Basic therms, parametrs, characterics whith are nessesery during preparation to lesson.

Therm	Definition
1. Reposition.	Anatomic alignment of fragments
2. Immobilization	Turning off function

4.2. Theoretical questions for lesson: 1. The principles of treatment of fractures of maxillofacial area? 2. What is transport immobilization of fragments of the bones? 3. At what stages of medical evacuation transport immobilization should be used? 4. Types of temporary immobilization of fragments of bones of face and jaw? 5. What is a permanent immobilization of bone fragments? 6. Types of permanent immobilization of bone fragments? 7. At what stages of medical evacuation is advisable to use a permanent immobilization? 8. What methods are used for permanent immobilization fractures of the upper jaw? 9. What methods are used for permanent immobilization of mandibular fractures? 10. What is the conservative treatment of fractures of the jaw? 11. What kinds of tires are used for the treatment of fractures of the jaws? 12. What are the rules for imposing tires in a broken jaw? 13. What is the fixation, types, indications, contraindications. 14. What device methods of treatment of fractures of jaws do you know?

4.3. Practical works (task) which are executed on lesson: 1.To be skilled in making and applying soft bandages, individual casts, ligature binding teeth, standard and custom tires. 2. Apply the skills of health care maxillofacial wounded on the stages of medical evacuation. 3. Conduct supervision for maxillofacial wounded.

5. TABLE OF CONTENTS OF THEME:

Temporary (transport) immobilization of bone fragments of the lower jaw. For temporary immobilization of bone fragments of jaw the most effective standard overlay transport are bandages, which consists of a Zbarzh’s head cap and tough chin sling Entin. Cap is fixed so that it is snug on his head, covering the frontal and occipital protuberance, and the ends of bandage are tied on his forehead. Use a rubber traction sling connected to the head cap. Depending on the number and length of the applied elastic sling rods can serve as oppressive or slings.

Press bandage is used: a) to stop the bleeding, and b) for all fractures of the upper jaw with most of the teeth in both jaws (compression band in these cases is to put in the proper occlusion of the upper jaw fragments by pressing its with healthy lower jaw), and c) if fracture of the lower jaw is outside the dentition.

For all other fractures imposing crushing dressings contraindicated due to possible additional displacement of bone fragments of the lower jaw, increased pain and worsening breathing.

In the absence of a standard transport bands, the simplest method of fixation is to serve verticomental bandage of gauze bandage, plain bandage, but with an elastic rod that is easy to do with pins and rubber bands.

Sometimes, instead of a cap can be used helmet tanker, the pilot, and instead of a sling - the second cap, belt or a piece of rubber, tree bark, etc. Such makeshift sling is easy to attach to the head-dress with pins and rubber rods. In winter, instead of sling bandage can use an ordinary hat with earflaps, which also can serve as a cap and chin, and a sling. To do this, lower the valve cap with earflaps and tie them, after putting a bandage on his chin from the PPI. Elastic traction is achieved by rubber bands, fixed pins.

In fractures of the lower jaw within the dentition (if at all fragments are at least two teeth in the upper jaw is antagonists) for temporary immobilization of bone fragments can be applied ligature method of binding the teeth. This requires: 1) ligature wire (bronze-aluminum or steel with a diameter of 0.3-0.4 mm), and 2) thumb forceps, 3) hemostat Pean 4) shears for metal.

The most effective and simple method of binding with teeth ligature are as follows. Wire with thumb forceps introduced between two adjacent teeth, facing away from the vestibular to the lingual side. Then wire cover the neck of one of the teeth, and again withdrawn through neighboring interdentium the eve of his mouth. Next to the same end of the wire cover both sides of the tooth with the vestibular, and free of ligature tooth - from the lingual surface. End of the wire is removed from the mouth between the teeth on the eve of that link, so that it was next to the other end of the wire, with one end of the loop must be located, adjacent to the neck of the teeth from the vestibular side, and the second - below it. The ends of the ligature pull together, pull hemostat and twisted together. In a similar way ligate the teeth-antagonists. Fragments of the lower jaw in the correct position, the jaws are compared and fixed in the bite, twisting the ends of each ligature pairs of upper and lower jaws.

