Jaw fracture

A maxillary fracture is an injury in which bone fragments are displaced in such a way as to disrupt the correct position of the upper jaw relative to the lower jaw. The patient is unable to close his mouth, any movement is accompanied by increased pain. If the injury was accompanied by rupture of the gums by sharp fragments, moderate bleeding is present.

Jaw fractures can be either traumatic (resulting from mechanical force) or pathological (caused by osteomyelitis, an extensive cyst or a malignant tumor). According to the place of formation and method, fractures of the upper jaw are divided into closed and open; the latter are much more common due to the anatomical features of the bone tissue.

Fractures of the upper jaw are often the result of mechanical impact from a blunt and hard object. The direction of the impact determines in which direction the bone fragments will be displaced. The most vulnerable parts of the jaw are at greatest risk: the places where the upper jaw connects to the lower jaw, or where it connects to the skull.

Fracture of the lower jaw - features

This type of injury has some features:

a fracture with displacement of bone fragments or the entire jaw is called complete;
if the injury is of an open type, then not only the mucous membrane of the oral cavity ruptures, but also the soft tissues of the face;
It is extremely rare that a comminuted fracture is diagnosed because it requires too much force.

A fracture of the lower jaw is characterized by the following signs:

pronounced asymmetry of the face, which is formed due to swelling and hemorrhage in the soft tissues at the site of injury;
acute pain when touching any part of the lower jaw, inability to talk or chew;
mobility of fragments, if any;
a radical change in the bite - the lower jaw may be too forward or, conversely, “retracted” deeper.

Anyone can provide first aid for the injury in question - you need to apply a bandage (place any straight object, such as a ruler, between the teeth) so that the damaged part of the jaw is motionless. If there is bleeding, it must be stopped by applying something cold, treating with hydrogen peroxide and other classical methods. Then all that remains is to wait for the ambulance team to arrive.

Types of Maxillary Fractures

Often this type of injury occurs after a powerful collision. Loss of consciousness is often a symptom of a concussion. The most serious consequences include damage to the base of the skull.

Lefort's typology classifies three types of mandibular fractures:

• The first, or subbasal type of fracture is a type of injury to the lower jaw, in which the damage gap runs parallel to the alveolar process: it passes through the base of the nose, the zygomatic arches, and often through the anterior and middle cranial fossae. With this type of fracture, severe displacement occurs relatively rarely. The fragments can be mobile, and the dentition is often disturbed. Nosebleeds often occur, caused by trauma to the mucous membrane of the maxillary sinuses.

• The second is the suborbital or middle type of fracture - the fracture passes through the base of the nose, the lower wall of the orbit, and the zygomatic-maxillary suture. In this case, the upper jaw is broken off along with the bones of the nose and cheekbone. This is often accompanied by profuse bleeding from the nose and malocclusion due to the fact that the jaw has been significantly displaced downward. There are dark red bruises around the eyelids – this is called the “spectacles sign”.

• The third is the lower type of jaw fracture. The fracture crosses the base of the pyriform foramen through the base of the maxillary sinuses. The fracture gap also goes through the bridge of the nose or eye sockets, and the zygomatic bone breaks off. This is the type of fracture that most often causes concussions.

Signs, first aid for a fracture of the upper jaw

A fracture of the upper jaw is much less common - only 30% of all facial injuries. This is a dangerous injury, because in most cases it is accompanied by severe complications - meningitis, osteomyelitis. Moreover, the higher the crack (fracture line) is formed, the more severe the consequences will be.

Symptoms of a jaw fracture (upper) can vary and depend on which part of it is damaged:

trauma above the palatine vault + nasal fracture + fracture of the maxillary sinus bone is accompanied by severe bleeding between the upper lip and upper teeth, extensive swelling of the upper part of the face;
separation of the upper jaw from the calvarium + a crack running through the orbit and bridge of the nose, characterized by severe swelling and rapid spread of hematoma under both eyes, numbness in this area, nosebleeds and uncontrollable salivation;
jaw avulsion + fracture of the base of the jaw can be diagnosed by drooping eyeballs and blurred vision.

