How is surgical treatment of a jaw fracture carried out?

What is a jaw fracture?

A fracture of the jaw is a violation of the integrity of the upper, lower or both bones of the jaw or their appendages, which occurred as a result of a road accident, fall, blow, or combat injury. Most often, this is a fracture with a large number of fragments, combined with other injuries (facial soft tissue injuries, hematoma, brain concussion, skull bone injuries), which requires complex treatment by a neurosurgeon and a maxillofacial surgeon.

What are the causes of trauma to the jaw?

The most common causes of jaw injuries are road accidents, unfortunate falls, blows to the face, and sometimes domestic injuries. Now combat wounds can be added to this list.

Fractures caused by a blow by a professional boxer are usually sharper and cleaner, with fewer bone fragments. Injuries resulting from a fall from a height or a road accident, on the contrary, are complex with a large number of fragments. In the warm period of the year, jaw fractures due to falling from a scooter are more common. They are somewhat reminiscent of chin injuries in a child: due to the shift of the center of gravity upwards, a person, falling, meets an obstacle with his face. However, unlike adults, children rarely break bones: it is more likely not a complete fracture, but a crack that can heal without surgery (but in any case, an examination by a maxillofacial surgeon is required). Combat firearm (most often mine and explosive injuries) fractures of the upper jaw have their own specificity: as a rule, not only the jaw is broken, but also soft tissues are significantly affected, teeth are broken, and each of them plays the role of a secondary wounding projectile with its own wound canal. These are open and contaminated wounds, often complicated by infection. Treatment involves at least several surgical interventions.

Classification of jaw fractures

All mandibular fractures within the dentition are considered open by default. They are also distinguished by localization (fracture of the articular process of the lower jaw, coronal process, branches of the lower jaw, body of the lower jaw, chin).

Fractures of the upper jaw, depending on the height of the impact, are classified according to the Le Faure system:

Le Fort I (lower) — the bone is broken along the lower border, the bottom of the maxillary sinus;
Le Faure II (middle) — the fracture passes along the base of the nose and the lower edge of the orbit, while part of the upper jaw can move independently of other bones of the middle of the face;
Le Fort III (upper) — the upper jaw is completely separated from the skull.

Upper Le Fort, which is the result of an extremely strong impact, is usually associated with brain trauma, and it is the main one. Therefore, first of all, the patient is examined by a neurosurgeon, and then the fracture of the jaw is treated. Or at least the neurosurgeon and the maxillofacial surgeon go into the operating room and work together.

What symptoms indicate a fractured jaw?

Le Fort I fracture of the upper jaw may not have characteristic symptoms. Severe swelling, facial asymmetry, and pain may also indicate a jaw contusion, and only a maxillofacial surgeon can make an accurate diagnosis and distinguish a jaw contusion from a fracture based on the CT scan. If there is liquefaction from the nose (flow of cerebrospinal fluid with blood impurities), and double vision in the eyes, these are signs of a fracture of the jaw behind the middle or upper Le Fort.

Symptoms of a fracture of the lower jaw are crunching of bone fragments when trying to move the jaw, pain and discomfort when trying to clench the teeth, visual asymmetry of the lower third of the face.

If you suspect a jaw fracture, you should consult a maxillofacial surgeon, and before that, provide first aid: stop the bleeding from the open wound by pressing a clean towel (T-shirt, scarf, etc.) to it and, as far as possible, immobilize the broken jaw. It is better not to treat the wound, so as not to damage anything additionally.

Methods of diagnosis of jaw fracture

Fractures of the jaws and other bones of the face are usually diagnosed with the help of computer tomography. In the Sirius Dent Medical Center, as befits a specialized institution, an urgent patient can immediately undergo a CT scan and receive a radiologist’s opinion upon arrival. A fracture of the lower jaw is also well visualized on an X-ray taken in several projections.

Can a fracture of the jaw be cured with medication?

Bone fractures, including jaws, are not treated with medication. After all, it is important not only to relieve pain and swelling, but also to return the fragments to the correct anatomical position. If the fragments are not repositioned, the jaw grows incorrectly. The range of consequences in such a case varies from a violation of the bite after a jaw fracture, asymmetry and disfigurement of the face, to persistent paresthesia (numbness) of a part of the face if the bone fragments damaged the trigeminal nerve, disability and the inability to fully chew and speak. If a fragment remains in the maxillary sinus, a person gets chronic sinusitis. Thus, except for a crack in the bone, which heals well on its own, it is possible to heal without surgery.

How to prepare for surgical treatment of a jaw fracture?

Surgical treatment of a jaw fracture is performed on the day of the injury or the next day. If for some reason it is not possible to do it right away, the surgical intervention is postponed for a few days so that the swelling goes down. The normal term for surgery on the jaw area, if there are no complications, is six to eight days. Before that, the patient must receive a consultation from an anesthesiologist and pass the necessary pre-operative analysis package. On the day of the operation, the patient must not eat any food for at least 6 hours.

Stages of surgery for jaw fracture

Of all the surgical methods of treating jaw fractures, we most often choose metallo-osteosynthesis. At the same time, we involve modern computer technologies. So, if it is a complex multiple combined fracture of the jaw with an open wound, part of the fragments may be lost. Then we visualize the model of the patient’s skull in a computer program, print the missing fragments from titanium and install them in place during surgery. Moreover, with the help of virtual modeling, we can immediately give the titanium fragments and plates the necessary curves to save time in the operating room.

After all the bone fragments are set in place, they are fixed with titanium plates and screws. Next, sutures are placed: on the mucous membrane with intraoral access or on the skin with external access. In the latter case, these are cosmetic sutures, which are usually used by plastic surgeons.

Since we are dealing with the face, it is important not to leave gross scars.

As a rule, the patient can go home the same day. Titanium plates are removed between 3 and 12 months after surgery or, if deeply placed, remain for life.

For temporary immobilization in the case of a jaw fracture, we do not use a splint, but orthodontic implants, which we tighten with rubber and in this way connect the upper jaw with the lower one.

Rehabilitation after surgical treatment of a jaw fracture

During the entire recovery period, it is necessary to regularly visit the maxillofacial surgeon for check-ups and follow his recommendations. For the first 2-3 weeks after the operation, the jaws remain firmly connected to each other, so the patient must eat only liquid food. The products are ground in a blender, diluted with water or broth, and a person can drink it through a tube. To diversify and enrich the diet with vitamins, you can add sports cocktails. It is also not worth talking at this time, it is necessary to protect the jaw and avoid physical exertion. During the next 2 weeks after the release of the jaws, the patient gradually begins to chew and returns to his usual diet. It is impossible to brush your teeth with a broken jaw, but after removing the ligatures, it is enough to visit a dentist for professional hygiene.