of the teeth, where tartar interferes with the advancement of wire ligatures between the dental spaces and the application of splints.

Stone removal is contraindicated if it is impossible to fix the fragments with your hands so that you can apply quite a significant force required when removing the stone, and if this is associated with pain and irritation of inflammatory tissues.

We must not forget about the danger of stone particles being sucked into the respiratory tract in seriously ill patients, which can cause pneumonia from the infection. In such cases, it is better to refrain from this operation until the patient recovers his strength.

Removal of teeth and roots that cannot serve as a support for fixing splints is carried out only in cases where the general condition of the wounded allows it. Then conservative dental treatment is carried out.

In the future, oral care will consist of constant irrigation several times a day, monitoring splints, changing tampons and external dressings.

With open wounds connected to the oral cavity, in addition to pus, a lot of saliva is released. To facilitate the care of such wounded people, it is recommended to hang a special rubber bag under the chin to collect saliva and pus. Rana

can be covered or covered with a light bandage. The skin around the wound is lubricated with Vaseline or zinc paste.

In the absence of a special rubber bag, it can be replaced with an unusable ice pack or a heating pad according to the diagram attached here; to prevent the walls of the bubble from collapsing, a wire frame is inserted on top (Fig. 21).

Sometimes, on the contrary, with a healing wound with a large defect in the soft tissues and bones of the face, patients suffer from drying out of the mucous membrane of the mouth and tongue. To eliminate this painful phenomenon, lubricate the mucous membrane with boro-glycerin or other mixtures (for example, glycerin 400.0, wine alcohol 50.0, essential anise oil 0.2, peppermint oil 0.2).

A good effect is rinsing with a solution of citric acid with half a teaspoon of glycerin per glass and a few drops of a solution of menthol in alcohol.

When a chin is torn off, a protective plate made of celluloid or rubber, made to the shape of the chin and tightly fitted to the edges of the defect, is very useful; it is attached to the headband. The plate prevents saliva from flowing out and the tongue from drying out (Fig. 22).

When the surface of the damaged walls of the oral cavity is cleared of dirty plaque and begins to become covered with granulations, the surgeon’s task is to properly heal the soft tissues in the oral cavity, i.e., eliminate unwanted adhesions and correct epithelization of defects in the mucous membrane, preventing possible wrinkling and narrowing of the openings of the walls of the oral cavity. For this purpose, a number of devices are used that are mounted on oral splints: supporting plates, immediate prostheses, layers of soft gut-percha, etc., a description of which will be given below.

Comprehensive rehabilitation of jaw fractures

General provisions

In the complex of rehabilitation after jaw fractures, such measures as timely and effective fixation of fragments, antimicrobial and restorative therapy, physical methods of treatment, physical therapy and oral hygiene are in the foreground.

Patients with jaw fractures are prescribed antibiotics that have the ability to accumulate in bone tissue (lincomycin, sodium fusidine, morphocycline, vibramycin, oleandomycin). In the first 3–4 days after injury, local administration of antibiotics to the damaged area is advisable. Along with antibiotics, sulfonamides and nitrofuran drugs are prescribed. General restorative therapy includes the use of B vitamins, ascorbic acid, methyluracil or pentoxyl orally, autohemotherapy, respiratory and hygienic exercises, and a balanced diet. The use of UHF therapy (up to 10 sessions), general ultraviolet irradiation (up to 20 sessions) immediately after immobilization of fragments, and microwave therapy is indicated. Exposure to a UHF electric field is prescribed on the 2-3rd day after fixation of fragments of the lower jaw with dental sutures and on the 3-5th day after osteosynthesis with wire in the treatment of fractures of the lower jaw.

Magnetic therapy is carried out on the 4-5th day after osteosynthesis or splinting. The magnetic field induction during the first two procedures is 9-10 mT, with subsequent 12-19 mT. A sinusoidal current is applied in continuous mode. The first two procedures are carried out within 10 minutes, the subsequent ones - 15 minutes.

For bilateral fractures, the impact is performed using two straight-core inductors, which are located on both sides of the face. The number of procedures depends on the clinical picture (on average 5-10 procedures). Starting from the 2-3rd procedure, there is a noticeable decrease in tissue swelling and pain in the fracture area.

The presence of metallic inclusions is not a contraindication to the use of magnetic therapy in the indicated dosages. To improve the consolidation of fragments, on the 12th–14th day after immobilization, calcium electrophoresis is performed on the area of ​​the affected half of the face. For this purpose, a 2–5% solution of calcium chloride is used. An active electrode with calcine chloride (anode) is applied to the skin of the face at the site of the projection of the former fracture, the second electrode (cathode) is applied to the area of ​​the forearm of the right or left hand. Duration of the procedure is 20 minutes. Current strength is 3–5 mA. The course of treatment consists of 12 procedures performed every other day.

The use of physical therapy helps to more quickly restore the function of the lower jaw. Therapeutic exercise is indicated in the stage of formed young bone regenerate (bone callus) after removal of the splints (4-5 weeks after the fracture).

Patients with jaw fractures are unable to take regular food due to impaired chewing and sometimes swallowing function. A patient with a jaw fracture should be prescribed a physiologically complete diet. However, food must be mechanically and chemically gentle. Fresh products are thoroughly chopped and diluted with broth. Spices are excluded and table salt is limited. The food temperature should be 45–50 °C. It can be prepared from special canned products (food concentrates, powdered mixtures, homogenized canned food). For patients with maxillofacial trauma, there are 3 diets (tables), which are identical in chemical composition and differ in consistency.

The first jaw (tube, tube) diet is distinguished by food with the consistency of cream. Prescribed for the entire period of treatment, when splints with hooking loops are applied and intermaxillary fastening with rubber rings is carried out. These patients have lost their chewing function and have poor swallowing function.

The second jaw diet is characterized by food with the consistency of thick sour cream. Indicated for patients whose chewing function is impaired, but swallowing function is preserved. It is prescribed at a certain stage of treatment, when intermaxillary fixation can be removed, or after osteosynthesis of fragments.

The general table (No. 15) is prescribed to patients after the consolidation of fragments.