First aid consists of completely immobilizing the upper part of the face and clearing the mouth of fragments of teeth/bones. In each case, the victim will experience nausea and may develop vomiting.

Maxillary fracture

During an extraoral examination of patients with type 3 fractures of the upper jaw, a violation of the integrity of the zygomaticalveolar ridges is revealed: tissue swelling, abrasions, an increase in the vertical parameters of the face. At the border of the transition of the immobile mucosa of the alveolar process to the mobile one, as well as on the hard palate, hemorrhages are diagnosed. Displacement of the damaged sections during a fracture of the upper jaw leads to rupture of the mucosa. Downward dislocation of the posterior fragment causes elongation of the soft palate.

During palpation examination, irregularities and recesses are determined on the alveolar process. When pressing on the hooks of the pterygoid processes, the patient feels pain in the area corresponding to the fracture line of the upper jaw. Disocclusion is more often observed in the anterior area, and malocclusion pathologies along the transversal and sagittal planes are less frequently diagnosed. The patient does not feel the tip of the probe touching the mucous membrane of the alveolar process, which indicates a loss of pain sensitivity. A CT scan for a type 3 maxillary fracture reveals areas of integrity disruption in the areas of the pyriform aperture and zygomaticalveolar ridges, and decreased transparency of the maxillary sinuses.

In case of a type 2 fracture of the upper jaw, the symptom of glasses is positive - the periorbital zone immediately after the injury is saturated with blood. Chemosis, exophthalmos, and lacrimation are observed. Pain sensitivity of the skin in areas corresponding to the level of damage is reduced. In the anterior section, as a rule, there is disocclusion. During a palpation examination, the dentist determines the mobility of the maxillary bone at the border with the orbit, in the area of the zygomaticalveolar ridge, as well as in the area of the suture connecting the frontal bone with the upper jaw. These same changes can be diagnosed by radiographic examination.

In type 1 fractures of the upper jaw, diplopia, chemosis, exophthalmos, subconjunctival hemorrhages, and eyelid edema are observed. If the patient is lying down, enophthalmos is detected. In a sitting position, diplopia increases, and when the teeth are closed, it decreases. By palpation, in case of an upper fracture of the upper jaw, it is possible to identify unevenness in the areas of the frontomaxillary, as well as the zygomatic-frontal sutures and the zygomatic arch. The load test is positive. Computed tomography reveals a violation of the integrity of the root of the nose, zygomatic arch, frontozygomatic suture, and sphenoid bone. A diagnostic test to determine the presence of rhinorrhea is the handkerchief test. After drying, the structure of the fabric soaked in liquor remains unchanged. If the scarf has become stiff, it means there is no liquorrhea, serous contents are released from the nasal passages.

It is necessary to differentiate a fracture of the upper jaw from other injuries of the bones of the maxillofacial skeleton. All patients should be examined by an oral and maxillofacial surgeon, as well as a neurologist. If the maxillary sinuses, optic nerve, or skull bones are damaged, treatment is carried out jointly with a neurosurgeon, resuscitator, ophthalmologist, or otolaryngologist.

Treatment of a jaw fracture

Therapy for injury should be carried out only by doctors, and the sooner qualified medical care is provided, the lower the risk of complications. Treatment of a jaw fracture may include the following manipulations:

if there is a wound (rupture of soft tissues, mucous membranes), then first the bleeding stops and disinfection measures are carried out;
manual comparison of bone fragments, giving the correct shape to the damaged jaw;
A splint must be applied - if the jaw is fractured, it must be completely immobilized for at least one month.

Additionally, painkillers and anti-inflammatory therapy are prescribed. If a fracture of the jaw processes is diagnosed, then, most likely, surgical intervention will be prescribed, which involves the implantation of specific metal plates. Your doctor will tell you more about the operation during your consultation. Sign up on our website Dobrobut.com.