Fixation with wire ligatures should not last more than 4-5 days because of the risk of loosening of the teeth. Ligature bonding of teeth is contraindicated in danger of bleeding from the mouth and vomiting, and the wounded are to be evacuated by air or sea (the possibility of vomiting on the way).

Orthopedic methods

The specialists task is not only to restore the anatomical shape of the damaged bone, to ensure normal relations tooth rows of the upper and lower jaws, and chewing muscles recover their function, to achieve full chewing. One of the main therapeutic measures that are used in fractures of the jaw, is the reduction and reliable fixation of bone fragments for the duration of fracture union.

The most effective and affordable method of treatment consolidate fragments of the lower jaw must be considered tooth tires, which can be individual and standard. Individual tires offered for the first time by S.S. Tigershtedt in 1916. Are smooth (one jaw) and toe loops and rubber traction (both jaws).

Most often, aluminum wire with a toe loops and interjaw traction rubber rings are used. Tires should contribute directly to the resumption of dental occlusion and give a reliable fixation of fragments to form callus.

For the manufacture and application of tires with toe loops the following tools and materials are required: 1) krampons 2) file for a semi-circular metal 3) aluminum wire diameter 1.5-1.8 mm, length 20 cm, and 4) the rubber rings of different diameter - 0.5-0.8 cm

For the manufacture of tires take a segment previously annealed aluminum wire, one end of which round out with the file to create a half-ring form around the neck of the tooth located distally or as a thorn wedged in the interdental gap.

Then, stepping back 1 cm, arch first toe loop (hook). Arching subsequent toe loops under the control of fitting on the dental arch, so they were placed respectively on buccal or labial surface of the tooth, and the total number of toe loops must be at least 6 (3 on each side). You should avoid placing hooks on the lower lip and tongue-tied by the bridle of the upper lip, as well as over the papilla. Hooks of lower jaw tire must resist tire hooks on the upper jaw, which provides a vertical rod with rubber rings. Hook height must not exceed 3-4 mm, as they may injure the mucous membrane of cheeks and lips. To avoid pressure on the gums, the hooks should bend at an angle of 45 ° to the horizontal plane.

Tire must have contact with the buccal or labial surface of each tooth. In the absence of teeth in the fracture, additional bending as the letter "P" should be used. The second end of the tire is placed in a semicircle or a spike. After manufacturing a tire, it should not have to be bend more to avoid its deformation.

Made tire fixed to the teeth with ligatures of brass, bronze, aluminum wire or stainless steel wire, diameter 0.3-0.4 mm. One end of the wire is introduced under the tire in the interdental gap from the vestibule into the mouth with the thumb forceps. Then, again taking over the wire with forceps and put it into the next interdentium so that it went over the tire. After that, pressing a finger to tire the arch, with krampons or Pean clip twist both ends of the ligature. Surplus ligature wire is cut with scissors for the metal, and the remaining ends of a length of 4-5 mm bend down to the tire so, that they do not injure the mucous membrane of the gums, lips or cheeks.

After traction and retention of bone fragments in the correct position, put rubber ring on the toe loop of the maxillary and mandibular tire. When stiffness of bone fragments of the lower jaw, to overcome the resistance of the muscles, put on rubber rings in an oblique direction. Next monitoring is provided. If fragments are in the correct position, the obliquity of rubber rings should be changed to vertical.

For fractures of the articular process of the lower jaw with a displacement of bone fragments place rubber gasket (thickness of 3-5 mm) in the side of the injury, between the upper and lower molars, and then put the rubber rings for interjaw traction.