If the chewing function is impaired, it is convenient to use a sippy cup for eating, with a 20 cm long rubber tube attached to the tip. The patient can independently bring the end of the tube to a defect in the dentition or retromolar fissure and introduce about 10 ml of liquid food into the vestibule of the mouth. Then, using the retained suction power, it can move the food into the mouth and swallow it.

If the patient cannot eat on his own, a nurse feeds him.

Tube feeding is carried out using a thin gastric or duodenal tube or vinyl chloride tube with a diameter of 7–8 mm and a length of about 1 m. The tube is inserted into the stomach through the nose after anesthesia of the mucous membrane of the lower nasal passage with a solution of cocaine or dicaine. The length of the immersed probe should not exceed 45 cm. If the probe accidentally gets into the trachea, this is accompanied by a strong cough. Food gruel in a volume of 500–600 ml is carefully injected into the stomach using a large syringe in portions of 100–200 ml. After feeding, the end of the probe is clamped with a clamp and secured to the patient’s head with a bandage or plaster. A thin rubber probe can be left in the nasal passage for 14–16 days, and a vinyl chloride tube for 3–4 weeks, as it is more resistant to the action of gastric juice.

Parenteral nutrition is prescribed to patients who are unconscious for a long period of time, and also as an addition to enteral nutrition. Nutrients can be administered intravenously, subcutaneously, intramuscularly. More often, the intravenous route is used, the technique of which is not much different from the intravenous drip administration of drugs. Proteins are introduced into the body in the form of ready-made mixtures of polypeptides and amino acids (aminopeptide, casein hydrolyzate TsOLIPK, hydrolysin L-103, aminokrovin), fats - in the form of ready-made fat emulsions (intralipid, etc.), carbohydrates - in the form of hypertonic solutions of glucose, fructose or mixtures thereof, sorbitol. In addition, vitamins (C, B, A, K) and minerals - sodium, potassium, calcium salts - are introduced. Protein hydrolysates and fat emulsions can be administered intravenously at a rate of 30–40 drops per minute, solutions of glucose and salts - faster (up to 60 drops per minute).

Patients with maxillofacial trauma should be fed at least 4 times a day, distributing the daily caloric intake unequally: breakfast - 30%, lunch - 40%, dinner - 20-25%, second dinner - 5-8%.

Patient care is of no small importance. There are general and special care. General care involves general hygiene measures, monitoring the activities of the cardiovascular and respiratory systems, gastrointestinal tract and urinary system.

Special care is oral care. If the patient is unconscious, he needs to wipe his teeth and oral mucosa at least 2 times a day with a solution of furacilin, ethacridine, and potassium permanganate. Walking patients take care of their oral cavity themselves. Since after splinting the process of self-cleaning of the mouth is disrupted, you should carefully irrigate the oral cavity at least 8-10 times a day.

The importance of oral hygiene in the complex rehabilitation of injuries and damage to the maxillofacial area

Rational oral hygiene using a toothbrush and toothpaste is both an integral part of general human hygiene and a component of comprehensive rehabilitation after injuries to the maxillofacial area. The effectiveness of general treatment directly depends on the intensity of oral hygiene performed and the degree of sanitization of the oral cavity. A low level of oral hygiene against the background of decreased immunity, weakening of the general resistance of the human body after injury, including in the maxillofacial area, contributes to the development of opportunistic microflora of the oral cavity, which can lead to the development of serious complications: post-traumatic omtheomyelitis, lymphadenitis, phlegmon and abscesses, the development of septic conditions. Therefore, rational oral hygiene and sanitation of the oral cavity (if possible) is in first place in the list of rehabilitation measures after injuries to the maxillofacial area.

There are many methods for removing dental plaque. Brushing your teeth with a toothbrush using horizontal, reciprocating movements is unacceptable, since this removes plaque only from the vestibular surface of the teeth. This method of brushing teeth leads to the fact that soft plaque is transferred from the surface of the teeth to the interdental spaces. In addition, there is a danger of wedge-shaped defects appearing, especially on protruding teeth; the gingival papillae may be damaged, and the lingual and palatal surfaces of the teeth are not cleaned at all.

Taking into account the individual characteristics of the oral cavity, it is advisable to recommend a combination of individual techniques that fit into the so-called standard method of brushing teeth, which combines horizontal, vertical and circular movements. The accuracy and thoroughness of the teeth brushing procedure are determining factors in the effectiveness of oral hygiene.

It is advisable to clean the teeth of both jaws according to a certain scheme: visually, each jaw is divided into 6 segments: 2 frontal (incisors and canines), premolars, molars, right and left.

Brushing can begin on the vestibular side of the molars on the right or left side of the upper jaw and continue to the opposite side, then clean the chewing surface of the teeth and finish cleaning on the palatal surface of the teeth. The teeth of the lower jaw are cleaned in the same sequence.

All surfaces of the teeth of each segment of the jaw must be cleaned with at least 10 paired movements of the brush. A total of 400–500 paired movements. Brushing time should average 3.5–4 minutes. Cleaning should be done twice a day: in the morning after meals and in the evening before bed. The bristles of the brush should be directed at an acute angle to the surface of the teeth. It is more rational to start brushing your teeth with sweeping movements, which allow you to ideally clean the vestibular and palatal (lingual) surfaces of the teeth. The chewing surfaces of the teeth are cleaned with reciprocating horizontal movements. Finish brushing your teeth with circular movements.

Rules for brushing teeth

1. Take a toothbrush with clean hands and wash it with warm running water.

2. Toothpaste is applied to the bristles of the toothbrush.

3. Rinse the mouth thoroughly with warm boiled water.

4. Implementation of the “standard method” of brushing teeth, which combines horizontal, vertical and circular movements. Vertical or sweeping movements should predominate in brushing your teeth.

5. Teeth brushing time is 3–4 minutes, which is 350–450 paired movements of the toothbrush over the surfaces of the teeth.

6. During the process of brushing your teeth and at the end, you must rinse your mouth with warm boiled water and a fluoride-containing elixir.

7. The toothbrush is washed with warm running water, the bristles are lathered with any toilet soap, the brush is placed in a glass with the head up.

8. You need to brush your teeth 2 times a day: in the morning after breakfast and in the evening before bed.

9. The service life of the toothbrush is maximum 1 month. The brush should be sparse, with a curved handle, a small head, and artificial bristles.

