Fracture of the upper jaw - symptoms and treatment

Depressed fractures of the skull bones are a violation of the integrity of the bony part of the head, which are characterized by pressing the bone into it. They are considered the most dangerous because they can cause damage to the dura mater, blood vessels, medulla and compression of intracranial structures.

The Neurology Department of CELT invites you to undergo diagnostics and treatment of depressed fractures of the skull bones in Moscow. Our multidisciplinary clinic is well known in the paid medical services market in the capital and region. We employ leading domestic specialists who have modern effective diagnostic and treatment methods. You can make an appointment with them online or by contacting our operators.

Main clinical symptoms of a frontal bone fracture

• Focal or diffuse nature of the headache;
• Severe subcutaneous emphysema in the forehead;
• With depressed fractures of the frontal bone, its deformation is visible;
• Dizziness;
• Nausea, which in the victim is not associated with food intake;
• Vomiting that does not bring relief;
• Brief or prolonged loss of consciousness;
• If the fracture line of the frontal part of the skull passes through the eye sockets, the victim experiences blurred vision, and sometimes double vision may occur;
• Injuries to the frontal bone are almost always accompanied by symptoms of a concussion or brain contusion.

Symptoms:

1. General cerebral;
2. Focal;
3. Dislocation;
4. Shell.

General cerebral symptoms

As a result of the injury, the victim may experience changes in the level of consciousness in the form of fainting, collapse or coma. The main symptoms are severe headache and dizziness . Nausea and vomiting not associated with food intake, cerebral asthenia or adynamia are often observed.

The headache is localized; its severity and duration depend on the severity of the injury. If the victim has a small subarachnodal hemorrhage or hematoma, then it becomes localized and intense.

A characteristic difference between nausea and vomiting due to injury to the frontal bone is the fact that its occurrence is not associated with food intake and its onset does not bring subjective relief to the patient.

Symptoms of cerebral asthenia or adynamia are manifested in the rapid exhaustion of nervous and reflex processes and functions, as well as in disruption of thinking and memory processes. The patient experiences a redistribution of muscle tone almost immediately after injury to the frontal bone (hypotonia and hyporeflexia).

Symptoms of increased intracranial pressure usually occur when the structures of the brain are compressed, as well as when it is crushed as a result of trauma to the frontal lobes.

The development of severe hypoxic changes in the brain during trauma is sometimes associated with occlusion of the airways by vomit, as well as saliva during loss of consciousness.

Focal symptoms

After the injury, the victim develops focal symptoms. They are clinical manifestations of local damage to certain areas of the brain. In the acute period, they are usually “blurred” and combined with manifestations of general cerebral symptoms.

Specific focal symptoms of trauma to the frontal lobes include apathetic-abulic syndrome. In the victim, it manifests itself as a combination of spontaneity with periods of indifference to the environment.

Aspontaneity is a decrease or absence of a person’s motivation for motor, speech, mental and other types of activity.

The main cause of epileptic seizures in a patient is hypoxic damage to certain parts of the brain or increased intracranial pressure.

Some patients experience disturbances in physiological pupillary reactions. With an objective examination, you can see a different range of manifestations of this symptom. Sluggish reactions of the pupils to light are observed in mild concussions, and a complete absence of pupillary reactions to light in severe brain injuries.

Rehabilitation

For people who have experienced such trauma, there are rehabilitation centers that are specially equipped and have qualified specialists. Drugs are also used to strengthen bones and accelerate regeneration.

Therapeutic massages, physical exercise, and the use of water procedures will be effective. Patients are re-taught simple elements of self-care, to revive memory, restore speech skills, develop motor skills of the limbs after paralysis, and also eliminate pain.

Occupational therapy with the use of specialized simulators is actively used. All this contributes to the adjustment of skills in the rehabilitation center, and not through trial and error at home. The interest of loved ones and relatives in a speedy recovery plays an important role. The purpose of such restoration is to improve the quality of life, adapt to new conditions and simplify daily activities.

Dislocation syndrome

When the frontal bone and calvarium are fractured, some patients develop dislocation syndrome. It is associated with the displacement of certain brain structures to a certain distance from the primary pathological focus. The cause of the development of this pathological syndrome may be an acute intracranial hematoma . The severity of the clinical manifestations of the syndrome depends on the rate of displacement of part of the brain and the increase in the size of the hematoma, as well as on the presence of concomitant cerebral pathology, for example, edema or vascular disorders.

In the development of the clinical picture, the premorbital state of the victim’s body and the presence of a history of diseases of the central and autonomic nervous system play an important role.

Consequences

The results of injuries can be both direct and long-term. Direct ones include those that appear immediately, for example, hematomas in the brain. When small and large vessels in the brain rupture, they can put pressure on tissues and impair their functionality. Due to a violation of the integrity of the frontal bone and improper aseptic treatment, infection may enter the wound. With splinter wounds, there is a chance of damaging the membranes and tissue of the brain.