One-jaw tires can be smooth: smooth-strap or tire with special bend. The use of such tires is limited by a failure of the resumption of occlusion and obtain the absolute stillness of debris, especially in gunshot comminuted fractures of jaws. They are used only in those cases where the fracture of the lower jaw is located within the dental arch, and there is no displacement of fragments, and the presence at least 2-3 teeth on each bone fragment. One-jaw tire is also used in alveolar bone fractures, fractures and dislocations of the teeth, if there are 2-3 teeth on each side.

Despite the widespread use of bent wire tires, they have several drawbacks: the complexity and duration of fabrication, trauma of the lip and cheek, the complexity of oral hygiene, maintenance in good condition as a result of oxidation of aluminum wire, prevents proper closure of dentition when there is a deep bite, inability to piece tire in store.

V.S. Vasiliev proposed and implemented in clinical practice standard tooth belt tires, in 1967 at the clinic of Oral and Maxillofacial Surgery of Kirov.

Tires are a long strip of 134 mm and a width of 2-3 mm. There are 14 ready-toe hooks, which are placed in three groups, and bent to one side. Two extreme groups of 5 hooks are placed on each side of the tire on the strife, and the third (4 hooks) - in the middle part. Such a placement does not prevent the toe hooks correctly closing dentition in victims.

Tires must be attached to the outer surface of the dental  arch, so that 4 toe hook in the middle of the tires were placed in the anterior pairs and symmetrically from the center line. Required tire length is pre-determined with ligature wire to the outer surface of the dentition in the mouth of the patient. Measurements are made separately for each side, then the tires has to be cut. Then, tires are fixed with ligature wire, diameter 0.3-0.4 mm, from the end of the tire on a larger fragment of the jaw, consistently from one tooth to the other. In the posterior region ligation performed in the usual way. In the region of the anterior teeth in the form of eight, which provides the most secure fit and prevents the slipping of tires. In the presence of a dentition bridge, ligature is fixed in the form of eight, but the main loop ligature wire should be placed vertically, covering interdental groove body of bridge.

After the splint, rubber rings are placed on the toe hooks. Place them evenly from one end of the tire to the other. There should be a small distance between the hooks of upper and lower jaws tire, to get the desired tension of elastic rubber ring.

Experience of using standard tooth belt tires at the clinic showed that it simplify and expedites splinting patients and did not interfere with the correct mapping of dentition with a deep bite. After sterilization, the tires can be used again.

Secondary medical personnel can also perform splinting.

Fixation of bone fragments of the upper jaw is one of the most difficult problems of maxillofacial trauma. It is very important to take into account the location of the fracture. Fixation of fragments is performed as with intraoral as well as with extraoral.

In partial alveolar bone fractures and dislocations of the upper jaw teeth, when both sides of the fracture are 2-3 abutment, a smooth rail-bracket of aluminum wire, which attaches itself to the teeth ligature wire is used. If the fragment of alveolar bone is located in the anterior and shifted palatal side, the tire must bend, departing from the misalignment of teeth in front and even beyond its` normal placement of 1-2 mm. Only after the tire is tied to healthy teeth, the fragment can be gradually attracted to arc, with wire ligatures or rubber rings.

To hold the fragments of the palatine and alveolar processes, as well as a soft tissue and tampons in the upper jaw, the tire of the reference plane is used. All of these tires should be placed on the inner surface of the premolars and molars, without touching the front teeth. When the tire is tied to the teeth with ligature wire, twist the ends in vestibule of the mouth. When there is missing a few teeth in dentition, the tire should be placed on the outer surface of the dental arch.

In case of the total tooth arch fracture, the intraoral fixation of upper jaw fragments is not enough. It should be combined with external elastic rod with hard chin sling or Z.N. Pomarancheva-Urbansky’s sling.

In cases of bilateral non-gun and gunshot fractures of the upper jaw, both-jaws splinting with elastic traction should be applied. The lower jaw should be tightened and fixedly mounted with chin sling to the head cap.

