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Classification.

I. Production.

• Industrial.
• Agricultural.

II. Non-manufacturing.

• Household:
  • transport;
  • street;
  • sports;
  • others.

Types of damage to the maxillofacial area.

I. Mechanical damage.

Localization.

• Soft fabric injury:
  • language;
  • large salivary glands;
  • large nerve trunks;
  • large vessels.
• Bone injury:
  • lower jaw;
  • upper jaw;
  • zick bones;
  • nose bones;
  • defeat two and more bones.

By character injury:

• cross-cutting;
• blind;
• tangents;
• penetrating the oral cavity;
• pTA impermeal;
• penetrating into the maxillary sinuses and nasal cavity.

By damage mechanism:

• bullet;
• svolded;
• balls;
• skilovoid elements.

II. Combined Damage

• radial;
• poisoning chemicals.

III. Burns.

IV. Frostbite.

Damage divide on:

• isolated;
• single;
• isolated multiple;
• combined isolated;
• combined multiple.

Combined injury - Damage to two or more anatomical regions with one or more affixing agent.

Combined injury - Damage resulting from the impact of various traumatic factors.

Fracture- partial or complete violation of bone continuity.


Traumatic damage to teeth

Severe acute and chronic tooth injury. The sharp injury to the tooth occurs with the one-time effect on the tooth of great strength, as a result of which injury, dislocation, the fracture of the tooth, is more common in children, the front teeth of the upper jaw are mostly traumatized.

Chronic tooth injury arises under the action of a weak amount of force for a long time.

Etiology: falling on the street, punch subjects, sports injury; Among the factors predisposing the wrong bite.

Features of the examination of the patient with acute teeth injury: the history of the victim, as well as the accompanying person, record the number and accurate time of injury, place and circumstances of injury, how long passed to appeal to the doctor; When, where and by whom the first medical care was provided, its character and volume. Find out whether there was no loss of consciousness, nausea, vomiting, headaches (may be ankle- brain injury), find out the presence of vaccinations against the tetanus.

Features of the external inspection: noted the change in the configuration of the person due to post-traumatic edema; The presence of hematomas, abrasion, leather breaks and mucous membranes, changing the color of the skin of the face. Also draw attention to the presence of abrasion, gaps on the mucous membrane of the anticipation and oral cavity. Carefully conduct an inspection of the injured tooth, radiography and electro-producer injured and nearby teeth.

The injury of the front teeth leads to such consequences as a violation of aesthetics due to the absence of the tooth, occlusion, the development of the symptom of Popov-Vodon (the nomination of the tooth that has lost its antagonist), as well as speech violations.


Classification of acute tooth injury.

1. Burst tooth.

2. Dislocation of the tooth:

• incomplete: without displacement, with a displacement of the crown in the direction of a neighboring tooth, with a rotation of the tooth around the longitudinal axis, with the displacement of the crown in the vestibular direction, with the displacement of the crown in the direction of the oral cavity, with the crown of the crown in the direction of the occlusal plane;
• framed;
• full.

3. The crack of the tooth.

4. Tooth fracture (transverse, oblique, longitudinal):

• crowns in the enamel zone;
• crowns in the enamel and dentin zone without opening the cavity of the tooth;
• crowns in the enamel zone and dentin with the opening of the cavity of the tooth;
• the tooth in the field of enamel, dentin and cement.
• the root (in the priest, medium and top-e-thirds).

5. Combined (combined) injury.

6. Dental injury.


Bruised tooth - closed mechanical damage to the tooth without a violation of its anatomical tract.

Pathochistology: Periodonta fibers are damaged, ischemia, a blast or gap of a period of periodontal fibers, especially in the field of the top of the tooth; Reversible changes are developing in the pulp. The vascular-nerve beam can be saved completely, a partial or complete gap can be observed. With a full break, the vascular-nerve bundle is observed in the pulp and her death.

Clinical painting of teeth injury: permanent many pain In the teeth, pain in prickling and vertical percussion of the tooth, the feeling of the "grown tooth", staining and darkening the crown of the tooth in the pink color, the mobility of the tooth, swelling, hyperemia of the gum mucosa in the injured tooth; No radiographic changes.

