Classification of posttraumatic complications of maxillofacial area ...

Classification of posttraumatic
complications of maxillofacial area.
Orthopedic methods of unreal joints
treatment and breaks which not
correctly accreted

Plan
Classification of posttraumatic
complications.
Clinics, diagnostics and methods of
orthopaedic treatment of breaks which
are wrong accreted.
Treatment of lower jaw breaks, which
did not accrete (unreal joint).

Violation of correlation between dental
rows can take place in vertical or
horizontal plane, and in a number of cases
there is displacement of wreckages in two
mutually perpendicular planes. In
accordance with it, there can be different
types of pathological bite. Most often
there is the open bite, rarer – cross bite
and bite that goes down.

From data of different authors, breaks
which accreted wrong, meet as
complication of lower jaw breaks from 0,2
to 14% cases: N.Michelson (1946),
S.Vaysblat (1950) – 4-5%,
B.Kabakov (1951) – 13,6%,
D.Entin (1951) – 2%,
Y.Bronstein (1951) – 0,2%.

According to a degree of occlusion
contacts violation in a horizontal plane it is
accepted to distinguish between three
groups of patients:
1. Occlusion contacts saved as a intercusp
closing.
2. Closing only by lateral surfaces (the
cheek hillocks of lower jaw contact with
palatal upper jaw).
3. Complete absence of teeth closing.

V. Svyatykhin in his classification divides
the non-union of lower jaw on:
interposition;
crack like;
with the defect of bone 1-2 sm;
with a presence or absence of teeth on
one or both wreckages.

Reasons of formation of fake joints can be
general and local factors.
Diseases which reduce reactivity of organism
and violate repairing processes in a bone are the
general factors: tuberculosis, avitaminosis,
dystrophy, vascular diseases, metabolic, illness
of ductless glands disturbances.
Local factors are the ill-timed setting of
wreckages, insufficient immobilization of them
between wreckages, removing a layer by the
layer of periostome on the large draught of jaw,
traumatic osteomielitis of jaws which flow long-
term.

Classification
of posttraumatic complications
All of the complications at the breaks of
jaws are divided into 3 groups:
Direct
Early
Remote

Classification
of posttraumatic complications
It costs to accept as direct: asphyxia, bleeding, shock,
primary disfigurement of a face, violation of language,
mastication, swallowing.
To early – consequences of vessels damage (to the
hemorrhage), which grow insufficiency, consequences of
nerves damages (paresthesias, violations of innervation),
syndrome of sharp disorder of water-electrolyte balance
of organism.
Remote or late breaks are treated as the second
hemorrhages, to broncho-pulmonar disorder, traumatic
osteomielitis, cysts, contractures of masetters, wrong
accretion of wreckages, sialosyrinxs, unreal joint, scar
deformations and second disfigurement of a face.

Classification
of posttraumatic complications
Direct (in place of event) and early (on the
stage of evacuation or in medical
establishment) complications fall into the
category of critical conditions during which
such physiology disorders take place, that
it is impossible to correct spontaneously,
for their removal partial or complete
correction is needed.

Classification
of posttraumatic complications
Late complications develop as a result of 4
principal reasons:
heavy damages of maxillofacial area with defects
of soft and bone tissues;
errors in providing of the specialized
stomatological help to patient and at looking
after them;
decline of general organism reactivity ;
rapid transformation of unpathogenic microflora
of mouth cavity into high-virulent and
pathogenic, stable to many antibiotics.

Clinics, diagnostics and methods
of orthopedic treatment
at wrong accretion of lower jaw fragments
If at the damage of jaws a specialized help was done on
time, the surgical roughing-out of wound, reposition and
immobilization of fragments are correctly conducted, the
process of healing flows favorably, anatomic integrity of
jaw gets better, correct occlusion of dental rows and
function of cavity of mouth recommences.
The tardy and unskilled granting of specialized help to
the patients with the breaks of jaws results in accretion
of fragments in wrong position, and wounds in soft
tissues with formation of rough scars, which limit
motions of lower jaw, lips, cheeks, tongue.

Clinics, diagnostics and methods
of orthopedic treatment
at wrong accretion of lower jaw fragments
Principal reasons of wrong accretion of lower jaw
fragments are: inexact setting and weak fixing of bone
fragments at their damage, and also late orthopedic
interference. Such complications, as osteomielit,
abscesses, phlegmons and other weaken regenerative
processes in bone tissue, prolongs the terms of
treatment and assists the development of deformations
Basic symptoms for diagnostics of wrong growing
fragments of jaws are: asymmetry of a face, decrease of
dental arc length, turn of lower edge of lower jaw
outside or inside, wrong inclination of teeth.

.
Clinics, diagnostics and methods
of orthopedic treatment
at wrong accretion of lower jaw fragments
Basic symptoms for diagnostics of wrong
growing fragments of jaws are: asymmetry of a
face, decrease of dental arc length, turn of lower
edge of lower jaw outside or inside, wrong
inclination of teeth.
However, a most widespread symptom is the
wrong closing of dental rows, during absence of
contacts between teeth by antagonists or to the
presence of contacts only between separate
teeth and groups of teeth. Original appearance
of patient changes, occlusion contacts are
violated.

The defect of bone, which is less than 2 sm,
named as unreal joint, and over 2 sm – the
defect of a bone.
A clinical picture at the unreal joint of lower jaw
is determined by the degree of fragments
mobility, direction of their shift, position of
fragments in relation to each other and upper
jaw, amount of teeth on fragments, state of
their paradontium, size of bone defect,
localization of unreal joint, presence of mucous
membrane scars and their sensitiveness.

I. M. Oxman defines four groups of unreal joints according to:
localizations of damage,
amount of teeth on fragments and the size of bone defect:
Both fragments have 3-4 teeth
– with the defect of bone up to 2 sm.
– with the defect of bone more than 2 sm.
Both fragments have 1-2 teeth
Defects of lower jaw with toothless fragments:
with one toothless fragment
with both toothless fragments
Bilateral defect of lower jaw:
at the presence of teeth on a middle fragment, but at absence
on lateral
at the presence of teeth on lateral fragments, but absence on
middle.

V. Kurlyandsky examines 3 groups of unreal
joints:
Non-united breaks within the limits of dental row
at the presence of teeth on fragments.
Non-united breaks within the limits of dental row
at the presence of toothless fragments.
Non-united breaks behind dental row.
Formation of unreal joint couses violation of a
biting and chewing of meal, swallowing and
speech.

Treatment
The best functional effect at unreal joints gives bone plate
with future prosthetics of dental row defects. Prosthetics
without proceeding in integrity of bone is recommended to
conduct when the operation of plastic is not indicated or it is
put aside for a long time (exhaustion of organism, flat refusal
of patient from operation). In these cases prosthetics carries
temporal character with the purpose of correct position
maintenance of jaw fragments and firmness that remained
before the moment of possible bone plastics.
Basic principle of prosthetics is that the parts of
prosthetic appliance are disposed on jaw fragments, are
connect motionlessly so that they do not hinder the shift of
fragments. Substituting of dental row defects for patients with
the non-united breaks of lower jaw with ordinary prosthetic
appliances will result in the functional overload of teeth.