For fractures of the upper jaw with a shift backwards, the following method of treatment can be used. The teeth tires with toe hooks are imposed on both jaws, bite is disconnected with rubber gaskets an intermaxillary elastic traction is set. Additionally, the jaw is tracted forward with steel spokes, fixed to the head of gypsum cap. Extraoral skeletal traction of the jaw forward can also be carried through a bedside unit with measured load, the patient thus should be in bed.

For severe fractures of the upper jaw the teeth tires and vehicles with extraoral rods are widely used.

During World War II, twisted wire tires with extraoral rods were also used, which are described by Y.Z. Zbarzh. The author recommends two options for bending such tires. In the first version to take a segment of aluminum wire, thickness of 1.5-1.8 mm, length of 75-80 cm, the ends of the wire are 15 cm in length, each bend towards each other. Then double ends of the wire and twist them into a spiral. The spirals should adhere to the following conditions: 1) the wire ends should be at an angle of 45 ° to each other during the twisting; 2) one end should be in the direction of turns in a clockwise direction, the second - anti-clockwise. The middle part of the wire between the last turn of the helix must be equal to the distance between the premolars.

In second version, to take a segment of aluminum wire of the same length, as in the previous case, and arch it so that part of the tire intraoral and extraoral segments of defined once, and the base segments should fall on the first premolar region, and the average of the tire - in area of the front teeth. After tightening their extraoral rods, as in the first version, arching over the cheeks toward the lobes of ears and connect to rods, which are vertically attached to the head the cast. The lower ends of connecting rods are bent into a hook up and connect with a piece of tire, using ligature wire, and the upper ends of the connecting rods attach to the headband. It is better to make two connecting rods on each side.

In the postwar period, Y.M.Zbarzh, A.І. Orlov, K.A. Petrov and others offered the standard apparatus for fixing bone fragments of the upper jaw. The most successful of those is the device proposed by Y.M. Zbarzh. It consists of a tire with extraoral rods, supporting headband (caps), connecting rods and couplings. Intraoral part of the tire is a double arc, which tightly cover the crowns of the teeth of the buccal and palatal sides. The teeth arc is tied with ligature wire. The reference plane can be established on the tire to fix the swab in the hard palate. Extraoral part of the tire is formed of two wire rods, which depart from the outer arc of the tire at the premolars. The rods have a special curve, which provides free access to them from the mouth.

Supporting Headband consist of a double stripe with the eight double stripes with loops at the ends, which are sewn to the upper surface of it. On the sides of the headband, there is metal bracket support with the axes and fixing screws. Securing the main part of the dressing (wide strip) conduct buckle in special design, that allows the cord to move in only one direction.

Linking device consists of four cores and eight pairs of clamps, which are implanted in pairs for special sleeve and clamped with the clamping screws.

Fixation of fragments of the upper jaw with the device, which is described, is performed in a specific order: first, implement tires fit to the teeth and tie it with wire ligature, then, impose a support headband, then fragments are compared and all the details are fixed with screws.

The use of this device allows, if necessary, repeat the position correction of bone fragments. To do this, loosen fixing in Couplers, and then he screws.

Y.M. Zbarzh apparatus can be used for fixation of bone fragments edentulous maxilla.

Medical surgical methods for binding fragments of jaws.

The main task of modern treatment of fractures is the creation of optimal conditions to accelerate the process of reparative regeneration, providing primary bone healing wounds. The principles of treatment, formulated in 1967 by L.I. Krupko:

- accurate comparison of fragments;

- to set fragments tight to each other across the surface of the fracture;

- rigid fixation of the entire surface of the fracture fragments, which excludes any mobility between them for the duration, required to complete fracture union.

Principles of modern treatment of fractures:

- Treatment should be initiated as early as possible and designed to combat shock, blood loss, prevention of infection;

- All stages of treatment should be painless;

- Restoration of anatomical integrity (reduction);

- Rigid fixation of bone fragments;

- Turn off the function of the injured body (immobilization);

- The application of functional treatment;

- The use of methods, which accelerate callus formation.