Treatment: anesthesia, tooth rest to the cessation of pain in pricking tooth (elimination of solid food for 3-5 days, a decrease in contact with antagonist teeth by stamping them; anti-inflammatory treatment: physiotherapy.


D.V. Sharov
"Dentistry"

Manual dedicated actual problem Traumatic damage to the soft tissues of the maxillofacial area. Dana classification, statistics and characteristics of damage associated with a feature of the structure and functionality of this area. A clinical picture and methods of treating firearms and uniform traumatic damage to soft tissues at the reachable stage (in the clinic and during transportation) and in the hospital are described. The characteristic and treatment of traumatic damage to the soft tissues of various departments of the maxillofacial region are presented. Complications are described associated with this pathology, methods of nutrition of patients, the care of the oral cavity, therapeutic gymnastics and physiotherapy. The manual is illustrated by 57 drawings. Contains control questions, situational tasks and test tests. The book is addressed to dentists, surgeons, maxillofacial surgeons, teachers and students of medical universities.

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Company LITRES.

Classification and statistics Traumatic damage Maxillofacial region

1.1. Classification of traumatic damage

Depending on the circumstances under which injury was obtained, it can be marked as injury military or peacetime. The latter, in turn, is divided into household, sports, industrial, transport (accident), resulting from natural cataclysms, terrorist acts, man-made disasters. Often, the place where the injury occurred, determines the severity and possible accompanying damage to the body.

During military operations, various injuries and damage to the maxillofacial region, due to one or many affecting factors at the same time, can be observed. In this regard, a possible future war will differ from all previous wars who knew humanity. This will impose an imprint not only a value, but also on the structure of sanitary losses. Combined lesions will appease - firearms in combination with the effects of high temperatures penetrating radiation and other mass lesions. You should also expect a large number of mechanical uniform damage to the face and the jaws caused by collaps and secondary wounded shells - wreckage of stones, bricks, wood, etc. In all previous wars, firearms were prevailing the prevail. They remain prevalent and with all local wars leading on the globe at the present time. However, a large proportion is already occupied by a thermal injury.

Considering the severity of gunshot damage, it should be remembered for new types of weapons, which can be attributed to ball bombs, remigraton type bullets of the caliber of 5.56 mm and others. When an explosion of a ball bomb from a spherical body, 300 thousand steel balls fly out (5.56 mm diameter and weighing - 0.7 g), which have a large punchy force and apply multiple injuries. In a homemade-made bomb as a filling, pieces of wire, nuts and other metal objects are used. Remigitton bullet due to the displaced center of gravity when introducing in fabric begins to tumble, causing in soft tissues and in the outlet area large destruction.

In the postwar period, the classification of damage to the maxillofacial region D. A. Entin and B. D. Kabakov (Alexandrov N. M., 1986), based on the materials of the Great Patriotic War, 1941-1945 were obtained the greatest distribution. But since then, the means of defeat have changed significantly. This circumstance was the basis for revising the working classification of injuries and damage to the maxillofacial region.

The proposed department maxillofacial Surgery and dentistry wishes them. S. M. Kirov Classification option, based on the work of D. A. Entin and B. D. Kabakov, was considered at a meeting of the problem commission "on dentistry and anesthesia" in the Presidium of the USSR AMN March 16, 1984 after making a number of amendments. Classification was adopted and proposed for use as a working in medical institutions.

In the presented classification, all damage to the chelyotnical region, depending on the nature of the damaging factor, are divided into four groups: 1) mechanical; 2) combined; 3) burns; 4) frostbite. In each of these groups, the zone of damage to the maxillofacial region is indicated: the top, medium, lower, side. Such division into zones is generally accepted and convenient to designate the localization of damage.

Table 1 shows the mechanical damage to the Chelytsnolitz region.

Table 1

Classification of mechanical damage to the maxillofacial region

Note.Personal damage can be single and multiple; isolated and combined; Concomitant and leading.

The classification provides the current meaning of the term " combined lesions", Under which it is customary to understand the multifactorial lesions, which are a consequence of the impact of two, three and more different affecting factors. For example, a combination of mechanical damage with burn, frostbite or impact of penetrating radiation is possible. It is difficult to consider everything possible options Multifactor lesions and hardly it is advisable in the classification to indicate all possible combinations - it would make it unjustified by cumbersome.

