jaw fracture
Introduction
Introduction to jaw fracture Jaw fractures include maxillary fractures and mandibular fractures. The external force is too large due to trauma and other causes of continuous interruption of the jaw bone, usually accompanied by damage to the head and face or other parts of the body or organs. It mainly affects the oral function and maxillofacial morphology of patients, and becomes an obstacle to the recovery of psychological and physiological state of patients after trauma. It is related to the quality of life of patients after injury and has received more and more attention in recent years. The treatment of jaw fracture is generally treated with open reduction and fixation. The prognosis is good, and the occlusal relationship and function can be restored after operation. basic knowledge The proportion of illness: 0.004% Susceptible people: no specific population Mode of infection: non-infectious Complications: oral ulcers
Cause
Cause of jaw fracture
The main cause of jaw fractures is various external injury effects, usually including impact injuries, traffic injuries, fall injuries, gunshot wounds, and a small number can be damaged by iatrogenic (such as impacted gum crown), but in summary, All external forces are directly or indirectly affected by the maxillofacial region. With the popularity of motor vehicles, the proportion of jaw fractures caused by traffic accidents has increased year by year, which is the main cause of jaw fractures. The wartime was caused by gunshot wounds.
Prevention
Jaw fracture prevention
This disease is mostly caused by traumatic factors, so paying attention to production and life safety, avoiding injuries, etc. is the key to prevent this disease, followed by diet adjustment for patients:
1, eat more vegetables, protein and vitamin-rich diet, can prevent the occurrence and development of osteoporosis.
2, early fractures should be light, in order to facilitate the swelling of the phlegm, the late should be partial taste, choose the right diet to adjust the liver and kidney, is conducive to the healing of fractures and functional recovery.
Complication
Jaw fracture complications Complications, oral ulcers
The disease often causes some complications due to the combined injury at the time of fracture. For example, the condyle area is severely traumatized, and may be accompanied by the injury of the tibial plate, which causes swelling in this area and bleeding in the external auditory canal. There may be cerebrospinal fluid otorrhea.
In addition, the disease is often complicated by complications such as infections and ulcers:
1. Infection is a common complication of open reduction of jaw fracture. When infection occurs, it should be used for pus culture and drug susceptibility test. According to the drug sensitivity test, sensitive antibiotics should be used to resist infection. If the fracture end forms dead bone, it can be removed surgically. The dead bone and granulation tissue were scraped, and the bone graft was repaired 6 months after the wound was healed.
2, the main cause of jaw fracture complicated with oral ulcers, one is due to the patient's fracture after the hook with the arch of the jaw and intermaxillary traction fixation, so that it can not normally perform closed movement, the mechanical self-cleaning effect of the oral cavity is affected; The oral epithelial tissue is continuously falling off, the saliva accumulates, the food residue is stagnant in the oral cavity and the dental arch splint, and it is not cleared in time, which leads to stomatitis and mucosal ulceration caused by food decay and degeneration. The second is to control the infection, and the bacteria in the body after a large number of antibiotics are applied. Group disorders, some normal bacteria in the mouth are inhibited, mold and other pathogenic bacteria abnormal reproduction, and third, because the patient can not eat properly, the body's resistance is reduced, etc. can easily lead to oral ulcers.
Symptom
Jaw fracture symptoms common symptoms jaw dislocation jaw joint pain comminuted fracture dyspnea eyeball shift occlusion relationship disorder
Clinical manifestations of mandibular fractures
1. The factors affecting the displacement of the fracture segment after fracture of the mandibular fracture include: the location of the fracture, the size and direction of the external force, the direction and inclination of the fracture line, whether the fracture segment has teeth and the pulling effect of the attached muscle. Among them, the pulling of each masticatory muscle plays an important role. Frequent fractures occur in different situations due to fractures in different parts and muscle pull in different directions.
2, bite and malocclusion is the most common sign of jaw fracture, which is of great significance for the diagnosis and treatment of jaw fracture. Even if the fracture segment is only slightly displaced, occlusion can occur and affect the function. There may be many situations such as early contact, opening and closing, reversing and straddle.
3. Abnormal movement of the fracture segment Under normal circumstances, the mandible moves in an overall movement, and abnormal activities occur only when a fracture occurs.
4, when the lower lip numbs the mandible fracture, sudden tearing or pulling often damage the inferior alveolar nerve, and the lower lip is numb.
5, Zhang mouth restrictions due to pain and muscles of the jaw muscles, most of the mandibular fractures have symptoms of mouth opening.
