Fracture of the upper and lower jaw

What is a jaw fracture?

Jaw fracture – This 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 damage is common, any injury can be the cause: strong blows to the face, falling on a hard surface.

Most often, traumatologists observe a fracture of the articular process, although there are injuries in the region 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 trauma are obvious: a person is unable to open his mouth wide, when he tries to talk, he experiences pain, the bite changes. Sometimes there may be double vision, numbness of the face, deformity of the cheekbone. The full list of symptoms will depend on the nature of the injury and its location.

Lower jaw fracture

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

• A complete fracture is considered when the fragments of the jaw have been displaced. They may vary in shape and quantity.

• A fracture is called incomplete when no displacement is observed.

• 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 adjacent tissues, but remains inside them.

• A comminuted fracture of the jaw is rare, as it requires the application of incredible force to occur. He needs mandatory surgery.

The following signs are characteristic of a mandibular fracture:

• Swelling and hemorrhage in the damaged area and the asymmetry of the face caused by these phenomena. Edema is usually severe, with reddening of the skin and an increase in its temperature. When the fracture is closed, blood accumulates in the soft tissues and forms a clot. With an open injury, blood enters the oral cavity more often than into the external environment. The stronger the blood loss, the larger the vessel was damaged, and the faster the 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 region is a canine fracture.

• The injury opposite the chin is mental.

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

• A fracture beyond the 8th tooth is angular.

• In the upper third of the jaw – a fracture of the branch of the jaw.

• Fracture of the base of the condylar process.

• A cervical fracture, that is, one that is located near the process of the jaw (condylar) and a coronal one, located near the coronoid process.

First aid, if a person has received a fracture of the lower jaw, is as follows:

• To begin with, the jaw must be fixed. This is done with a bandage. Under the teeth, you need to put a flat hard object, for example, a ruler. Then the lower jaw is pressed against the upper jaw and immobilized by wrapping it with a bandage. If a person is not conscious, then this cannot be done, since it will be possible to skip swallowing the tongue or getting vomit into the airways.

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

• It is important to leave the oral cavity clean from possible fillers, in particular: blood clots and vomit.

• Try not to disturb the person before the arrival of the medical team. It is better that he sits, 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 pill, it is necessary to crush it into powder and, having dissolved in water, give the victim a drink. An intramuscular injection will be even more effective, but, as a rule, it is rarely possible to do it when providing first aid. It will help alleviate the condition and the cold, which will narrow the blood vessels, reduce swelling and pain. But before applying ice, it must be wrapped with a cloth.

After carrying out these activities, the person must be taken to a medical institution for further therapy by professionals. An x-ray is used to diagnose a fracture. Since this is a serious injury, often accompanied by a spinal injury, an additional x-ray of its cervical region is often prescribed before starting treatment. This is done to avoid damage to the spinal cord. It is also necessary to make sure that the person does not have a concussion and intracavitary cranial bleeding.

Fracture of the upper jaw

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

It is classified according to the line of fracture:

• The lower line (lefor one) has a direction from the beginning of the pear-shaped aperut to the process of the sphenoid bone (pterygoid).

• The middle line (lefort two) runs along the bones of the nose, capturing the bottom of the orbit and the pterygoid process.

• The top line (lefort three) is 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, the more often undesirable consequences occur.

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

• If a fracture occurs under the palatine vault, with a fracture of the maxillary sinus and a fracture of the nose, the victim has 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 fault line crosses the orbit and bridge of the nose, then there is numbness of 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 separation of the jaw is supplemented by a fracture of the base of the skull, then the function of vision will be impaired, the mouth will not open. The face will be asymmetrical, hematomas resemble glasses, eyeballs are lowered down.

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

First aid, in addition to the basic measures in the form of immobilization, anesthesia and bleeding control, should be supplemented by the restoration of respiratory function. To do this, it is necessary to remove all foreign objects from the mouth, in particular, fragments of teeth and vomit. If a person feels sick, then you should immediately put it on its side, or face down.

Displaced jaw fracture

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

The most commonly used tires are made of wire, with fixation by the teeth. The bones are collected manually by the surgeon, the patient at this time can be under both local and general anesthesia. Fixation of fragments can also be carried out using a nylon vein. Next, the jaw is fixed with metal knitting needles or plates that are superimposed on the outside.

When fixation is carried out, the patient is advised to rest, with the implementation of antimicrobial measures.

Double jaw fracture

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

• The middle part of the jaw is directed downward.

• Lateral go inward and upward.

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

Sequelae 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. As complications are distinguished:

• Displacement of one dentition.

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

• Strong displacement of fragments with deformation of the face, due to muscle strength.

• Displacement of teeth with the occurrence of an abnormal bite.

• Meningitis.

• Osteomelit.

Jaw fracture treatment

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

Basically, the activities are reduced to the following actions:

• Treatment of an existing wound, its disinfection.

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

• Comparison of possible fragments, and combination of whole bones.

• Reliable fixation of the jaw with a special splint. It needs to be completely immobilized. A splint is applied for up to 1,5 months, until the jaw bones grow together. Sometimes doctors implant metal plates into the jaw through surgery. They are fixed with screws.

• Carrying out anti-inflammatory therapy.

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

Splinting for a broken jaw

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

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

• Superimposed on one side, when the fracture is one-sided, for this a wire is used that fixes the damaged areas.

• Superimposed on both sides, while the design 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, with fastening by the teeth and fixing the jaws with rings.

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

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

Nutrition for a broken jaw

Correction of the diet in such injuries is a necessity. This is due to the fact that during intensive care and during recovery, the jaws will be in a fixed state, which means that a 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 equated to the state of sour cream. Therefore, it is advisable to feed the patient with broths and soups, vegetables and fruits, passed through a meat grinder or blender, boiled cereals. Be sure to include milk drinks in the menu.

When the tire is removed, do 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 the prevention of malfunctions in the digestive tract.