10. Toothpaste is used only for therapeutic and prophylactic purposes.

Despite the ever-increasing level of dental care, the emergence of new materials and technologies in the treatment of dental caries, the fact that mechanical cleaning of teeth is necessary is undeniable.

Toothbrushes

A toothbrush is the main tool for removing deposits from the surface of your teeth and gums. Without it, it is impossible to carry out effective hygiene measures.

Natural bristles of toothbrushes:

1) there is a median canal;

2) bristles with burrs, the surface is porous;

3) the end of the bristles separates during processing.

Artificial bristles:

1) channel is missing;

2) the surface is smooth, non-porous;

3) the end of the bristles is rounded.

Currently, there are many models of toothbrushes. Each consists of a handle, a head with “bushes” of bristles planted on it. There are types of toothbrushes that differ in the shape and size of the heads, the location and thickness, the length and quality of the bristles, and the size and shape of the handles. Natural bristles and synthetic fibers (nylon, setron, perlon, polyurethane) are used to make toothbrushes.

From the comparison it is clear that toothbrushes made of artificial fiber have a number of advantages over brushes made of natural bristles.

The effectiveness of using toothbrushes, and, consequently, their correct individual choice, depends on the so-called hardness of the bristles. There are 5 degrees of bristle hardness: very hard, hard, medium hard, soft, very soft.

Exceptions are children's toothbrushes, which are made from soft and very soft bristles. Very hard and rigid brushes, if used incorrectly, can injure the gums and hard tooth tissues.

Pre-treatment with warm water makes the brush softer. Medium-hard brushes are most effective because their bristles are more flexible, which allows them to clean the gingival sulcus and better penetrate between teeth. Using a very soft toothbrush combined with careless brushing can result in pigmented stains forming on your teeth. If the periodontal and teeth are in normal condition, it is recommended to use brushes of medium hardness.

The frequency and form of bush planting are important in the design of the brush. The optimal distance between bushes is considered to be 2.2–2.5 mm. The parallel form of bush planting is the simplest and most effective. Brushes are often produced with a dense bush, which makes their hygienic maintenance difficult and also reduces the cleaning effect on the proximal surfaces of the teeth.

In addition to the frequency of bush planting, there is the concept of “trimming” the brush field and “bushes”. Most modern brushes have a serrated surface, with the edge bristles in the “bushes” sitting lower than the central ones. This design allows the central bristles to enter narrow interdental spaces, but if the bristles are hard, only the central bristles have the cleaning ability, since they do not allow the side bristles to touch the tooth surface during cleaning.

Brushes with a smooth surface remove plaque well without damaging the mucous membrane of the gums.

The main functional part of a toothbrush is the head. Brushes with small heads are most effective. A toothbrush with a short head has a relatively large working area. With this brush you can thoroughly clean all areas of your teeth.

For children, the length of the working part of the toothbrush is 18–25 mm, and the width is 7–9 mm; for adults – length 23–30 mm and width 7.5–11 mm.

Electric toothbrushes are available. In an electric toothbrush, the automatic movements of the head (vibrating and rotating) are carried out by a motor located in its handle. The frequency of movements in an electric toothbrush is quite high, approximately 50 movements per minute.

The importance of an electric toothbrush in oral hygiene is assessed differently. Research has shown that electric toothbrushes do not have any particular benefits. However, the less informed the patient is about the technique of brushing his teeth when using a simple brush, the more advantages are revealed when he uses an electric one, which, due to its novelty and necessity, stimulates the desire to regularly care for his teeth. Automatic movements of the brush free the patient from the need to carry out the correct movements, which, by the way, are often unknown to him. In this regard, the use of an electric toothbrush can be recommended for children, disabled people or patients with insufficient dexterity.

A toothbrush gets dirty easily, so it needs to be kept absolutely clean. After brushing your teeth, the brush should be rinsed under running water and thoroughly cleaned of food residues so that it can dry well, for example, in a glass with the head up. This significantly reduces the number of microorganisms in the brush, and the bristles retain their hardness and shape.

As soon as your toothbrush shows signs of wear, it should be replaced as it becomes functionally unusable. Loss of bristles, their fibering, loss of shape, bushiness, shortening of the bristles are signs of unsuitability and the need to replace the brush. Typically, a toothbrush should be replaced 10 times during the year, i.e. a monthly replacement is necessary. It is during this period that the culmination of microorganisms accumulate in the toothbrush, and it becomes a breeding ground for infection; ordinary soaping no longer ensures its ideal cleanliness.

However, even careful adherence to oral hygiene using only a toothbrush does not allow for good cleaning of the lateral surfaces of teeth and interdental spaces from plaque. As a result, it is extremely necessary to use other means in personal hygiene: dental floss, toothpicks, special dental toothbrushes, interdental stimulators, oral irrigators, brushes.

dental floss

For more thorough removal of plaque and food debris from the interdental spaces, i.e., cleaning hard-to-reach proximal surfaces of teeth, waxed or unwaxed threads are used.

There are round and flat threads. A flat waxed floss is more convenient, as it passes through contact points more easily, does not break, and covers a larger surface of the tooth. The following method of its use is recommended: a thread 35–40 cm long is wound around 1 phalanx of the middle fingers of each hand. Slowly and carefully insert into the interdental space and then tighten at the base of the gingival sulcus. Using several back-and-forth and up-and-down movements, the floss removes all soft dental plaque from the distal surface of the tooth. Then the medial surface is cleaned. To do this, carefully, so as not to damage the gingival papilla, move the floss, pressing tightly against the tooth, along its surface back and forth through the contact point and remove plaque. Then the thread is advanced through the interdental papilla to the base of the adjacent gingival groove of the next tooth and its lateral surface is cleaned. The procedure is repeated until the lateral surfaces of all teeth are cleaned. You should not push the floss with great force, as this risks damaging the gum tissue.

To make floss easier to use, there is a special holder.

Therefore, after appropriate prior instruction and hands-on demonstration, dental floss should be strongly recommended to patients as an excellent means of cleaning the sides of teeth and interdental spaces. Threads impregnated with a 2% sodium fluoride solution are used simultaneously to treat the lateral surfaces of teeth and for the prevention of caries.