Rehabilitation after a jaw fracture includes physiotherapy, massage and facial exercises. Patients often have to relearn how to chew and speak without distorting sounds.

A jaw fracture is a dangerous pathological situation, as a result of which the integrity of the bones is disrupted and their displacement occurs. The lower jaw is more mobile and less resistant to various injuries, which is why its fracture occurs. The most common cause is mechanical factors (impact, fall, accident), but it can also be a consequence of serious bone diseases. Taking into account the causes of occurrence, traumatic and pathological fractures of the lower jaw are distinguished.

The first type is most often found in young and middle-aged men, which is due to both anatomical features and lifestyle. In men, the chin protrudes more, so in case of facial injuries, it takes the brunt of the blow. In addition, the risk of getting a jaw fracture increases for those who engage in boxing and martial arts, enjoy extreme leisure activities, or get into fist fights. When playing sports and riding a motorcycle, you must use protective equipment (helmets, mouthguards).

For information about prices and treatment times, call:

or fill out the feedback form:

Signs of a jaw fracture

This pathological condition can also be determined visually by a violation of the linear integrity of the bones. Depending on the location of the impact, a fracture line is formed between the small molars, in the area of the fangs or the angle of the jaw.

Main features:

Atypical jaw mobility and noticeable movement in the mouth
Severe pain, even shock and dizziness
Inability to close your mouth normally
Rupture of the mucous membrane, bleeding and increased salivation
Facial swelling and difficulty chewing, swallowing and speaking.

Types of jaw fractures

According to clinical manifestations, fractures are classified into open and closed.

– The open form is much more common and is considered very dangerous, since bone fragments extend beyond the gums and tear soft tissues. Fragments of broken bones are infected, so without timely measures they can provoke an infectious-inflammatory focus.

– With a closed form, bone fragments do not damage the mucosa; accordingly, this form avoids many complications and is easier to treat.

Based on other characteristics, the following types are distinguished:

– A fracture without displacement (incomplete), which is characterized by the formation of a gap, but while maintaining the normal ratio of bone fragments.

– A displaced fracture occurs when bone fragments are displaced under the influence of external and internal factors.

– A comminuted fracture is uncommon, as it requires a very powerful point blow (for example, with a metal tool). In this case, many bone fragments are formed, displaced to one degree or another.

Diagnosis of a jaw fracture

The easiest way to diagnose fractures, in addition to visual inspection, is radiography, which allows you to determine the fracture line and its location. The next method is orthopantomography, which produces a panoramic image of the entire dental system. It makes it possible not only to identify the number of bone fractures and their severity, but also damage to the temporomandibular joint or dentition. The most accurate information about the clinical picture is provided by computed tomography. This diagnostic method is usually indicated when several fractures are detected, including damage to teeth, and when fractures of adjacent bones are suspected.

First aid and treatment

It is strictly forbidden to self-medicate for fractures, but you can provide first aid to the victim to alleviate the general condition. It is necessary to fix and immobilize the jaw, give pain relief and stop bleeding if there is any. Cardiopulmonary resuscitation is sometimes necessary because the fracture may obstruct the upper airway. However, these measures (artificial respiration, chest compressions) should be carried out with certain experience. If the person is unconscious, call an ambulance immediately.

In most cases, they resort to surgical treatment of jaw fractures (osteosynthesis). External, intraosseous, extraosseous or transosseous osteosynthesis can be performed. For example, with external fracture, special wires are inserted through bone fragments, and with external fracture, a metal plate secured with screws is placed at the site of the fracture. The most common method of treating fractures is the application of bone plates, which reduces soft tissue trauma and allows the fragments to be fixed. During the rehabilitation period, the patient is prescribed antibiotics, restorative drugs and physiotherapy, and a gentle regime and diet correction are recommended.

