Fractures of the parasymphysis and symphysis

These fractures are commonly associated with fractures of one or both condyles. The thickness of the anterior mandible between the canine regions often ensures that these fractures are fine cracks which are little displaced and may be missed if the occlusion is undisturbed locally. The presence of bone tenderness and a small lingual haematoma may be the only physical signs.

More severe impact over the symphysis can lead to considerable disruption of the anatomy. A single fracture line is often oblique, which allows over-riding of the fragments with lingual inversion of the occlusion on each side. Frequently trauma of this degree results in bilateral parasymphyseal fractures or comminution of the whole symphyseal bone. There is often associated soft-tissue injury of the chin and lower lip since these fractures are always caused by direct violence.

These fracture patterns are often associated with quite severe concussion, in which case the separation of the fragment to which the genio-glossus muscle is attached may contribute to loss of voluntary tongue control and obstruction of the airway. If consciousness is not impaired, considerable disorganization of the anterior mandible and the adjacent soft tissue can take place without any significant loss of voluntary control of the tongue. Direct impact by a small high-velocity missile would produce this type of injury without impairment of consciousness.

A fracture of the symphysis is not accompanied by anaesthesia of the skin of the mental region unless the mental nerves are injured after emergence from their foramina

6. MATERIALS FOR SELF-CONTROL:

А. Questions for self-checking: 1. Anatomy and physiology of face skeleton. 2.Anatomy of mandible. 3. Anatomy of masseter muscles. 4. Variants of mandible’s fracture.5. Clinical features of mandible’s fracture. 6. Basic method of examination of patient with mandible’s fracture. 7. Additional method of examination of patient with mandible’s fracture. 8. Treatment of mandible’s fracture. 9. Indications for surgical treatment of mandible’s fracture.

B. Tasks for self-control: 1. For a patient, 28 years old, the fracture of lower jaw in area of the corner to the left, and its body in area of 46 with displacement is diagnosed. What treatment should be prescribed for such patient? (Answer: Tigirshtedt’s tire with locking loops on rubber traction.).

2.A patient, 20 years old, was conveyed to the casualty ward after 6 hours after a trauma. Objectively: violation of bite due to displacement of fragments. Teeth on upper and lower jaw, except of 35, are preserved. On X-ray graph is the lower jaw fracture. Fragments are displaced. What method of treatment (fixings of fragments) should you propose? (Answer: Direct osteosynthesis (overbone plates)).

3. A patient, 21 years old, got to the clinic of maxillofacial surgery with complaints of spontaneous pain in area of lower jaw corner to the left, slight swelling of this area, limited opening of mouth, impossibility to bite. From anamnesis: he got a trauma a day before, he was beaten by unknown men, he did not lose awareness, he did not asked for help, he was inoculated against tetanus 2 months ago. Objectively: asymmetric face due to the edema of the left masticatory area, when palpating a sickliness is determined, opening of mouth is limited up to 1,5 sm, symptom of “loading” is positive in the area of lower jaw corner to the left, “symptom of step” takes place in area between 37 and 38 teeth. (Answer: Angular fracture of lower jaw tothe left with the displacement in area of 37, 38).

C. Materials for test control. Test tasks with the single right answer (a=II): 1. What of the indicated methods belongs to the direct osteosynthesis? A) bone stitches; B) overbone plates; C) Kirschner’s spokes of; D) bone staples; E) Veber’s tire. (Correct answer: A).

2. Enumerate fixative means for the operative method of lower jaw osteosynthesis: A. According to Makienko, to Pavlov, to Kabakov, to Zbarzha, to Limberg, to Lvov. C. According to M.M. Solovyov, V. Magarill. D. According to H.A. Badzoshvili. E. According to Penn-Brown, V.F. Rudko, I.I. Yermolayeva, S.I. Kulagova. (Correct answer: A).

3. What kind of asphyxia can develop when two-sided angular fracture: A. Dislocational. B. Obturative. C. Stenosis. D. Valvular. E. Aspirative. (Correct answer: A.).

D. Educational tasks of 3th levels (atypical tasks): 1. Patient S., 28 years old, after the injury complains of a painful swelling in the body of the mandible on the left. Palpation of the left mandibular body is painful; there is mobility of fragments at area of 34, 35 teeth. When patient try to close mouth there is contact only molars antagonists at the left side. At X-ray in the lateral projection at the left there is fissure of fracture at area of 34, 35 teeth. The diagnosis: fracture of the body of the mandible at area of 34, 35 teeth. What type of surgery should be applied? (Correct answer: non-direct osteosyntesis.).

2. The patient is asked to maxillo-facial surgery department with complainings of swelling in the lower jaw at the left. Inability to open the mouth. An objective examination established that palpation of the angle of the mandible on the left marked tenderness, a symptom of the steps, the positive symptom of loading on both the left and right side. What diagnosis can be expected to install? (Correct answer: Bilateral angular fracture without displacement).

 

THEME 10. DAMAGES OF UP PE R JAW I N PEACE-TIME AND UNDER EXTREME CONDITIONS: ANATOMY OF DAMAGES, CLASSIFICATION, CLINICAL COURSE, MEDICA L AID FOR INJURED PERSON AT THE PLACE WHERE TRAU MA IS GOT AND AT THE STAGES OF MEDICAL EVACUATION. TREATMENT OF WOUNDS AND PRINCIPLES OF PLASTIC SURGERY WHEN UPPER JAW IS AT DAMAGE.