Long-term consequences can be considered symptoms and syndromes, the appearance of which occurs after some time, when all tissues have resumed their functions. Examples: paralysis, paresis, encephalopathy, meningitis, mental disorders, coma, epilepsy.

Brain concussion

With this type of injury, pathophysiological changes in the brain occur at the cellular level. As a result of the injury, the victim's consciousness turns off for a short period of time, usually from several seconds to several minutes. Memory fragments may be lost for a certain period of time. Often, immediately after an injury, unpleasant symptoms of nausea and vomiting appear. After the person regains consciousness and begins to speak, he complains of a severe headache and dizziness. Frequent symptoms of a fracture of the frontal bone are muscle and reflex weakness, “flickering spots” before the eyes, and tinnitus.

Autonomic manifestations may include facial flushing, sweating, chills, or a feeling of heat. Some patients have disturbed sleep, it becomes intermittent, suffering from insomnia at night and drowsiness during the day. This type of injury may cause pain in the eye sockets or double vision when reading.

An important feature of a concussion with a fracture of the frontal bone is the fact that the victim has no symptoms of impairment of vital functions: cardiovascular and respiratory.

A neurological examination of the patient reveals a decrease in tendon reflexes, small-scale tremor of the fingers and horizontal nystagmus.

What causes depressed skull fractures?

A skull fracture is a traumatic disruption of the integrity of the skull, which poses a serious danger to human life. They account for about ten percent of all fractures and about a third of the total number of severe traumatic brain injuries. Most often they are diagnosed in young people leading an active lifestyle or in representatives of socially disadvantaged categories of citizens.

Depressed fractures occur when a person collides with an object whose area is smaller than the area of ​​the skull. This can happen if a person falls or his head quickly approaches such an object. At the same time, experts identify a number of conditions that have a serious impact on the consequences of injury. These include the following:

• Head acceleration direction;
• The shape and material of production of the object that injured the skull;
• The presence of objects that soften the blow of a fracture;
• The difference in contacting areas upon impact;
• The hardness of the bone at the fracture site.

Brain contusion

A brain contusion is damage to the brain matter of the skull of varying degrees as a result of hemorrhage and destruction. In addition, the patient may experience subarachnoid hemorrhages, fracture of the vault and base of the skull. The clinical picture is due to pronounced edema and swelling of its structures.

Clinically, there are three degrees of severity of brain contusion, each with its own characteristics of the manifestation of clinical symptoms in the victim.

Severity of brain contusion:

1. Mild degree. This skull injury is characterized by loss of consciousness for a very short period of time (up to 20 minutes). After the patient regains consciousness, he complains of severe headache and nausea. Unpleasant symptoms appear - short-term vomiting, dizziness, weakness. In some cases, partial amnesia is possible. As a rule, with this type of injury, the function of the cardiovascular and respiratory systems is not impaired in the victim. A patient with a brain injury may experience moderate tachycardia or bradycardia, as well as a slight increase in blood pressure. Pathological neurological symptoms are not expressed. Upon physical examination, the victim exhibits moderate anisocoria and some meningeal symptoms appear (for example, stiff neck and pathological tendon reflexes).
2. Average degree. In this case, the victim experiences a longer loss of consciousness (on average, it is 20 minutes). After this, he cannot remember anything, what events preceded the injury or happened immediately after it. Some patients experience mental disturbances and experience nausea and repeated spontaneous vomiting. With this degree of severity of brain contusion, a disorder of the cardiovascular and respiratory systems appears. The patient experiences an increase in heart rate, rhythm and breathing disturbances. The clinical picture shows meningeal symptoms. The victim also develops other pathological neurological symptoms: impaired sensitivity and speech, in some cases the development of paresis and paralysis occurs.
3. Severe degree. This type of injury has a number of clinical features. The patient experiences prolonged loss of consciousness. He can be in a comatose state for several hours, sometimes for several weeks or months; over time, focal symptoms increase. As a result of a brain injury, a patient may experience severe motor agitation and develop pathological neurological symptoms in the form of impaired breathing and swallowing, floating eyeballs, bilateral pupil dilation or constriction. In some patients, muscle tone changes and horizontal nystagmus is observed, as well as paresis and paralysis.

Quite rarely, patients experience generalized epileptic seizures.

Brain contusion is usually accompanied by extensive subarachnoid hemorrhages.

Fractures of the skull bones

In the acute stage, treatment is usually conservative. It consists of repeated lumbar punctures (or lumbar drainage), dehydration therapy, and prophylactic use of antibiotics. In a significant number of cases, it is possible to cope with liquorrhea in this way.