Toothpicks

Other additional and well-proven oral hygiene aids are toothpicks. They are made of wood, plastic, bone, in shape - triangular, flat, round, they are used not only to remove food debris from interdental spaces, but also mainly to remove plaque from the side surfaces of teeth. Their use is especially effective if there are spaces between the teeth. If the teeth are tightly spaced and the interdental spaces are filled with interdental papillae, the possibilities of using a toothpick are limited.

Interdental stimulators

The instrument is used to massage the gums and interdental spaces. Interdental stimulators are made of rubber, have different degrees of hardness and colors, and are fixed in the hole of the toothbrush handle.

Used to thoroughly clean the proximal surfaces of teeth. The tool consists of a handle and a working fleecy part. Allows you to clean the interdental spaces with reciprocating and clockwise rotational movements.

This text is an introductory piece.

The main task of a dental surgeon during the treatment of a fracture of the upper or lower jaw is to restore the anatomical structure of the broken bone and the correct relationship of the dentition. Many techniques help to achieve this, but the effectiveness of treatment also depends on how correctly and quickly first aid was provided.

Before hospitalization

First aid to the victim includes:

• stopping bleeding (pressing or packing the wound, applying cold);
• if necessary, cardiopulmonary resuscitation;
• pain relief (analgin, revalgin intramuscularly);
• immobilization of the jaw with the help of fixing bandages (contraindicated if the victim is unconscious, since this increases the risk of suffocation from the retraction of the tongue or vomit entering the respiratory tract).

Treatment methods

1. Surgical, or osteosynthesis, involves fastening jaw fragments with special, often metal, structures.
2. Conservative or orthopedic - involve the use of special splints that fix the fracture site.

Osteosynthesis

Indispensable for complex, comminuted and multiple fractures with displacement, loose teeth and complete absence of teeth, for periodontal disease and other inflammatory diseases of the gums in the area of ​​injury. Osteosynthesis is also effective in cases of fracture of the condylar process complicated by dislocation of the articular head of the lower jaw.

Fastening materials can be steel knitting needles and rods, pins, nitride-tinan wire with shape memory, quick-hardening plastics, polyamide thread, special glue.

However, osteosynthesis with metal miniplates is considered the most convenient and safe method today. They allow you to cut through the skin and muscles on only one side, which simplifies the operation itself and shortens the recovery period. Another undeniable advantage is the ability to reliably fix fragments in areas with significant dynamic loads.

Splinting the jaw

This is the immobilization (fixation) of bone fragments using a special plastic or wire structure.

The technique, created by military doctors at the beginning of the 20th century, is successfully used by dentists today. Tire manufacturing materials have changed, methods of its imposition have been improved.

Today, a specialist has many types of tires in his arsenal:

• from standard Vasiliev band splints, the simplest and cheapest treatment method;
• up to the Tigerschdedt aluminum splints, which are performed individually for each patient, due to which they are more effective. In addition, they evenly distribute the load and minimally injure the teeth.

The type of splinting depends on the type of injury and can be unilateral (with a fracture of one jaw) or bilateral (when both are damaged).

If the teeth are preserved, it is not difficult to apply a bent dental wire splint. It is bent according to the shape of the dental arch and fixed with bronze-aluminum wire ligatures, which, like a hairpin, cover the tooth on both sides. Manipulations are performed under local anesthesia.

In case of a fracture of both jaws, a structure with a more rigid base is installed, in addition to the wire, hooks and rings are also used to immobilize the lower jaw.

Is it possible to do without splinting?

Even if the case is not severe - the fracture is unilateral, closed and without displacement - it is imperative to take measures to prevent the development of such unpleasant complications as:

• accidental displacement of fragments,
• re-injury
• development of inflammation of soft tissues,
• infection of the fracture site.

To do this, it is necessary to immobilize the jaw by any available method. This can be a sling bandage, but it is much more convenient and effective to use a splint. In case of a complicated fracture, splinting is absolutely indispensable, regardless of the location of the injury.

What will happen to the tooth at the site of injury?

If it is mobile, crushed, dislocated or prevents the reduction of jaw fragments, it will have to be removed. The same fate awaits a tooth in the presence of periodontal disease, cysts, granulomas and other inflammations. In other cases, teeth can be saved, but require careful monitoring.

Treatment tactics for displaced fractures

In such cases, before applying a splint, it is necessary to compare the jaw fragments, for which reduction orthopedic devices are used. A broken upper jaw requires traction using special dental splints.

Such injuries are very dangerous because they can cause asphyxia. But correctly provided first aid will prevent suffocation. Clear the oral cavity of foreign bodies or blood, lay the victim face down, placing a cushion rolled up from clothes, blankets, etc. up to the chest.

Rehabilitation after a jaw fracture

For successful treatment of a jaw fracture, anti-inflammatory and restorative therapy, physiotherapy, mechanotherapy and special oral hygiene are also important.

1. Within 3-4 days after the injury, antibiotics must be prescribed to prevent inflammation, which are injected directly into the area of ​​injury.
2. General strengthening therapy is taking vitamins C, P, D and group B, drugs that stimulate tissue regeneration and restore the level of leukocytes in the blood.
3. Among the effective physical procedures, we note UHF therapy, general ultraviolet irradiation, and magnetic therapy. After the third procedure, swelling and pain are noticeably reduced, swelling subsides. For better healing of fragments, 2 weeks after a jaw fracture, electrophoresis is performed using a two to five percent solution of calcium chloride.
4. Mechanotherapy, or physical therapy, accelerates the restoration of jaw function and helps if, after an injury, the mouth opens poorly or does not open at all. It can also be practiced at home, starting 4-5 weeks after the fracture, when the splints are removed and a callus has formed.
5. Special hygiene involves irrigation at least 8-10 times a day. For unconscious victims, their teeth and mucous membranes are treated with a special solution at least twice a day.

How to eat?

Since during intensive therapy and during the recovery period the jaws are rigidly fixed and habitual chewing of food is out of the question, correction of the diet is necessary during this period.

Food should have the consistency of low-fat sour cream. These are broths, pureed soups, carefully chopped vegetables and fruits, milk drinks, liquid cereals. Spices are excluded, salt consumption is limited. The temperature of the dish should not be higher than 45-50 °C. The most convenient way to eat food is through a straw.