6, gingival tears often seen gingival tears, discoloration and edema.
Clinical manifestations of maxillary fractures
1. The fracture line of the fracture of the jaw line is as described in the classification section. It is easy to occur in the suture and the weak bone wall. The most common clinically is the transverse fracture and the isolated fracture. The Le Fort classification even if the fracture is broken. Sort the height of the line.
2, the fracture end displacement of the maxilla does not adhere to the powerful masticatory muscle, the impact of the muscle pull displacement is small, so the fracture block is more likely to shift with the direction of the impact force, or droop due to its gravity, usually appear Shift in the backward direction.
3, the occlusion relationship disordered displacement of the maxillary fracture segment will inevitably cause the occlusion relationship disorder. If one side of the fracture segment is displaced downward, there will be occlusal early contact on the side. When the maxilla and the pterygoid fracture at the same time, because the pterygoid muscle is pulled downward, the posterior teeth are often contacted early, and the anterior teeth are open and closed.
4, sputum and periorbital stenosis of the maxillary fractures in the sacral and periorbital often accompanied by intra-tissue hemorrhage, edema, the formation of a unique "glasses symptoms", manifested as periorbital ecchymosis, upper and lower iliac crest and subconjunctival hemorrhage, or There is a shift in the eyeball and a double vision occurs.
5, craniocerebral injury of the maxillary bone fracture often accompanied by craniocerebral injury or skull base fracture, cerebrospinal fluid leakage.
Examine
Examination of jaw fracture
The examination methods of this disease mainly include the following two types:
1, X-ray inspection:
Conventional X-ray plain film is simple to operate and has short imaging time. It is the preferred method for maxillofacial fracture examination, especially the interference of the surrounding bone in the mandibular body. It can be diagnosed immediately and the shape of the fracture line is also poor. Due to the interference of the connected bones, the overlapping of the bones and the overlap of the teeth, on the one hand, the unsatisfactory fractures of the sagittal fracture and the posterior wall of the maxillary sinus, on the other hand, the multiple fractures and comminuted fractures are difficult to display and are prone to missed diagnosis. Therefore, for routine X-ray plain film examination showing suspicious fractures, CT should be further examined.
2, CT examination:
CT transverse scan can accurately display the fracture. The transverse fracture line is consistent with the scan line, and often missed diagnosis. Coronal scan is needed to compensate for the deficiency. However, coronary scans are difficult for patients with severe disease. For example, CT three-dimensional reconstruction technology can display transverse fractures in any aspect, especially those with complex structures such as temporomandibular joints. It can be applied with "cutting technique" and multi-planar reconstruction technique, and comparative studies on both sides can visually show fractures and joints. Dislocation, and can clearly show the fracture line and the size and spatial position of the fracture piece, but CT three-dimensional reconstruction technology also has its shortcomings, such as partial volume effect makes the thin sieve bone and the broken small bone in the cavity difficult Therefore, CT images must be scanned in conjunction with transverse transposition when CT three-dimensional reconstruction is used to diagnose maxillofacial fractures.
Diagnosis
Diagnosis and diagnosis of jaw fracture
Diagnosis of mandibular fracture
In the first diagnosis of the jaw fracture, the cause, location and clinical manifestations of the injured person should be understood. The direction and location of the trauma should be understood. The detailed medical history will help to identify the location and type of the fracture. After the injury area and X-ray auxiliary examination, the diagnosis is generally not difficult to make. Specific to the mandibular fracture, combined with the medical history and the above clinical manifestations, supplemented by imaging examination can confirm the diagnosis. Diagnosis of mandibular fractures Previously, mandibular lateral slices or curved tomographs were often taken, but the details of the fracture and the three-dimensional state were not clearly displayed, and the subsequent therapeutic aid was limited. CT scans are now available for a comprehensive understanding of fracture information. In particular, 3D CT reconstruction can visually observe and analyze the location and displacement of fractures from multiple angles, which helps guide the subsequent fracture reduction.
Diagnosis of maxillary fracture
1 clinical manifestations (see the clinical manifestations of maxillary fractures)
2 Imaging examination of the Fahrenheit position and the lateral position of the skull is an imaging method for the diagnosis of maxillary fractures in the past. Due to severe image interference, the detailed details of the fracture are difficult to see. CT scan is a commonly used imaging examination method. Axial and coronal CT, especially 3D bone reconstruction can visually observe and analyze the location and displacement of fractures from multiple angles, and whether it involves the bottom of the bone, etc., avoiding The blindness of surgical exploration.
