Tasks for individual work during preparation to lesson.

7.1. List of basic terms, parameters, characteristic, which a student must master at preparation to lesson:

Term	Definition
1.Isolated trauma.	This is damage of one anatomical area by single injured factor.
2. Compleх trauma.	This is damage of two and more anatomical areas by single injured factor.
3. Combined trauma.	This is damage by several injured factors.

4.2. Theoretical questions to lesson: 1. What is trauma? 2.Statistics of traumatic injures of maxillofacial area. 3. Classification of injures of bones of maxillofacial area. 4. Classification of injures of soft tissues of maxillofacial area. 5. Basic methods of examination of patients at policlinic. 6. Additional methods of victim’s examination.

4.3. Practical works (task) which are executed on lesson:

1. Conduct palpation of maxillofacial region of a patient with a suspected fracture of the upper jaw. 2. Conduct a test of indirect loads in a patient with a suspected fracture of the lower jaw.

5. TABLE OF CONTENTS OF THEME:

The facial skeleton can be roughly divided into three areas: the lower third or mandible, the upper third, which is formed by the frontal bone, and the middle third, an area extending downwards from the frontal bone to the level of the upper teeth or, if the patient is edentulous, the upper alveolus.

Fractures of the middle third area have also been called «upper jaw fractures» or «fractures of the maxillа», but in view of the fact that bones adjacent to the upper jaw are almost invariably involved in such injuries, these terms are not strictly accurate. It is better to use the term «mid-facial». Fractures of the facial skeleton are but one component of a spectrum of «maxillofacial injuries» and they are associated with varying degrees of involvement of the overlying soft tissues and such neighbouring structures as the eyes, nasal airways, paranasal sinuses and tongue. They can vary in severity from a simple crack in the upper alveolus to a major disruption of the entire facial skeleton.

Fracture of the mandible worldwide occurs more frequently than any other fracture of the facial skeleton apart from the nose. Fractures of the zygomatic complex are also common and are often associated with facial lacerations. All doctors working in Accident and Emergency departments should therefore be able to recognize these injuries and be familiar with the basic management. Fractures of the lower jaw or alveolus may present to a dental surgeon in his practice or, albeit rarely, be a complication of a difficult tooth extraction. The study of the management of facial bone fractures has therefore a real practical application which is not merely relevant to those studying for higher qualifications or pursuing a career in oral and maxillofacial surgery.

The mandible has a basic structure similar to a long bone with a strong outer cortex and a cancellous centre. In contrast, the bones of the middle third, while presenting a superficial appearance of strength, are in fact comparatively fragile and they fragment and comminute easily. In view of the fact that they articulate and interdigitate in a most complex fashion, it is difficult to fracture one bone without disrupting its neighbours. This gross comminution is difficult to visualize, for mid-facial injuries are usually closed injuries, but in a severe fracture the skeleton may be comminuted into 60 or 70 separate fragments.

Fractures of the facial skeleton may broadly be divided into two main groups:

1. Fractures with no gross comminution of the bone and without significant loss of hard or soft tissue.

2. Fractures with gross comminution of the bone and with extensive loss of both hard and soft tissue.

The majority of fractures fall into the first category. Those in the second group typically result from missile injuries in war situations, industrial injuries involving machinery or major road accidents where there is direct injury from sharp objects moving at relatively high velocity. Although arbitrary, this broad division is useful because the general management of the second group is entirely different from the first, both in the primary and in the reconstructive phases.

Aetiology. The contemporary causes of fracture of the facial bones are, in order of frequency: interpersonal violence, sporting injuries, falls, road traffic accidents, and industrial trauma. For 30 years after the Second World War road traffic accidents were found to be the major cause of these injuries, accounting for between 35 and 60 per cent of fractures of the facial bones (Rowe and Killey, 1968; Vincent-Townend and Shepherd, 1994). Perkins and Layton (1988) reviewed the aetiology of maxillofacial injuries in general and emphasized the changes which had occurred during the previous 20 years. More recently this changing pattern of maxillofacial trauma has been reviewed by van Beek and Merkx (1999), who have compared their own longitudinal studies from The Netherlands with similar data from Hamburg and Great Britain. Economically prosperous countries all show a striking reduction in the broad category of road traffic accidents and the increasing influence of interpersonal violence and sports injuries.

The relative importance of the various factors which affect the incidence of facial bone fractures is influenced by:

1. Geography.

2. Social trends.

3. Alcohol and drug abuse.

4. Road traffic legislation.
5 Seasons.

History and local examination