Fracture of the lower jaw - symptoms and treatment

Diagnosis of patients with fractures of the lower jaw is carried out in order to establish the location, number of fractures, as well as to determine injuries to nearby tissues, vessels and nerves.

Diagnostic methods are basic and additional (instrumental).

Basic diagnostic methods are carried out with a standard set of instruments in the emergency room, dental office or dressing room. The doctor finds out the patient’s complaints, learns about previous diseases and previous operations. At this stage, it is very important to establish the time of injury, since the duration of the injury plays a big role in further treatment tactics.

During the investigation, the doctor will find out whether the injury was sustained at home, at work, or during a fight, and whether it is of a criminal nature. In case of injury during violent acts, the doctor is obliged to report the incident to the police. After that, an internal affairs officer talks with the victim, finding out the details of what happened. In this regard, there is often a concealment of the real reasons for the injury, and the patient sometimes invents very ridiculous and implausible stories.

Sometimes collecting complaints and medical history is difficult or impossible due to the patient’s serious condition or alcohol/drug intoxication.

A clinical study begins with an external examination; post-traumatic swelling, changes in skin color, the presence of abrasions, hematomas, and bleeding are detected. Next, palpation is carried out, during which the nature of the swelling is revealed, inflammatory infiltrate, hematoma, and subcutaneous emphysema are excluded. Palpation of the lower jaw is carried out symmetrically, starting from the branch of the lower jaw and ending in the chin. The presence of a bony step indicates a fracture of the mandible. The degree of mobility of the fragments and the direction of their displacement are also determined.

When examining the oral cavity, special attention is paid to the mucous membrane of the alveolar part of the lower jaw, identifying violations of integrity and bleeding. The relationship of the dentition and the displacement of the central line of the lower jaw when opening and closing the mouth are determined. The landmarks are the labial frenulum, the line between the central incisors of the upper and lower jaw.

Often, the opening of the mouth with jaw fractures is limited. When rocking the lower jaw, relying on the chewing teeth and the basal edge, you can determine the degree of pathological mobility of the lower jaw and the location of the fracture.

Additional diagnostic methods:

X-ray : an X-ray of the skull is taken in a direct projection in order to exclude fractures of other parts of the face and an X-ray of the lower jaw in lateral projections, the number of fractures, the presence or absence of displacement, diastasis (gap) and the presence of teeth in the fracture line are analyzed.
An orthopantomogram is a more modern method, with functionality similar to an x-ray. One detailed image is taken, and it is possible to view it on the monitor screen using various programs.

Computed tomography allows you to most accurately identify fractures of the lower jaw, measure the distance of displacement of fragments, diastasis, determine the size and number of fragments, and the presence of foreign bodies. Using certain setting modes, you can determine the violation of soft tissues (muscles, blood vessels, nerves) and the presence of hematomas.

Assessment of the general condition of the body - examination of organs and systems of the body, identification of viral and chronic diseases. For this purpose, a physical examination, digital chest x-ray, ultrasound examination, and laboratory diagnostic methods are used. If necessary, consultations with related specialists are carried out. All this helps to select the most effective therapy for the patient, taking into account the characteristics of a particular clinical case.

Main causes of jaw fracture

Such pathologies arise under the influence of mechanical stress on the bone, the force of which exceeds its strength. Most often, fractures of the maxillofacial region (MFA) occur in the following cases:

Road traffic accidents.
Extreme sports.
Pronounced physical impact.
Firearms.

Not everyone who finds themselves in such unpleasant situations suffers a broken jaw. The skull bones are very strong, so the incident must be really serious. True, there are people who are more susceptible to non-gunshot fractures of the lower and upper jaw than others.

If the following conditions are present, the bones of the skull break more often and more easily:

Oncological diseases.
Inflammatory processes in bone tissue.
Infectious diseases, especially tuberculosis.
Taking certain medications.
Impaired bone mineralization.
Metabolism problems.
Acute deficiency of vitamins and microelements.

