Fracture of the lower jaw - symptoms and treatment

Osteosynthesis of the jaw is a method of surgical treatment of bone fractures using special, most often metal, structures. Osteosynthesis surgery is performed if the fracture site cannot be secured with splints, and also when it is difficult to fix bone fragments. There are different methods of performing the operation, they can be used depending on the type of injury and its severity.

Osteosynthesis allows you to maintain the required level of blood circulation in the damaged bone, which means that such a fracture will heal faster. Not only the integrity of the bone is restored, but also its structure, and this will take only a few weeks.

During the rehabilitation period, it is important to follow certain rules and monitor your well-being and the condition of your bone tissue. Violations of doctor's instructions can lead to pain and even loss of chewing functions.

Indications for osteosynthesis

Osteosynthesis may be prescribed in the following cases:

• if there are not enough stable molars at the fracture sites;
• upon impact, the fragments moved significantly;
• broken jaw bone behind teeth. With such an injury, individual parts of the bone tissue are displaced;
• the injury occurred as a result of the development of inflammatory diseases that thin the bone tissue;
• in case of a fracture of the lower jaw, if too small or massive fragments have formed;
• if the branches and body of the jaw are incorrectly positioned relative to each other;
• it is necessary to perform reconstructive surgery or osteoplasty.

Types of osteosynthesis

There are several methods of osteosynthesis; the doctor decides what type of operation the patient needs. Most often, surgeons combine several methods with each other to achieve better results.

Osteosynthesis of the jaw can be:

• Open. It is usually used for severe fractures. During the operation, soft tissue is cut and bone fragments are exposed. They are connected to each other and non-functional small fragments are removed, compressed soft tissues and fascia are released. However, with such an operation, there is still the possibility of tissue peeling off from the bone, then the callus at the fracture site will not be formed correctly. And this can affect the patient’s quality of life. In addition, stitches remain on the skin and paresis (decreased activity) of facial muscles is even possible. Depending on the type of fastening device, it is possible that the incision on the face will have to be made again to remove the fastener.
• Closed. The doctor combines bone fragments without cutting facial tissue;
• Focal. The fixing fastener is applied directly to the fracture site;
• Extrafocal. Fasteners are placed on top of the skin, above the fracture site.

Orthognathic surgery. Osteotomy of the upper and lower jaw. Genioplasty.

In the 21st century, modern orthodontics has enormous potential for solving the problems of malocclusion, which are associated with the incorrect location of the skeletal structure of the upper and lower jaws. Malocclusion can be either congenital or acquired as a result of injuries.

By the age of 16-20, such a jaw anomaly becomes more pronounced, which creates a certain discomfort, both psychological and aesthetic. People become unsure of themselves, and their self-esteem begins to decline. But this is not only a matter of aesthetics; such a pathology contributes to the development of a number of joint diseases, tooth loss, respiratory dysfunction, etc. All problems associated with eliminating such facial disharmony, returning normal occlusion (bite) and facial aesthetics can be solved by orthognathic surgery .

At the Federal State Budgetary Institution Scientific and Clinical Center of Otorhinolaryngology, Federal Medical and Biological Agency of Russia, orthognathic operations are performed by employees of the scientific and clinical department of maxillofacial surgery. Our Center employs some of the best specialists in Russia in the field of orthognathic surgery - Ph.D. Senyuk A.N., Lyashev I.N., Mokhirev M.A. Nazaryan D.N. , who apply not only the most modern world techniques, but also use their own developments.

“We often have to correct the mistakes of doctors who, with insufficient experience working with such patients, or in the pursuit of profit, corrected malocclusion, which ultimately led to severe complications and patient dissatisfaction with the final result of treatment,” says the head of the department of maxillofacial medicine. Facial and Reconstructive Surgery, Ph.D. Nazaryan D.N.

In their practice, our specialists carry out complex treatment, which includes orthopedic and orthodontic interventions, to achieve functional and aesthetic goals. Only an experienced specialist can determine that braces and orthodontic wires will not be able to relieve a patient with a skeletal jaw deformity from a protruding chin or a “ gummy smile ”, but on the contrary, they can lead to tooth dislocation and the development of the temporomandibular joint. We take a comprehensive approach to solving such problems, the essence of which lies in preliminary stage-by-stage preparation and preliminary 3D planning. Computed tomography, photography, plaster and STL models allow us to perform a complete preoperative analysis and simulated surgery. Orthognathic surgery allows you to move one or both of the patient's jaws back and forth, up and down. The treatment procedure takes place according to a pre-planned scheme, which involves moving the jaws, chin, soft tissues, eliminating dentoalveolar compensation, and aligning the dentition in relation to the main bone.

