Treatment of a jaw fracture - What is splinting after a jaw fracture

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).

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.

The essence of osteosynthesis and what kind of procedure it is

With osteosynthesis, the doctor not only connects the fragments of the damaged jaw, but also securely fastens them with metal structures or glue.

Open focal osteosynthesis is carried out using:

Bone suture. If the lower jaw or cheekbone is broken and the injury is recent, it can be fastened with a bone suture. For this, stainless steel, titanium wire or nylon thread is used.

During the operation, the doctor dissects the soft tissues of the face and fixes the fragments with wire. If the fragments are connected using a bone suture, the patient retains chewing function and can continue to care for the oral cavity. This method is contraindicated if the fracture site is inflamed or the patient has an infectious or purulent bone lesion.

Installation of periosteal metal mini-plates. This method has proven itself in the treatment of all types of jaw bone fractures, except those in which a large number of fragments have formed. In this case, it is enough to make an incision only on one side. The doctor aligns the fracture sites, applies mini-plates to them and screws them on. Nowadays, mini-plates are most often fixed inside the oral cavity.
Fixation with quick-hardening plastics. It is practiced only for fractures of the lower jaw. After exposing the bone fragments, the doctor makes a bone groove and places a special fixing compound in it. Excess plastic is removed with a cutter, after which the wound can be sutured.
Osteoplast glue. This composition for fixing bone fragments is made of purified epoxy resin with an organic antiseptic - resorcinol. After application, the glue hardens in 8-12 minutes and reliably fixes the combined bone fragments. Nowadays this method is rarely used.
Metal staples. For osteosynthesis, staples made of nickel-titanium alloy are used. At low temperatures, the alloy becomes plastic and is easy to shape into the desired shape. Then, at room temperature, the staple regains its previous shape. During the operation, it is first cooled, then inserted into the prepared holes on the bone fragments. As soon as the staples warm up, they straighten and securely fix the fracture site. Metal staples are especially convenient for fixing a fracture of the angle of the lower jaw.

Closed focal osteosynthesis is practiced for healing fracture sites where bone displacement has not occurred. Methods:

Installation of Kirschner spokes. The doctor inserts metal needles into the bone fragments using a surgical drill. For reliable fixation, the needles are fixed into each fragment to a depth of up to 3 cm. There is no need to dissect soft tissues; the operation is performed through the mouth. This is a low-traumatic practice, but wearing needles creates a lot of inconvenience for the patient.
Applying a surrounding suture. Applicable when the fracture gap is displaced forward or backward along the jaw. In this case, the suture passes through the central part of each bone fragment. If there are a lot of fragments, the operation takes a long time, but this is one of the most reliable methods of osteosynthesis. It allows the patient’s jaws to be restored even after very complex injuries.

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. The materials used to make the splint have changed, and the methods of applying it have been improved.

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

from standard Vasiliev tape splints, the simplest and cheapest method of treatment;
to aluminum Tigerschdedt splints, which are made 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 (when one jaw is fractured) 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 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.

When both jaws are fractured, a structure with a more rigid base is installed; in addition to wire, hooks and rings are also used that immobilize the lower jaw.

Diagnostic methods

To determine a fracture of the zygomatic bone, methods such as visual inspection and palpation are used. In difficult cases, an X-ray examination is prescribed to clarify the severity of the damage, as well as determine the optimal recovery tactics. The resulting image reflects a violation of tissue integrity, as well as a likely decrease in the transparency of the axillary areas and the continuity of the outer radius of the orbit near the affected area.

Features of treatment

The treatment plan is determined by the symptoms of the pathology, the results obtained during the X-ray examination, as well as the assessment based on the results of the medical examination. The priority task is to restore the intact bone structure. In situations where the anomaly is characterized by a displacement of the cheekbone, surgical intervention is prescribed, the purpose of which is to correct the position of the separated elements.

If the injury is not associated with displacement, it is possible to limit oneself to conservative therapy, which involves taking medications selected based on the indications of the clinical picture. The agents used include anti-inflammatory, analgesic, antibacterial substances, and neuroprotectors. In situations where there is a possibility of contact between the wound and a dirty surface, administration of tetanus serum is also recommended. Standard conservative treatment tactics include:

Ensuring a calm state for a period of 10-14 days, with partial fixation of the jaw;
Use of low-temperature compresses in the first 48 hours;
Eating liquid foods and prescribing physiotherapeutic procedures.

In case of severe pain, analgesics are also prescribed. In the future, magnetic therapy, electrophoresis and UHF, as well as other procedural measures, can be used to relieve swelling and pain.

Surgical intervention involves the use of one of the author’s techniques, which include the Keene, Duchant, Dubov and Limberg protocols. Within each operation, the preparatory stage is important, during which the risk to the patient’s health is assessed, the appropriate type of anesthesia is determined, and an action plan is drawn up. The rehabilitation period involves the use of painkillers and antibiotics, as well as a course of physical therapy.

Is it possible to do without splinting?

Even if the case is not severe - the fracture is one-sided, 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.

Indications for osteosynthesis of the jaw with plates

The main indication for installing metal plates for osteosynthesis is the prevention of complications that cannot be effectively prevented by applying a traditional splint. In the case of osteosynthesis, an important task for the surgeon is to compare the fragments and fix them in the correct position. If successful, fusion will take up to 3–4 weeks.

Indications:

fracture behind a row of teeth;
inflammation that provoked injury;
significant displacement of bone elements;
high mobility of teeth at the fracture site;
incorrect position of the jaws relative to each other.

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.

Within 3-4 days after the injury, antibiotics must be prescribed to prevent inflammation, which are injected directly into the area of injury.
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.
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.
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.
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.

Proper nutrition while wearing a splint

Diet significantly influences the healing process of a jaw fracture. The body's resources must ensure the supply of bone tissue with microelements.

The following basic recommendations should be followed:

you will have to eat porridge-like dishes through a tube;
food should be high in calories and varied;
Particular attention should be paid to products with a high calcium content and fermented milk products.

Alcoholic drinks are strictly forbidden. Vomiting can cause death due to the inability to open the mouth independently. The person will simply choke on the vomit.

In nutrition, it is recommended to use infant formula and cocktails for athletes.

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.

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.

Types of zygomatic bone fractures

In accordance with the accepted classification, there are several types of fractures, for differentiation of which various criteria are used:

The presence or absence of displacement, which determines the severity of the damage;
The area of localization of the injury;
The period that has passed since the damage occurred;
Single or multiple, as well as one- or two-sided nature of the injury;
The specificity of the line along which the fracture runs (straight or oblique).

Characteristic signs of pathology include:

Limitation of jaw mobility;
Pain that occurs when trying to open your mouth;
Distortion of the facial contour and deformation of the bone structure;
Hemorrhage into mucous tissue, eyelid structure, or conjunctiva;
Bleeding from the nose from the side of the injured cheekbone;
Visual disturbances, swelling of the areas around the eyes, severe headache.

At the first suspicion of a fracture of the zygomatic bone, you should consult a doctor and undergo a comprehensive diagnosis.