Compliance with these provisions provides primary bone fusion in the shortest possible time.

Osteosynthesis fits the current requirements the best.,It is the operative method of fixing the wreckage, lacking a number of shortcomings.

Osteosynthesis is a surgical operative treatment of fractures, aiming at a strong connection of bone fragments by using different materials. Currently osteosynthesis is widely spread in maxillofacial trauma, especially in the treatment of mandibular fractures.

Method of operational consolidation of bone fragments, should not be opposed to orthopedic practices. If a surgeon can not achieve a lasting consolidation of bone fragments during the operation, he must complete the immobilization by using one of orthopedic methods. In some cases, orthopedic treatment may be supplemented by internal fixation.

Methods of surgical interventions may be extraoral and intraoral (through injury of soft tissues). Operative fixation of bone fragments of the upper jaw in gunshot injuries combined with an operation - maxillary sinusotomy and revision of the maxillary sinuses, are a necessary component of the prevention of traumatic sinusitis. Operative fixation of fragments of the upper jaw can be provided by using metal miniplates, screws, needles (for Mokienko), bone joint. Usually, wire of special stainless steel grades is used as a suture material: nichrome, tantalum, titanium, 0.6-1.8 mm in diameter, as well as polyamide, yarn and woven polyester with a diameter of 0.7-1.0 mm. In case of intraoral access, the sutures of small diameter (0.1-0.3 mm) are often imposed on the alveolar process. Such a suture, however, can not firmly secure fragments itself and plays a supporting role in the toothfixing.

The use of extraoral access allows you to conduct an audit of the fracture throughout, facilitates for reduction and retention of bone fragments in position during application of holes and bonding of bone fragments. The use of suture diameter (0.6-1.0 mm) provides a robust and reliable fixation of fragments without additional immobilization.

Surgical and orthopedic treatment of fractures of the maxilla. Methods of surgical treatment are combined with orthopedic methods often. Such orthopedic techniques are based on the method of fixing the tire on the tooth of the upper jaw to the head or a support bandage to intact facial bones and the frontal bone.

One of those methods is the Fidershpil surgical and orthopedic way (І934), the essence of which is that the fragments of the upper jaw tooth fixed with tires to the gypsum cap with pieces of thin steel wire or nylon thread, conducted through the thickness of the soft tissues of the cheeks. In cases where the wreckage before fixing can not reach the correct reduction, it is necessary to implement flexible traction by using rubber rings. In order to provide the necessary direction of stretching, in a Mount plaster cap the metal frame as a visor, in different parts of the wire arc, which are fixed to the upper end of the thread. Suspension of the upper jaw to the head support bandage may also be effected by means of the pin through the thickness of the upper jaw (Thomas, 1944).

The basis of the second group of methods of fracture treatment is the idea of suspending the upper jaw to the bones of the skull fixed - zygomatic and frontal, connecting them with tooth-wire tires (Faltin, 1916, Adams, 1942). The essence of the method of fixing the fragments Faltina-Adams is: depending on the level at which there is a fracture, the fixation is carried out for infraorbital region, zygomatic bone (arc), the zygomatic process of the frontal bone with ligature attached to the rail of the upper jaw tooth. On each side of the "reference site" bare bones, often outside access, and after drilling holes through them spend a wire loop or polyamide yarn, which ends with a thick needle, output in advance of the oral cavity and attached to the tooth tire. During the ligature around the zygomatic bone or arch there is no need for drilling holes.

The application of these techniques for the regulation of the bite should be resorted to intermaxillary fixation dressings ligature or both-jaws teeth splinting.