However, in some patients, the leakage of cerebrospinal fluid continues weeks and months after the injury and can cause repeated meningitis. In these cases, there are indications for surgical removal of liquor fistulas. Before surgery, it is necessary to accurately determine the location of the fistula. This can be done by radioisotope research with the introduction of radioactive drugs into the cerebrospinal fluid or using computed tomography and magnetic resonance imaging, especially if these studies are combined with the introduction of special contrast agents into the cerebrospinal fluid.

For nasal liquorrhea, trepanation of the frontal region is usually used. The approach to the location of the cerebrospinal fluid fistula can be carried out both extra- and intradurally. It is necessary to carefully close the dural defect by suturing or repair using aponeurosis or fascia.

The bone defect is usually closed with a piece of muscle.

If the source of the CSF rhea is an injury to the wall of the sphenoid sinus, a transnasal approach with sinus muscle tamponade and a hemostatic sponge is usually used.

With cracks in the bones of the base of the skull passing through the air cavities, in addition to the leakage of cerebrospinal fluid, air may enter the cranial cavity. This phenomenon is called pneumocephalus. The reason is the emergence of a kind of valve mechanism: with each inhalation, a certain amount of air enters the cranial cavity from the paranasal sinuses, but it cannot come back out, because when exhaling, the sheets of torn mucous membrane or dura mater stick together. As a result, a huge amount of air can accumulate in the skull above the cerebral hemispheres, causing symptoms of increased intracranial pressure and brain dislocation with rapid deterioration of the patient’s condition. Air accumulated in the skull can be removed using a puncture through a burr hole. In rare cases, it becomes necessary to surgically close the fistula in the same way as is done for liquorrhea.

With fractures of the base of the skull passing through the optic nerve canal, blindness may occur due to contusion or compression of the nerve by a hematoma. In these cases, intracranial intervention with opening of the canal and decompression of the optic nerve is justified.

Cranioplasty. The consequences of traumatic brain injury can be a variety of, often extensive, defects of the skull. They arise as a result of comminuted fractures; if it is impossible to save a bone flap due to high intracranial pressure and prolapse of the brain into the surgical wound. Bone defects can be caused by osteomyelitis if the wound becomes infected.

Patients with large bone defects react to changes in atmospheric pressure. The development of a scar-adhesive process along the edges of the bone defect can cause pain syndromes. In addition, there is always a danger of damage to areas of the brain not protected by bone. Cosmetic factors are also important, especially for frontobasal defects.

These reasons justify the indications for cranioplasty.

Defects in the convexital parts of the skull can be closed with the help of prostheses made of fast-hardening plastic - styracryl, galacost. While this polymer is in a semi-liquid state, a plate corresponding to the skull defect is formed from it. To avoid the accumulation of blood and exudate between the dura mater and the plastic plate, several holes are made in the latter. The graft is firmly fixed with sutures to the edges of the defect. Tantalum plates and mesh are also used to close bone defects.

Recently, the bone of the patient himself has been used for cranioplasty. For this purpose, a symmetrical area of ​​the skull is exposed and a bone fragment corresponding in size to the bone defect is cut out. Using special oscillating saws, the bone flap is separated into two plates. One of them is placed in place, the other is used to close the bone defect.

A good cosmetic effect can be obtained by using specially processed cadaveric bone for cranioplasty, however, recently the use of this method has been refrained due to the risk of infection with the virus of slow infections.

The most difficult cranioplasty is for parabasal injuries, including the frontal sinuses and orbital walls. In these cases, a complex operation to reconstruct the skull is necessary. Before surgery, the extent and configuration of bone lesions should be carefully studied. Volumetric reconstruction of the skull and soft tissues of the head using computed tomography and magnetic resonance imaging can be of great help. To restore the normal configuration of the skull in these cases, the own bones of the skull and plastic materials are used.

First aid

If the frontal part of the skull is fractured, the victim must apply a hemostatic bandage to the site of damage to the skin. Emergency doctors must deliver him on a stretcher to the traumatology or neurosurgical department of the hospital to clarify the diagnosis and determine the further scope of treatment and diagnostic measures. If the patient is conscious, then he must be transported in a supine position, strictly horizontally, without lifting the head end of the stretcher.

If the victim is unconscious, transportation is carried out in the drainage position (head on side) to prevent vomit from entering the upper and lower respiratory tract.

If the victim is unconscious and has symptoms of dysfunction, he is hospitalized in the intensive care unit of the hospital.

For clinically significant edema and swelling of the brain, intensive care includes the following resuscitation measures:

1. Carrying out artificial ventilation of the lungs (hyperventilation mode);
2. Correction of hemodynamic disorders;
3. In case of massive blood loss, it is necessary to replenish the volume of circulating blood and against this background, osmotic diuretics are prescribed;
4. Against the background of stable hemodynamics, the patient is prescribed 25% magnesium sulfate;
5. If psychomotor agitation develops in the patient, a sedative is prescribed (0.5% sibazon solution, 20% sodium hydroxybutyrate solution).