Treatment

Methods for correcting fractures of the lower jaw are selected based on the severity of the injury that harmed his health. The treatment plan consists of the use of conservative methods (orthopedic methods, which are used in 90% of cases of injury), surgery, and hardware reposition. The main treatment measures include:

performing an operation to reposition fragments;
applying a splint to the lower jaw;
creating and maintaining the necessary conditions for faster bone recovery;
taking medications (antibiotics, drugs to strengthen the immune system);
physiotherapeutic procedures.

Surgical intervention - may include the following manipulations:

installation of brackets on the upper jaw;
fixation of the jaw with knitting needles;
fixation with plates;
fixation of the jaw with extraoral structures.

To cope with a fracture of the upper jaw, especially in the most severe forms, complex surgical interventions may be required.

Orthopedic methods are based on immobilization and fixation of the jaw at the fracture site using a splint.

Types and localization of mandibular fractures

Non-gunshot, most often linear fractures of the mandible occur in the area of the condylar process, the angle of the mandible, the central incisors, the canine and the mental foramen. These places are usually called “places of weakness.”

Direct fractures of the mandible occur at the site of application of force.

Reflected fractures are localized due to the direction of impact and the area of damage. For example, as a result of a lateral impact, a reflected unilateral fracture of the neck of the lower jaw often occurs. The maximum tension in the bone tissue in the midline area is created due to bilateral compression of the mandibular bone in the region of the molars (sixth, seventh and eighth teeth).

How the fragments will be located during a fracture of the lower jaw depends on several factors. These include: the strength of the damaging factor, the volume of the injured area, as well as muscle groups attached to the surface of the injured area.

Symptoms

A fracture of the alveolar process of the upper jaw has several characteristic features. The most common symptoms:

sharp pain
inability to completely close your mouth,
occurrence of malocclusion,
dysfunction of chewing and swallowing,
hematomas,
dislocations and mobility of one or more teeth,
severe swelling of soft tissues,
bleeding.

If you suspect an alveolar bone fracture, you should seek medical help as soon as possible.

Treatment methods for fractures

Treatment of fractures of the alveolar process of the upper jaw includes several stages:

pain relief,
antiseptic treatment,
repositioning of all fragments,
immobilization with special structures.

Displaced fractures require complex treatment. In case of serious injuries, the wound is inspected, the sharp edges of bone fragments are smoothed and the mucous membrane is sutured. The bone fragments are returned to the correct position and securely fixed with staples or splints. To prevent complications in the first days after injury, antibacterial therapy and rinsing the mouth with herbal decoctions are prescribed.

With timely provision of qualified assistance, bone callus is formed within 8 weeks. The speed of recovery depends on the individual characteristics of the body.

Fracture of the lower jaw

A person receives most of all jaw injuries after exposure to a strong mechanical force on the bone. In some cases, a violation of the integrity of bone tissue can occur spontaneously, due to a disease of the body, such as, for example, osteomyelitis, neoplasm and others. Among victims diagnosed with a fracture of the lower jaw, more men than women.

Such an injury can cause a lot of harm to a person’s health, so it is not advisable to delay visiting a doctor, or start treatment on your own, since fractures of the lower jaw with a high degree of severity, for example, shrapnel injuries or with displacement of the bone from the articular cavity, can cause:

changes in normal bite;
the lower jaw may begin to close poorly, which will lead to problems with chewing and the ability to speak;
the addition of inflammatory processes due to infection of the affected areas of the oral cavity.

Consequences of a jaw fracture

Such a complex injury cannot go away without a trace; even with proper treatment, certain complications are present:

Deformation of facial features. Asymmetry arises, sometimes very noticeable (see photo). Typically, this consequence occurs when the jaw is fractured with displacement. With less dangerous pathologies, such a change is almost imperceptible.
Loss of teeth and their curvature. In many cases, gaps form between the teeth and the bite is disrupted.
The remaining teeth may become loose when chewing, most often this phenomenon occurs after an angular fracture.
The vast majority of patients experience jaw crunching after treatment for a fracture. Moreover, this can last until the end of life.
Due to liquid nutrition, problems with the gastrointestinal tract arise.