Tires and laboratory-type devices. Tires and devices, which are made in dental laboratories, called laboratory. According to the purpose, they can be fixed, substitute and repositioned. However, this does not mean that any of these devices or tires perform only a specific function. Usually some type of tire or device may combine the functions repositioned, fixing and replacement.

Z. Y. Shura divides the machines that are used in the treatment of fractures of the jaws into four main groups: fixed, repositioned, splinting, combined.

During World War II, a variety of devices and structures were used, which are laboratory type. Many of them areused nowadays, and some of them had lost its purpose in connection with the development of methods of operative treatment of fractures of the jaws.

Currently, the most common and effective in the treatment of fractures of the jaw are brazed tires of various structures: Weber’s teeth-gingival tire, Vankevich’s tire modified by Stepanov, Guning-Port’s tire and a few others.

Soldered tires. These tires are used for fixation of bone fragments of the lower and upper jaw. After reduction, they are fixed to the teeth with cement. Soldered tire consists of crowns, which cover some of the abutment teeth, which are placed on either side of the fracture line. If possible, the second molars and premolars, one of each side should be used. Crown abutments are not dissected, and therefore the crown increases the bite. Necessary bits in places of contact points grind that will restore occlusion. Initially a doctor should take the imprint of the teeth of the lower jaw, after preliminary reposition of fragments. Then arc wire, made of rigid metal, diameter of 1.5 mm, should be soldered to the equator crowns facially on the resulting model. If necessary, the same arc cad be soldered on the lingual (palatal) side. There are two types of soldered tires: smooth and with spacer. The tire with a spreader is used for defect of teeth arch.

Tires and removable devices. Guning-Port tire is a removable brace, used in the treatment of fractures of the edentulous jaws. Guning-Port tire consist of two bases, connected by a column in the lateral parts. There is a hole in areas of the front teeth for the patient's diet. It was manufactured of a rubber. Port proposed to manufacture a tire of pure tin in order that it can be sterilized. Currently, the tire is made of acrylic mass. To do this, prepare prints from both jaws, then a models. Model is fixed in the articulator in the right position, then the wax model bases should be placed on the upper and lower jaw, which connect to the back teeth with wax column, length that does not exceed the height of the bite. Then cut in the middle of the column and the wax in the usual manner and replace it by plastic. Finished plastic bases are placed into the mouth and after the reduction of bone fragments connect to the site columns quick-plastic. Apply a tire along with the chin sling.

Apparatus for reduction and fixation of bone fragments of the upper jaw. For fractures of the upper jaw can be used Shura device. It is combined device with hard rods. It consists of a brazed extraoral tire, terminals and plaster bandages with reference rigid rods directed downward. Firstly, it is necessary to make a soldered tire with base on 6543 \ 3456 teeth. A rectangular tubes (the size of the parties 4x2 mm and a length of up to 1.5 cm) should be soldered on the buccal surface of crowns 65 \ 56. The steel rods of wire with a cross section, corresponding to the cross section of rectangular tubing and a length of 20 mm, should be injected in the tubes. The bars should be arched so, that they come out of the mouth at its angles and directed upwards. Intraoral end of each rod is to be squished, and to be the same in diameter as the lumen tubes that are soldered to the tire. Headband made of plaster bandages. The rigid rods should be attached to the headband around the outer edge of the orbit (both sides), so that they reach the level of the nose. Changing the direction of extraoral rod ends that come out of the mouth, and by connecting them with rods, which descend from a cast, you can move the upper jaw in the right direction, and lock it in the desired position.

6. MATHERIALS FOR SELF - CHECKING:

А. Questions for self-checking: 1. Modern principles of treatment of bone fractures. 2. Methods of immobilization of bone fragments of the lower jaw. 3. Methods of immobilization of bone fragments of the upper jaw.

B. Tasks for self-checking: 1. The patient, 20 years, of diagnosis: traumatic fracture of the lower jaw teeth in 46, 47, with displacement of bone fragments. Objective: intact teeth, bite orthognathic. What type of permanent immobilization advisable to use? (Answer: Tooth both-jaw wire tire with toe hooks).