Electricalravum should be attributed to the group "Burns", although it is done very conditionally. No doubt that the electrician is largely different from conventional burns both by the local tissue reaction to the impact electric currentand according to the general response of the body, by the nature of emergency measures and the subsequent treatment of damage gained. The facial electrician is rare, and create for it in the classification special group Damage is inappropriate.

Obviously the need to allocate in the classification rubrics " soft fabrics », « bones"And dividing damage to the nature of the injury. It is only necessary to indicate that firearms always belong to the category of open, while uniform damage can be both open and closed.

Often damage to the maxillofacial region are combined with damage to other parts of the body. According to international Classification Diseases, the body of a person is commonly divided into seven anatomical regions: head, chest, neck, belly, pelvis, spine, limbs. For example, if the face and chest will be amazed at the same time, they talk about combined damage. And if such damage is applied with one wounded shell, then it is indicated as combined solitary if the damaging agents were two or more, then in this case they talk about multiple combined. If two or more agents caused the damage to one anatomical region, they talk about isolated multiple lesion. In case of damage to one anatomical region with one wounding projectile, the wound is called single isolated.

When combined damage, it is necessary to determine the priority of assistance depending on the severity of one of the damage. In the process of treatment, the leading may be the damage, which was at first concomitant, then the wounded will be transferred to another branch. These definitions are inconsistent even for the same wounded and matter mainly when primary stage diagnosis. The concept of "combined damage" to the general presentation of the simultaneous damage to the various parts of the body must add head damage, at which the brain, organ of vision or ENT organs, requiring participation in the treatment of neurosurgeon, ophthalmologist or LOR specialist, are affected at the same time.

In the classification of traumatic damage to the CheLUsnolitse region, it is necessary to distinguish the degree of their gravity, which is determined by the volume and localization of injury, the type of affected fabric, the nature of injury and common state victim.

A. V. Lukyanenko (1996) offers a classification that consists of two sections. In the first section, firearms of the face are classified by the form of injury (isolated, multiple, multiple wounds of head, combined wounds). In the second - by the nature of the injury and its consequences, threatening life. Two classification partitions correspond to two diagnosis parts.

According to the severity of damage to the injury of the maxillofacial region, they are divided into three main groups.

Easy degree of damage.Traumatic damage to the maxillofacial area of \u200b\u200ba light extent is characterized by the following signs (see col. Plot, Fig. 1):

- isolated limited damage to the soft fabrics of the face without the true defect and without damage to the organs (language, salivary glands, nerve trunks, etc.);

- isolated damage to alveolar processes of jaws or individual teeth without disruption of the continuity of the jaws;

- damage not penetrating into the natural cavities of the maxillofacial region;

- single or multiple blind injuries of soft fabrics of the face with standard fragmentation elements (balls, arrows, etc.), small fragments of the shells of mine-explosive devices, subject to the location of the fragments away from vital organs, large nervous trunks or vessels, without damage to the branches facial nerve, output with large salivary glands;

- bruises and abrasions of the face;

- Uniform fractures of the lower jaw without displacement of fragments.

Average degree of damage. Traumatic damage to the maxillofacial region is moderately characterized by the following features (see col. Plot, Fig. 2):

- isolated extensive damage to the soft fabrics of the face without the true defect, accompanied by damage to the individual anatomical formations and organs of the maxillofacial region (language, large salivary glands and their ducts, eyelids, the wings of the nose, ear shells, etc.);

- damage to the bones of the facial skeleton with a violation of their continuity or damage penetrating into natural cavities;

- small blind injuries with the localization of foreign bodies (bullets, fragments) near vital anatomical formations, organs and large vessels.

Heavy damage damage. Traumatic damage to the maxillofacial region of severely characterized by the following signs (see col. Plot, Fig. 3):

- isolated wounds of only soft tissues, accompanied by extensive true defects or loss of small, but functionally and cosmetic fragments - external nose, eyelids, lips, oars, tongue, soft sky, etc.;

- damage to the upper or lower jaw, accompanied by a true defect of the bone penetrating into the oral cavity, with damage to the solid sky, penetrating the cavity of the nose and the incomparatory sinuses;

- multiple, multi-skilled fractures of the bones of the facial skull;

- damage to large nerve trunks and branches trigeny nerve, large vessels and venous plexuses;

- The presence of foreign bodies (fragments, bullets), secondary caring shells (teeth, bone fragments) near the vitality and functionally important anatomical formations of the maxillofacial region.