You need to understand that a head injury is always dangerous. Only correct and timely medical care will reduce the number of consequences to a minimum.

Diagnosis of a jaw fracture

In case of fractures of the lower jaw, when the victim goes to a traumatologist, he will conduct the necessary set of diagnostic studies.

Before prescribing treatment, the doctor needs to know the exact location and severity of the fracture. For this, the patient is prescribed radiography, visual examination and palpation of the injured jaw.

Without a detailed diagnosis, it will not be possible to determine the severity of the injury. But if you take into account the present symptoms, an experienced traumatologist will be able to provide emergency care in case of a serious patient’s condition.

Classification of jaw fractures

Experts distinguish more than a dozen different types of fractures, and the treatment of the patient depends entirely on whether the injury belongs to one type or another. First of all, fractures of the lower and upper jaw can be distinguished, but these groups are also divided into several smaller ones depending on a number of signs.

Types of jaw fractures by severity of injury

Closed fracture. It damages the bone, but the surrounding soft tissue remains intact. This type of pathology is less dangerous, since the treatment lasts relatively short. A non-gunshot closed fracture of the lower jaw heals without complications in 3–4 weeks.
Open fracture. Bone fragments can move to the side and damage soft tissues, blood vessels and joints. This pathology can be recognized by severe bleeding. Open fractures of the lower jaw are more common.

An open injury is doubly dangerous, since it carries a high risk of bacterial infection and severe blood loss. Medical assistance must be provided immediately.

Types of jaw fractures based on displacement of fragments

Fracture without displacement. With such an injury, the bone can even be divided into multiple fragments, but they are in a standard position and do not move relative to each other. The crack may be incomplete. Injury is easier to treat and carries with it minimal consequences.
Displaced fracture. In this case, the jaw fragments change their position, which causes additional pain and complicates treatment. With open injuries, the bone is always displaced.
A displaced fracture of the lower jaw is more common than the same injury to the upper part of the skull. Damage can be recognized by severe swelling and facial asymmetry.
Comminuted fracture. The bone splits into separate fragments of different sizes, which are arranged in a chaotic manner. In most cases, the pathology is accompanied by damage to soft tissues and requires immediate medical attention and long-term treatment. Often, after hospitalization, patients also have to see a plastic surgeon.

Types of jaw fractures by location of injury

The types of fractures of the lower and upper jaw are determined not only by symptoms, but also by location:

A midline fracture is located in the middle of the bone.
If the injury is located near the lateral incisors, it is defined as incisive.
A canine fracture is an injury to the third teeth of the upper or lower jaw.
A crack in the chin area is designated as mental. It is one of the most common jaw injuries due to the fact that a person's chin protrudes noticeably.
An angular fracture can only occur in the lower jaw. It is located in the corners of this bone, closer to the base of the skull.

Doctors may use a more extensive classification of such injuries. It’s even difficult to imagine exactly how many types of pathology there are - each case is individual in its own way.

First aid for fractures of the lower jaw

It can be carried out either at the scene of the incident or in an ambulance. It can be provided by both medical and non-medical workers in the form of mutual assistance.

The victim’s damaged jaw is temporarily (for several hours) fixed (the upper jaw is pressed to the lower) using bandages or other devices in order to be able to deliver him to a medical facility.

For fixation, the following can be used: a circular bandage parietal-mental bandage, a soft chin sling (Pomerantseva - Urbanskaya), an Entin splint (standard transport rigid bandage), as well as various types of intermaxillary ligature binding. If the patient has a traumatic brain injury, ligature binding is used with extreme caution - fixed jaws do not allow opening the mouth, and can lead to aspiration of vomit or blood.