2. A patient, 24 years old, was admitted to the hospital with a diagnosis: fracture of the alveolar process of the left maxilla, near 25, 26, 27 teeth, without displacement of fragments. Which tire should be applied for permanent immobilization? (Answer: a Tigershtedt’s smooth tire-bracket).

3. A patient 35 years delivered in maxillofacial department after a car accident. Did not lose consciousness. Objectively: the face is asymmetrical due to edema face more to the right, his mouth half open, the upper jaw is movable, is biased downward. What is the optimal type of permanent immobilization of the fragments should be used? (Answer: The Zbarzh’s unit).

C. Matherials for test control. Test tasks with one right answer (α = II): 1. What refers to the temporary immobilization of bone fragments of the lower jaw? A. Smooth-tire bracket. B. Intermaxillary ligature binding teeth. C. Weber’s tire. D. Vasiliev’s standard tape tire. E. Guning-Port’s tire. (Correct answer: B).

2. What type of permanent immobilization is used in the conservative treatment of fractures of the lower jaw? Ligature binding teeth by Ivey. B. Direct intraoral fixation. C. Zbarzh’s device (complex). D. Tigershtedt’s Both-jaw tire with toe hooks. E. Osteosynthesis by Fidershpil. (Correct answer: D).

3. What is referred to therapeutic immobilization of bone fragments of jaws? A ligature binding rostral teeth. B. Direct extraoral fixation. C. Individual gypsum sling. D. Osteosynthesis. E. Osteosynthesis by Fidershpil. (Correct answer: D).

D. Educational tasks of 3 th levels (atypical tasks): 1. Patient R., 28 years, his diagnosis is established: fracture of the mandible in the field of a corner on the right outside a tooth alignment with shift of fragments. Make the treatment plan. (Answer: 1) temporary immobilization (necessarily) – a fundiform bandage; 2) medical immobilization - an osteosynthesis of the bottom jaw; 3) antimicrobic therapy; 4) physical and exsersice therapy; 5) the preparations accelerating processes of reparative osteogenesis).

2. The patient was delivered to specialized hospital, he has a gunshot fracture of the mandible at the level of the right corner. On a small fragment teeth is absent, on big are intacte, isn't mobile. What method of treatment should be applied? (Answer: osteosynthesis of the mandible).

3. Parient M, 27 years, his diagnosis is established: bilateral mental fracture of the mandible with shift of fragments. What methods of treatment can be applied to this patient? (Answer: the conservative – the intramaxillary fixation by Tigershtedt’s or a bilateral osteosynthesis).

 

Theme № 15 A constant (medical) immobilization of jaws with splints –orthopedic methods of treatment damages of bones of the facial part of skull: requirements, kinds, lacks and advantages. Achievement of national scientists, employees of department.

1. ACTUALITY OF THEME. Knowledge of methods of a constant (medical) immobilization of fragments at damages of maxillofacial area will which allow the doctor - stomatologist to organize and render rationally the qualified and specialized medical aid by the victim in a peace time, in a wartime and in extreme situations.

2. СONCRETE AIMS: 2.1. To analyze the indication and contraindication for orthopedic methods of treatment of fractures of bones of the face. 2.2. To explain ways of manufacturing of splints for treatment of fractures of the facial bones. 2.3. To offer the new approach in a choice of designs for orthopedic treatment of fractures of maxilla and mandible. 2.4. To classify orthopedic designs for treatment fractures of bones of the face. 2.5. To treat the data of X-ray pictures of bones of the facial skeleton with fractures. 2.6. To draw schemes, the schedules of application of splints at treatment of fractures of maxilla and mandible. 2.7. To analyze possible complications at treatment of fractures of bones of the facial skeleton by orthopedic methods. 2.8. To make the plan of treatment of different types of fractures of bones of the facial skeleton with splints.