You need to gradually switch to your usual diet after removing the splint. This is important not only for restoring chewing functions, but also for preventing disorders in the gastrointestinal tract.

When are the splints removed, and how long does it take for the jaw to heal?

The older the patient and the more complex the fracture, the longer the period required for rehabilitation. Approximately it ranges from 45 to 60 days. Removal of the splints is carried out on days 30-45, if the treatment did not include osteosynthesis, and on days 5-14 after it.

How much does it cost to treat a broken jaw?

The price depends on the nature of the injury, whether osteosynthesis was performed, what splints were used, and whether the patient attended physical therapy procedures. But let's say for sure that the service is not cheap. Osteosynthesis alone will cost from 14,000 to 55,000 rubles.

It is also necessary to consider the cost of subsequent dental treatment to restore lost teeth or damaged teeth after splinting. Our service will help you choose a competent specialist and not waste your money. Compare prices and services of different clinics, read reviews from real patients.

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It is clear that not a single broken bone will heal immediately. In case of a jaw fracture, treatment at home is possible only after contacting a traumatologist. The doctor will take a photo and provide first aid. Such an injury will require pain relief. It may also be necessary to stop the bleeding and fix the bone fragments with staples. The hospital will provide antibiotic therapy, physiotherapeutic treatment, and the broken jaw will be fixed with a bandage.

The duration of treatment and subsequent rehabilitation depends on the complexity of the fracture and lasts from 3 weeks to several months. Naturally, the patient spends most of this time at home.

The main attention should be paid to the consistency of the food you eat. You cannot eat solid food until the bones have completely fused (at least a month). The menu should consist of broths and liquid soups. Fruits and vegetables can be eaten pureed. All other food should be pureed using a blender. The food is then diluted with water. The patient takes food through a straw. It is important to choose foods rich in calcium.

For fractures, you can use decoctions of herbs such as:

• horsetail (relieves swelling);
• marsh cudweed (pain reliever);
• chamomile (reduces inflammation).

They are used to reduce the intensity of pain, remove inflammation and speed up healing. To ensure sound sleep, you can take infusions of lemon balm, valerian, motherwort, and St. John's wort before bed.

External compresses can be used after removing the fixing bandage. For these purposes, comfrey roots are used. You can also rub fir oil into the fracture site.

It is believed that mumiyo accelerates bone fusion, causing enhanced tissue regeneration. It is taken both in its pure form, washed down with water, and as part of various medicinal mixtures (with egg yolk, vegetable oil).

Such compositions are used both internally and externally. The dosage of mumiyo in all cases is standard - 0.2 g once a day (orally on an empty stomach). The course of treatment is 10 days, followed by a week break.

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What is a jaw fracture?

A jaw fracture is a trauma to the face, with damage to the integrity of its bones. Occurs when the intensity of the traumatic factor exceeds their strength. This injury is common and can be caused by any injury: strong blows to the face, a fall on a hard surface.

Most often, traumatologists observe a fracture of the articular process, although there are also injuries in the area of ​​the angle of the lower jaw, in the middle of the body of the lower jaw bone, in the projection of the mental process. The fracture can be complete or not, open or closed.

Signs of injury are obvious: a person is unable to open his mouth wide, he experiences pain when trying to talk, and his bite changes. Sometimes double vision, numbness in an area of ​​the face, and deformation of the cheekbone may occur. The full list of symptoms will depend on the nature of the injury and its location.

Fracture of the lower jaw

If we talk about a fracture of the lower jaw, then we should consider the main types of such injury:

A complete fracture is considered when there is a displacement of fragments of the jaw. They may vary in shape and quantity.




A fracture is called incomplete when there is no displacement.

With an open injury, both the mucous membranes of the mouth and the soft tissues of the face are damaged.

With a closed injury, the bone does not break through the adjacent tissues, but remains inside them.

A comminuted fracture of the jaw is rare because it requires incredible force to occur. He requires mandatory surgical intervention.

The following signs are characteristic of a fracture of the lower jaw:

Swelling and hemorrhage in the damaged area and the resulting asymmetry of the face. The swelling is usually severe, with redness of the skin and an increase in its temperature. When the fracture is closed, blood accumulates in the soft tissue and forms a clot. With an open injury, blood more often enters the oral cavity than into the external environment. The greater the blood loss, the larger the vessel was damaged, and the faster first aid and delivery of the victim to a medical facility is required.

Sensation of pain when touched. It intensifies when you try to talk, as the periosteum is damaged.

Displacement of fragments of varying degrees of severity, their mobility.

Change in bite.

Increased sensitivity and electrical excitability of teeth.

Depending on where the injury is localized, there are:

Fracture passing through the center of the incisors - median.

The injury between the first and lateral incisors is incisal.

A fracture localized in the canine area is a canine fracture.

The injury opposite the chin is mental.

Injury to the body of the jaw, the one located between the 5th and 8th teeth.

In the upper third of the jaw there is a fracture of the jaw branch.

Fracture of the base of the condylar process.

Cervical fracture, that is, the one located near the process of the jaw (condylar) and coronal, located near the coronoid process.

Providing first aid if a person has suffered a fracture of the lower jaw is as follows:

To begin with, the jaw must be fixed. This is done using a bandage. You need to place a flat, hard object, such as a ruler, under your teeth. The lower jaw is then pressed against the upper jaw and immobilized by wrapping it in a bandage. If the person is not conscious, then this cannot be done, as it will be possible to miss swallowing the tongue or getting vomit into the respiratory tract.

If there is bleeding, then it must be stopped. To do this, the wound is pressed or tamponed with a clean, preferably sterile, material. If you additionally apply cold to the site of injury, this will help reduce blood flow and also somewhat alleviate the pain symptom.

It is important to keep the oral cavity clear of possible debris, in particular: blood clots and vomit.

Try not to disturb the person before the arrival of the medical team. It is better for him to sit; if this is not possible, then you can lay him face down or on his side.