1.2. Traumatic damage statistics

According to statistics, the amount of damage to the maxillofacial region in the Great Patriotic War (Great Patriotic War) was 4.5-5.0% of the total number of injuries, in peacetime - about 3.0%. However, at present, during local military conflicts (LDV), the share of the wounds of the maxillofacial region increased to 9%. Gunshot damage to the bones of the front skeleton of the lower jaw - 58.6%, the upper jaw - 28.9%, both jaws - 21.5%. Skulent bone is usually damaged in combination with other bones of the facial skeleton. Isolated damage to soft tissues make up 70%, with damage to the bones of the facial skeleton - 30%. Depending on the wounding projectile: bullets - 33.6%, fragments - 65.3%, other - 1.1%. Penetrating oral cavity - 42.4%, impermeal - 57.6%.

The frequency and structure of maxillofacial injuries during the local modern conflict presented in Table 2.

table 2

Frequency and structure of maxillofacial injuries during local conflicts

At the time of Alexander the Macedonian wounded in the Chelyusnolitse region, they did not assist at all, they were left on the battlefield. During the First World War (1914 - 1918), 41% of such wounded were dismissed from the army because of the "serious deformity of the face" with significant violations of vital functions. In hostilities in the area of \u200b\u200bLake Hassan (1938) and on the Khalkhin-goal River (1939), 21% of military personnel returned to the army, and during the Great Patriotic War (1941-1945 .) Only 15% did not return to line, that is, 85% of the wounded replenished the ranks of the existing army.

Wounds of soft tissues of the maxillofacial area when conducting combat operations are almost twice as often as damage to the facial skeleton. At the same time, damage to the bones of the facial skeleton in peacetime prevailing the wounds of the soft tissues of the maxillofacial region.

Control questions

1. Name the principle that is based on the creation of a classification of traumatic damage to the maxillofacial region?

2. How is the injury of peacetime divided?

3. What is the difference between concepts combined and isolated injury?

4. What is the difference between single damage from multiple?

5. What is combined damage?

6. What is the order of rendering medical care Depending on the concepts of "accompanying" and "leading" injury?

7. How do traumatic damage to the Chelytsnolese region differ depending on the degree of damage? To give brief description Each degree.

Situational tasks

1. In the hospital was delivered after an accident with damage to the lower third of the face. Not shouting, not moaning, does not answer questions. Conduct an assessment of the patient's condition.

2. In the hospital brought wounded with a knife injury to the left cheek, penetrating the oral cavity. Put the diagnosis according to the classification.

3. In the clinic addressed the wounded with a tangent fragmentation injury of the attribute region. When inspected, damage to the eye was revealed. Where should I be sent wounded to provide medical care?

4. In the hospital was brought by a wounded with a back and a fracture of the lower jaw. What type, according to the classification, belongs to this defeat?

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A given familiarization fragment of the book Traumatic damage to the soft tissues of the maxillofacial area. Clinic, diagnosis and treatment (T. I. Samedov, 2013) granted by our book partner -

22972 0

Damage to the maxillofacial area during combat operations are found in 8.5% of the wounded. At the same time, in 4.4% of cases, the wounded are treated in specialized people of the liquid-facial departments of hospitals. In 4.1% of cases injured are combined. In this case, damage to the liquid-facial area is diagnosed in the wounded, which are treated in other profile surgical departments.

The frequency of damage to the person may vary depending on the nature of the conditions of combat operations, the presence or absence of individual and collective means of protection in military personnel, from the prevailing type of weapons used (mines, sniper fire, shells and bombs with standard afflicting fragments, etc.). From the same factors, to a certain extent depends on the structure of firearms of the maxillofacial region.

By the nature of tissue damage Allocate:

- injured only soft tissues, including with damage to the language, salivary glands, large nerve trunks and vessels;

Injuries and damage to the bones of the facial skeleton, including injuries of the upper or (and) lower jaw, zicky bone, nose bones, damage to two and more bones of the face.