If the victim does not have clinical manifestations of cerebral edema, then to provide first aid it is necessary to:

1. In order to prevent aspiration syndrome, sanitation of the trachea and bronchi is carried out;
2. Artificial ventilation should provide the brain with the necessary oxygen concentration (normative ventilation mode);
3. It is necessary to replenish the volume of circulating blood in the first hours after injury and blood loss;
4. Maintaining optimal blood pressure numbers;
5. Anesthesia;
6. The use of antihypoxants and antioxidants;
7. Use of hormonal drugs (corticosteroids);
8. Neurovegetative protection of the brain.

Pre-hospital emergency care for a patient

If you suspect a fracture in the frontal bone, you should urgently call an ambulance. If the victim is conscious, he should be placed on his back with his head fixed. When the fracture is open, a disinfectant dressing is needed for the wound. Be sure to apply cold to the affected area (cold compress, dry ice). In the case when a person is unconscious, it is necessary to turn the head to the side for the safety of the patient, namely to prevent asphyxia (blockage of the airways) during vomiting; remove dentures and jewelry.

Treatment

For a fracture of the frontal bone, conservative and surgical treatment is indicated. Conservative therapy depends on the severity and type of fracture, as well as the clinical manifestations of cerebral edema. When choosing a treatment method, the doctor must take into account the patient’s premorbid condition and his age. In case of a concussion, the patient must remain in bed . He is prescribed sedatives and vegetotropic drugs.

The scope of surgical intervention in the neurosurgical department depends on the presence or absence of hematomas and brain damage from bone fragments or other foreign objects.

The sooner the victim receives medical care and undergoes neurosurgical intervention, the greater the chance of his survival and rehabilitation.

Fracture of the upper jaw - symptoms and treatment

When providing first aid to the patient, it is necessary to stop the bleeding and prevent aspiration (penetration into the respiratory tract) of blood and vomit. If the lower jaw is not damaged and there are a sufficient number of teeth on both jaws, it is necessary to apply a sling-like bandage, pressing the lower jaw to the upper jaw, or perform immobilization (immobilization) with a rigid chin sling [4].

If there is a risk of respiratory failure, immediate insertion of an airway is required to maintain the conductivity of the airways [1]. In addition, it is necessary to provide pain relief and quickly transport the patient to specialized medical institutions. The most important thing at this stage is to preserve the life and health of the patient.

There are many methods of non-surgical treatment of fractures of the upper jaw, for example, various types of bandages and external fixations, which are currently practically not used.

The most common method of orthopedic treatment of fractures is bimaxillary splinting - the application of splints and brackets to the dentition with reposition of fragments and fixation of the bite in the patient’s usual position. This method is conservative and low-traumatic, but in some cases it does not allow obtaining good fixation of fragments of the upper jaw, especially in high and complex fractures. On average, fractures of the upper jaw require immobilization and limitation of chewing load for a period of 4-5 weeks.

The most modern and adequate treatment method at the moment is osteosynthesis (fixation with titanium bone structures) of fractures of the upper jaw. This is a surgical procedure performed through intraoral incisions. With this treatment option, it is possible to accurately compare and fix the fragments to create conditions for their fusion [7].

In the treatment of high fractures, a coronal approach is also used, which allows for cosmetic and wide access to the bones of the entire midface and orbits [5]. Timely implementation of osteosynthesis allows you to prevent late postoperative complications, facilitate the patient’s rehabilitation and speed up recovery.

Fractures with gross violations of the integrity of the upper jaw and significant displacement of fragments towards the pharynx are recommended to be treated surgically. There is no clear opinion regarding other types of fractures - tactics are dictated by the patient’s condition and the specific clinical situation.

It is worth noting that it is very important to constantly wear intermaxillary fixation for tight contact of fragments and to prevent their mobility, especially under the influence of chewing load [9]. High-quality oral hygiene and patient observation by an oral and maxillofacial surgeon are also necessary.

Recovery from fractures takes from four to six weeks, depending on the nature of the fracture, the characteristics of the patient’s body and the method of treatment.

Patients with fractures of the upper jaw should eat liquid food in the early stages, and soft food in the later stages. Eating hard foods and active chewing should be limited. Other recommendations are given based on general somatic and neurological disorders (bed rest, etc.).

Consequences of a frontal bone fracture

An isolated linear fracture of the frontal bone in the absence of clinical signs of brain damage is treated conservatively and usually does not have any subsequent complications.

In other types of frontal bone fractures with brain damage and the presence of hematomas, the following complications and consequences develop:

1. Encephalitis;
2. Meningitis;
3. Epilepsy;
4. Post-traumatic hydrocephalus;
5. Brain cysts and scars;
6. Coma;
7. Death.