If severe pain occurs, it is necessary to alleviate them. For this, analgin, revalgin, naproxen are used. Since a person with such an injury will not always be able to swallow a tablet, it is necessary to crush it into powder and dissolve it in water and give it to the victim to drink. An intramuscular injection will be even more effective, but, as a rule, it is rarely possible to do it when providing first aid. Cold, which will constrict blood vessels, reduce swelling and pain, will also help alleviate the condition. But before applying ice, it must be wrapped in a cloth.

After carrying out these activities, the person must be taken to a medical facility for further treatment by professionals. X-ray examination is used to diagnose a fracture. Since this is a serious injury, often accompanied by a spinal injury, an additional x-ray of the cervical spine is often prescribed before starting treatment. This is done to prevent damage to the spinal cord. It is also necessary to make sure that the person does not have a concussion or intracavity cranial bleeding.

A fracture of the upper part is somewhat less common and accounts for up to 30% of all cases of jaw damage.

It is classified depending on the fracture line:

The inferior line (lefor one) has a direction from the beginning of the pyriform aperuta to the process of the sphenoid bone (pterygoid).

The middle line (lefor two) runs along the bones of the nose, including the bottom of the orbit and the pterygoid process.

The upper line (lefor three), directed to the cheekbone, through the bones of the nose.

The danger of injury lies in its consequences, which can be expressed in meningitis, concussion and osteomelitis. The higher the break line is located, the more often undesirable consequences occur.

Signs of a fracture of the upper jaw, depending on its type:

If there is a fracture under the palatal vault, with a fracture of the maxillary sinus and a fracture of the nose, the victim experiences swelling of the cheeks, nose and lips, with severe bleeding between the lip and teeth.

If part of the upper jaw is torn off from the base of the skull, and the fracture line crosses the orbit and bridge of the nose, then there is numbness in the area under the eyes, and pronounced hematomas in the same place. Blood flows from the nose, often it is impossible to stop salivation. The sense of smell is either completely absent or significantly impaired.

If the jaw separation is accompanied by a fracture of the base of the skull, then vision function will be impaired and the mouth will not be able to open. The face will be asymmetrical, the hematomas resemble glasses, the eyeballs will be lowered down.

Regardless of the type of fracture, a person often experiences nausea, vomiting may occur, the bite will be disturbed, and the pain will be pronounced. All other functions are difficult, somehow: respiratory, chewing and speech. A concussion almost always accompanies this injury.

First aid, in addition to basic measures in the form of immobilization, pain relief and bleeding control, should be supplemented by restoring respiratory function. To do this, it is necessary to remove all foreign objects from the mouth, in particular, tooth fragments and vomit. If a person is feeling nauseous, they should immediately lay them on their side or face down.

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Displaced jaw fracture

In case of a jaw fracture, displacement of fragments can be observed in three directions: sagittal, vertical and transversal. They play a decisive role in determining treatment tactics and choosing the device that will be used to reduce them.

Most often, splints made of wire are used, secured by the teeth. The bones are collected manually by the surgeon; at this time the patient can be under either local or general anesthesia. Fixation of fragments can also be carried out using a nylon core. Next, the jaw is secured with metal knitting needles or plates, which are applied externally.

When fixation is carried out, the patient is recommended to rest and take antimicrobial measures.

Double jaw fracture

A double jaw fracture is characterized by the fact that it diverges in three directions:

The middle part of the jaw is directed downwards.

The lateral ones extend inward and upward.

This injury is dangerous because after receiving it, a person may die from asphyxia, which occurs as a result of the tongue recessing. Therefore, it is necessary to especially carefully monitor its condition.

Consequences of a jaw fracture

In order to avoid the consequences of a jaw fracture, you should not self-medicate, but seek medical help as soon as possible. Complications include:

Displacement of one row of teeth.

The formation of pronounced gaps between the teeth, which will be located at the site of the fracture.

Severe displacement of fragments with facial deformation due to muscle strength.

Displacement of teeth resulting in an abnormal bite.

Meningitis.

Osteomelit.

Treatment of a jaw fracture is the prerogative of the doctor. The sooner it is started, the better for the patient.

Basically, the activities come down to the following actions:

Treating the existing wound and disinfecting it.

If there is a displacement of the nasal septum, then its alignment.

Comparison of possible fragments and alignment of whole bones.

Reliable fixation of the jaw using a special splint. She must be completely immobilized. A splint is applied for up to 1.5 months, until the jaw bones heal. Sometimes doctors surgically implant metal plates into the jaw. They are fixed with screws.

Carrying out anti-inflammatory therapy.

When the main course is completed and the splint is removed, then it will be possible to move on to the rehabilitation stage. It should be aimed at restoring several vital functions: chewing, swallowing, speech, vision.

Splinting for a jaw fracture

Splinting is one of the main methods of treating jaw injury. The procedure involves fixing fragments using a structure consisting of plastic or wire.

The type of splinting depends on the nature of the injury:

It is applied on one side when the fracture is one-sided; a wire is used to fix the damaged areas.

It is applied on both sides, while the structure has a more rigid base. In addition to it there are hooks and rings.

When both the upper and lower jaws are broken and there is displacement, then it is advisable to use double-jaw splinting. For fixation, copper wire is used, fastened to the teeth and fixing the jaws with rings.

If a plastic version is used, it should be placed under the chin and secured with a bandage around the head. But this method is indicated in cases where assistance must be provided in a short time in order to deliver the victim to the traumatology department.

When the fracture is complicated and there is significant displacement of the fragments, then before splinting, it is necessary to compare them.

On topic: 12 folk methods for home treatment

Nutrition for a jaw fracture

Correction of the diet for such injuries is a necessity. This is due to the fact that during intensive therapy and during recovery, the jaws will be in a fixed state, which means that the person will not be able to fully control them.

The minimum time for bone fusion is a month, which means that during this time the victim will have to consume only liquid food. Its consistency should be equal to that of sour cream. Therefore, it is advisable to feed the patient with broths and soups, vegetables and fruits, minced through a meat grinder or blender, and boiled porridge. It is imperative to include dairy drinks in the menu.

Find out more: What can and cannot be eaten if you have a fracture?

When the splint is removed, you should not immediately switch to solid food. It must be introduced gradually. This is important not only for the normal restoration of the functioning of the jaw, but also for preventing disruptions in the gastrointestinal tract.