By the nature of the wound canal Mechanical, including firearms, damage to the maxillofacial region are divided into through, blind and tangents.

In relation to natural cavities of the facial department of the head Eliminate injuries penetrating and impenetrable in one or more natural cavities: in the oral cavity, in the cavity of the nose or in the ocolone sinuses.

A characteristic feature peculiar to only the damage to the head is frequent (up to 50% for gunshot wounds) the one-time destruction of tissues of several adjacent anatomical areas (zones), when the insulated injury of the tissues of the maxillofacial region is accompanied by damage to the fabrics of the ENT organs, organs of vision, skull and head organs brain. Such injuries are advisable to qualify as injured by the soup-facial area, accompanied by damage to one, two or more anatomical regions of the head. This feature is important when organizing intra-paragraph and evacotransport sorting wounded when providing specialized medical care.

With compulsible injuries of damage to the maxillion-whether there can be both leading gravity and accompanying.

By clinical flow Isolated injuries and damage to the maxillofacial area are divided into three main groups.

Light injured:

Isolated (tangent, cross-toile, blind) limited damage to the soft fabrics of the face without the true defect and without damage to the organs (language, salivary glands, nerve trunks, etc.);

Isolated damage to alveolar processes of jaws or individual teeth without disruption of jaw continuity;

Not penetrating the natural cavity of the maxillofacial region;

Single or multiple blind injures of soft fabrics of the face with standard fragmentation elements (balls, arrows, etc.), small fragments of mine-explosive shells, subject to the location of the fragments, away from vital organs, large nerve trunks or vessels, without damage to the branches of the facial nerve , output ducts of large salivary glands;

Bruises and abrasions of the face;

Unmixed fractures of the lower jaw without displacement of fragments.

Wounds middle severity:

Isolated extensive damage to the soft fabrics of the face without the true defect or accompanied by damage to the individual anatomical formations and organs of the maxillofacial region (language, large salivary glands and their ducts, eyelids, the wings of the nose, ear-sinks, etc.);

Damage to the bones of the facial skeleton with a violation of their continuity or penetrating natural cavities;

Small wounds with the localization of foreign bodies (bullets, fragments) near vital anatomical formations, organs and large vessels.

Heavy injured:

Isolated injured of only soft tissues, accompanied by true extensive defects of soft tissues or loss of small, but functionally and cosmetic fragments - external nose, eyelids, lips, oars, language, soft sky, etc.;

Damage to the upper or lower jaws, accompanied by a true defect of the bone penetrating into the oral cavity, with damage to the solid sky, penetrating the nasal cavity and the incomplete sinuses; multiple, multi-skilled fractures of the bones of the facial skull;

Damage to major nerve trunks and branches of triple and facial nerve, large vessels and venous plexuses;

The presence of foreign bodies (fragments, bullets, secondary shells near the vitality and functionally important anatomical formations of the maxillion of the region.

The severity of injury is determined not only by volume, but also the nature of damage to organs and individual anatomical formations of the maxillofacial region, their life and functional value (large vessels, tongue, nervous trunks, throat, trachea, etc.).

With a minor volume of damage to soft tissues (scratches, bruises, cuts, etc.) and bone structures (for example, a fracture of the tooth crowns), the victims are treated outpatient. To the victims with extremely severe wounds attention at all stages medical evacuation It must be maximal in order to prevent death, eliminate or prevent the development of complications, threatening life.

Treatment of light isolated injuries of the maxillofacial area is carried out in military field hospitals for easy-wing. In medical units and units of the military unit, the treatment has been treated with minor damage.

The wounded with insulated damage to medium severity and severe, with similar in gravity combined damage in the presence of a leading injury of the tissues of the maxillofacial region, are subject to evacuation into specialized military hospitals, intended for the treatment of injured headed, neck and spine.

The wounded with combined wounds, in which damage to the maxillofacial region wears the accompanying "in gravity" character, are sent to the military-medical institutions of the corresponding profile for the main injury. Treating victims with burns and frostbizations of the maxillofacial region is carried out in hospitals designed specifically for this category of wounded.