Orthognathic surgery is performed with maxillary osteotomy , where intraoral bone incisions are made above the teeth and below both eye sockets, allowing the upper jaw, including the palate and upper row of teeth, to be repositioned. This movement is positioned using a pre-made special splint, which will reliably guarantee its correct position of the lower jaw in relation to the soft tissues.

A mandibular osteotomy involves making bone cuts behind the molars, along the jaw, and downward so that the mandible can move as a single unit. As a result of this manipulation, the lower jaw, with the help of a titanium plate, smoothly moves to a new location.

The genioplasty operation is aimed at leveling the midline of the patient’s face, during which the chin part of the lower jaw is cut off and moved in the correct, harmonious direction.

All orthognathic operations are performed using intraoral access and do not have external incisions or scars. Such operations, in order to avoid relapses associated with continued jaw growth, can be performed on patients over 18 years of age, since it is believed that by this age the growth of a person’s jaws is completed. Orthognathic operations are performed under general anesthesia and, depending on the planning of the treatment requiring correction, can last from one to six hours.

In our Center, using specially made titanium plates, specialists fix all detachable parts of the jaw. After surgery, the following temporary symptoms are possible: postoperative swelling, bruising in the lips and cheeks, difficulty communicating in the first week after surgery, limited oral hygiene, numbness in the operated area, and a feeling of nasal congestion. In order to minimize risks and complications after surgery, the patient should follow the doctor's recommendations during the recovery period. After surgery, patients are recommended to eat semi-liquid food; there are no special dietary restrictions.

Thanks to Andrey Nikolaevich Senyuk in Russia, orthognathic surgery began to be carried out entirely using intraoral approaches, using preliminary preoperative planning in such a way that a precisely planned result in advance is achieved, coinciding with the final one both in terms of aesthetics and occlusion. It was he who organized the first international conference of orthofacial surgery in Russia.

Many years of experience in orthognathic surgery and deep knowledge of the problem will allow our highly qualified specialists to work wonders, as noted by the patients themselves), restoring self-confidence to patients and leading a fulfilling lifestyle. The surgical team of the department, headed by Doctor of Medical Sciences, Professor Karayan A.S., develops an individual treatment program for each patient, and attention and warmth from the treating staff are guaranteed to everyone!

Clinical cases

Example 1

Other examples:

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:

1. 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:

1. 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.
2. 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.

Osteosynthesis using ultrasound

With the help of metal fasteners, the jaw bones can be fixed quite firmly. But during surgery, it is most often necessary to cut through facial tissue and the salivary glands or branches of the facial nerve can be damaged.

It is less traumatic to perform osteosynthesis using ultrasound. In this case, the bone-fixing devices can be inserted shallowly into the bone and a small amount of scars remains on the patient’s face.

The doctor uses low-frequency ultrasound on a titanium plate with spikes. A plate with holes for the dental bur is placed at the fracture site and adapted to the shape of the jaw. An instrument is then used to make shallow holes in the bone through the plate. After which low-frequency ultrasound vibrations are directed to the base of the spines. In this way, the spikes gradually sink into the bone tissue, reliably fixing bone fragments. In this case, an antiseptic solution is supplied through the instrument, which treats the wound.

The bone tissue around the spines becomes denser under the influence of ultrasound. This occurs due to the large contact area, reducing pressure on the bone due to the use of a spike and the internal compression force of the bone tissue.

Ultrasonic osteosynthesis can reduce the time of surgery and reduce the amount of postoperative trauma. The method gives fewer complications and provides a good cosmetic effect.

Purpose of the operation

When performing an operation, the surgeon sets himself the following goals:

• Combine the fragments;
• Fix the bone with special splints until its integrity is restored;
• Secure the fragments with metal plates and knitting needles;
• Fix the dentition with special structures;
• Create conditions for favorable bone healing.

If such goals are achieved using conservative methods, then there is no need for surgery. Disturbances in the bone structure also cannot be ignored. Otherwise, unpleasant changes develop that lead to impaired chewing and articulation, as well as chronic pain in the jaw.