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Peculiarities

No one is immune from such a fracture, but it is most common in men aged 20 to 45 years.

Reasons that lead to these injuries:

• structural features of the bone (movable arch fixed at the extreme points);
• protruding chin (it bears the brunt of the impact);
• falls, blows.

A jaw fracture is a rather dangerous injury, since if bones and their fragments are displaced, the airways can be blocked, blood vessels, nerves of the head, neck, and even the brain stem can be damaged. During a fracture, infectious complications from diseased teeth are possible, which lead to osteomyelitis (bone damage).

Violation of the integrity of the jaw bones can lead to death. This danger arises with complex fractures, which lead to other serious disorders and are accompanied by associated injuries.

A broken jaw in itself is a dangerous, but not fatal injury.

The lower jaw has certain places that are susceptible to fractures due to certain injuries. Fractures happen:

• open;
• closed;
• with offset;
• without displacement of fragments;
• splintered.

Symptoms of a fracture of the lower and upper jaw

Accurate diagnosis of the fracture, its type and severity determine further treatment.

Symptoms indicating a violation of the integrity of the jaw bones are quite extensive. They can be identified visually, as well as by the sensations of the victim. Quite often, a fracture is accompanied by a traumatic brain injury and loss of consciousness, so it is very important to receive timely, qualified medical care.

And so, the main signs indicating a serious injury to bone tissue:

• severe pain at the site of injury, intensifying when attempting to move; if nerve endings are affected, the pain is unbearable;
• bleeding into the oral cavity or into the outer surface through a damaged skin vessel;
• swelling of the face. The swelling is quite pronounced in the area of ​​fractures, characterized by pastosity, local temperature rise, and redness;
• if the lower jaw is damaged due to external influences, wounds, abrasions, and hematomas may appear on the skin;
• deformation of the jaw (after displacement) and disruption of the skin texture;
• pain when pressing on the chin;
• bleeding from the nose or ears is sometimes accompanied by leakage of cerebrospinal fluid (you can see it with a napkin that is applied to the nose and, if there is a yellowish spot on it, this indicates the presence of cerebrospinal fluid in the blood).

To establish an accurate diagnosis, the doctor not only studies the symptoms, but also conducts additional examinations that help determine the severity of the injury, possible complications, and associated injuries. For this purpose, X-rays, orthopantomography, computed tomography, and MRI are used.

First aid for jaw injury

Self-medication for jaw injuries is life-threatening and risks possible complications. Therefore, if you receive any jaw injury that results in signs of a fracture, you should immediately call an ambulance. You can highlight what first aid is based on before the arrival of specialists. This:

• cardiopulmonary resuscitation (if breathing stops);
• stopping bleeding;
• anesthesia;
• jaw fixation.

A displaced fracture can result in bone fragments blocking the trachea, which can result in suffocation and death. Therefore, first of all, it is necessary to clear the mouth of broken teeth and vomit (this must be done extremely carefully so that displaced fragments do not cause even more harm). The tongue should also be fixed. This can be done using a metal spoon or gauze. If the person is unconscious, then a puncture is made in the tongue two cm from the tip and a thread is pulled through it, the second end is sewn to the collar. The tongue should rest against the inside of the teeth. The position of the victim should be horizontal with his head turned to the side.

If there is no breathing, artificial respiration is performed - “mouth to mouth”. Cover the victim's mouth with a handkerchief and blow in air, while holding the nose with your fingers. If the pulse cannot be felt, then perform an indirect cardiac massage (90-100 pressures per minute). A combination of these two resuscitation procedures would be correct. It is carried out by 30 pressures and 2 injections.

An open fracture is accompanied by severe bleeding. The first aid to stop it is to press a cotton swab or napkin to the wound and apply cold compresses to slow down the blood flow.

Since a fracture of the jaw bone causes severe pain, until the ambulance arrives, it is necessary to alleviate the condition of the injured person and, if possible, relieve severe pain symptoms. It is unlikely that a person will be able to take a painkiller pill, so you need to resort to administering the drug intramuscularly. If this is not possible, then you can try grinding the tablet into powder and diluting it in a small amount of water and giving it to drink. It is recommended to use the following drugs: analgin, naproxen, revalgin. Also remember that cold relieves pain symptoms well. Before medical help arrives, you can apply cold for 15-10 minutes, take a break for a couple of minutes and repeat the procedure.

Immobilization of the jaw for transportation is carried out only when the victim is conscious. Stabilizing the jaw means preventing further damage and reducing pain. In case of a fracture of the upper jaw, a plate of dense material is placed under the upper teeth and tied to the head using a piece of fabric (see photo 1).

photo 1

The same type of fixation is performed in case of injury to the lower jaw.

First aid is sometimes so important that it can save a person's life. This is especially true for open fractures with displacement and head injuries. The first minute is important for stopping bleeding and resuscitation efforts to restore heart rhythm and breathing.

Fracture treatment

Treatment depends on the type of injury and the severity of the fracture. The main stages are distinguished:

• eliminating the source of bleeding (ligation of the damaged vessel, suturing);
• wound treatment and splinting. First you need to eliminate the consequences of the injury in the mouth (remove fragments of bones, teeth, blood clots) and only then stitches are applied;
• treatment with antibiotics for an open fracture;
• if the respiratory rhythm is disturbed, the doctor extends the tongue and secures the jaw in the desired position;
• Depending on the severity of the fracture, fixation of bone fragments is also carried out. First, they need to be compared into a coherent composition. There are cases when intermaxillary traction is first used, followed by the application of a splint;
• Doctors use a special intermaxillary fastener to secure broken pieces of the jaw. To do this, special hooks are attached to the intact and broken jaw, between which a rubber ring is installed, which acts as a mechanism for fastening bone fragments.
• splints are installed to fix bone fragments. Splinting is performed using special wire (see photo 2).

Let us dwell in detail on such a procedure as splinting. It is performed by a qualified dentist. Its main task is to fix bone fragments. Splinting is indicated for bone displacement. Before performing this manipulation, an X-ray of the jaw is taken, from which the degree of damage is determined, after which treatment is carried out. The first consequences of violating the integrity of the jaw are the removal of all teeth in the area of ​​the fracture before applying a splint. The damaged bone is collected piece by piece and secured with special clamps.

There are several types of splinting. The choice depends on the severity of the fracture. This can be unilateral, bilateral or double-jaw splinting. Splinting is an effective way to achieve complete immobilization of jaw bone fragments.

The consequences of jaw fractures in most cases are eliminated surgically. This treatment is aimed at restoring bone integrity (osteosynthesis). His methods are determined by the severity of the fracture in the victim. This may be external osteosynthesis. It allows the jaw to partially return its functionality until it is fully restored. It is carried out by fixing the bones with special knitting needles. Treatment with intraosseous osteosynthesis involves inserting a special guide into the medullary canal of the bone. Bony repair allows you to treat a fracture by applying a metal plate using screws and screws. This method allows treatment without applying a plaster cast. Transosseous osteosynthesis is the connection of fragments with special means that are carried out at an angle through the fracture.

Treatment is not limited to the methods listed above. Today, there are many other techniques and techniques that are used to treat jaw fractures. The attending doctor chooses how and with what to treat the fracture, based on the capabilities of the clinic, his own skills, and also on the basis of the severity of the injury.

After matching the bones and applying fixing bandages, the treatment does not end. Depending on the severity of the injury, surgery, and possible complications, a course of therapy is prescribed. Treatment with anti-inflammatory drugs and antibiotics is considered mandatory. This is necessary to prevent the development of infections, inflammations and for the general strengthening of the body.

Treating a broken jaw yourself at home is strictly prohibited. This can lead to serious complications. These injuries should only be treated by a professional facial surgeon. Who will be able to correctly diagnose and piece together the damaged jaw, which will not only restore its full functions, but also preserve the shape of the facial part of the head.

How long it takes to recover depends on many factors:

• complexity of the fracture and severity of surgery;
• age and general condition of the patient;
• presence of concomitant diseases and injuries;
• following the doctor's recommendations.

The jaw heals on average in about two months. The splints are removed after one and a half, without osteosynthesis. If this method was used, then after two weeks.

The rehabilitation period plays a major role in a speedy recovery. Depending on the severity of the fracture, special exercises and physiotherapeutic procedures are prescribed. It is recommended to start exercise therapy no earlier than a month after the injury and, of course, after removing the splints and fixing bandages. The exercises are aimed at restoring facial expressions, speech, chewing and swallowing functions. How long it takes to completely restore the jaw also depends on the individual characteristics of the patient, the severity of the injuries suffered and personal perseverance in achieving the goal.

Features of catering

Violation of the integrity of the jaw bone and all the above-described manipulations aimed at its restoration entail great difficulties in the implementation of natural processes. Nutrition during this period should be liquid, but at the same time contain all the substances necessary for a person. You can only eat food that has been ground and diluted to a liquid state. Nutrition is provided by the following methods:

• a sippy cup with a rubber tube that is inserted directly into the stomach. It can also be used at home to feed the victim;
• gastric tube, it is installed in the hospital;
• drip, used when the patient is unconscious;
• nutritional enemas, in severe cases, when the unconscious patient does not have veins for the administration of maintenance drugs.

Nutrition also involves the presence of certain foods in the diet. During this period, food prepared at home should completely replenish the body’s daily need for microelements, proteins, and fats. This should be a complete meal containing high-calorie dishes. It is useful for the patient to eat boiled meat, dairy products, vegetables and fruits for recovery. Everything should be ground to a mushy state and diluted with liquid. You need to eat dishes with a lot of vegetable fats. Food should be heated to 40-45 degrees. You can take it at home through a straw. Drinking alcohol is prohibited.

traumahelp.ru

A fracture is the displacement of bones from their physiological position. As for the jaw, there are fractures of the lower and upper jaws, which we will consider separately.

Fracture of the lower jaw And

Description of injury

Such a fracture is characterized by complete or partial displacement of the jaw bones from their anatomically correct position. It often occurs due to mechanical damage to the jaw during sports, an accident, a fight, or a gunshot wound. Depending on the nature of the damage, the following types of mandibular fractures are distinguished:

• a complete fracture, when in addition to bone displacement, fragments also shift;
• incomplete fracture - when the main bone is displaced, the fragments do not change their position;
• open fracture - when the bones are displaced, the oral and sometimes nasal cavity ruptures;
• a closed fracture, which is almost impossible to detect during visual inspection, since it is hidden in the thickness of the tissue.

Symptoms of a mandibular fracture

In some cases, it is very difficult to determine that a patient actually has a fracture. A broken jaw may not show any obvious signs of trauma, and the displacement of the bones may only be visible on an x-ray. In general, based on symptoms such as sharp or dull pain in the cheekbones or chin, malaise, headache and dizziness, a traumatologist can make the correct diagnosis.

Broken jaw: treatment

— combination of bone fragments (if necessary);

— application of a splint;

— fixation of both the lower and upper jaws for the entire period of bone fusion;

- taking antibiotics and antispasmodics.

Broken jaw: consequences

Depending on the nature of the damage, the following consequences may occur: displacement of the dentition, development of malocclusion, regular displacement of bone fragments under any load on them, disruption of respiratory, swallowing and chewing functions, as well as speech. Possible sticking of the tongue into the throat, lack of sensitivity in the lower jaw, as well as pain in the fracture area. Unfortunately, despite all attempts at recovery, a broken jaw will never look the same again.

Jaw fracture: symptoms

It is considered a very dangerous injury, since it cannot be avoided without causing a concussion and displacement of the nasal bones. Such fractures often occur in traffic accidents or when shot from a firearm.

When the upper jaw is fractured, the following symptoms are observed:

- severe pain in the area of ​​injury;

- a feeling of bone displacement due to difficulty or complete lack of breathing;

- violation of respiratory, chewing and swallowing functions, as well as speech;

- hemorrhage in the eyeballs;

- general malaise, weakness.

Treatment of a fracture of the upper jaw must be carried out under the strict supervision of a doctor in order to avoid improper fusion of bones and re-displacement of fragments. Basically it includes the following activities:

— treatment of the injury, its mandatory disinfection;

- alignment of the nasal septum;

- combination of broken bones, as well as their fragments;

— strong fixation of the fracture with splints to create complete immobility of the entire jaw;

- anti-inflammatory therapy.

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