The category of wounded, requiring multi-step restoration operations or a long-term process of the rehabilitation of the rehabilitation to continue treatment in TGMZ. The victims with combined wounds of the maxillofacial region can move in the process of their rehabilitation according to the testimony both in other branches of the same specialized hospital and other medical institutions.

Anatomy-physiological features of the maxillofacial region predetermine a number of features in the state of the Russian Academy of Sciences and the wounded. The main one includes: the probability of development different species asphyxia (dislocation, obtultational, wallotic, valve, aspiration); Difficulties when stopping bleeding, inconsistency external view wounds of true gravity injury and state of the victim; Disfiguring the consequences of a significant part of injuries and psychological trauma; the difficulty of organizing feeding, thickening thirst; The inability to use the usual gas mask.

The correct accounting of these features is of fundamental importance for the successful provision of full-fledged assistance to the wounded in the maxillofacial area at the stages of medical evacuation.

Diagnosis of injuries are made after removing the dressings. The injuries of soft tissues are determined by identifying disorders of the integrity of the skin or by the presence of subcutaneous or deeply located hematomas, swelling of soft tissues. Damage to the bones of the face is pre-diagnosed on the basis of inspection and anamnesis, clinical picture Damage, palpation data or instrumental examination. At the same time, the asymmetry of the contours of the face, the location of the bones, the presence of pathological mobility and displacement of bone fragments, as well as the direct signs of their displacement (bite disruption, the grooves of the gum mucosa, the pathological mobility of the teeth, the symptom of the "steps" during the fractures of the zick bone) and indirect (anesthetia or hypoxicia of individual innervation zones of trigeminal nerve, symptom of "points", pain in the axial load on the chin, limiting the mobility of the lower jaw in the individual directions, bleeding from the nose, diplopy, etc.).

The presence of injuries of the bone of the person is set in the process of revision of the wounds during surgical treatment. The final nature of damage to the bones of the facial skeleton, the localization of foreign bodies and secondary wounded shells (bone fragments, teeth, etc.) is set after a x-ray examination.

With all injuries of the face and jaws, it should also be carefully examined purph cavity In order to identify possible damage to individual teeth and mucous membranes. In the process of diagnostics, the availability and nature of damage to vital and functionally important organs and anatomical formations - language, solid and soft sky, salivary glands and their ducts, nerve trunks, vessels, pharynx, trachea, etc. During the examination of victims at minno-explosive Wounds should be taken into account the possibility of closed injury with soft tissue contusions. The damage to the large nerve trunks or individual branches may indicate the sections of hypo-and anesthesia in the innervation zone of the trigeminal nerve, on the injury of the facial and sub-speaking nerves - the asymmetry of the function of the facial muscles of the face and language. The presence of damage to the incomplete sinuses indicate traces of bleeding in the nasal cavity of the corresponding side.

Military field surgery instructions

Table of contents of the topic "Injuries of the maxillofacial area (chlo). Dental damage. Fractures of jaws. Toothpro. Pain in the teeth.":
1. Injuries of the maxillofacial area (chlo). Clinic (signs) injury of the maxillofacial region (chlo). Emergency (first) assistance in the injury of the maxillofacial area (chlo).
2. Damage to teeth. Fracture tooth. Dislocation tooth. Clinic (signs) tooth fracture. Emergency (first) Help with tooth damage (fracture, tooth dislocation).
3. Fracture of the alveolar lower jaw process. Clinic (signs) fracture of the lower jaw process. Emergency (first) assistance in the fracture of the alveolar lower jaw process.
4. Fracture of the body of the lower jaw. Dislocation of the lower jaw. Clinic (signs) of fracture, dislocation of the lower jaw. Emergency (first) Help with a fracture, dislocation of the lower jaw.
5. Fractures of the upper jaw. Fractures of the zick bone. Classification of the upper jaw fractures. Clinic (signs) fracture of the upper jaw. Emergency (first) assistance in the fracture of the upper jaw, zicky bone.
6. Toothpache. Pain in the tooth. Causes of dental pain. Pulpitis. Clinic (signs) pulpitis. Emergency (first) Help with dental pain, Pulp.
7. Periodontitis. Upper periodontitis. Clinic (signs) periodontitis. Emergency (first) Help with the top-bottomontitis.
8. periodontitis. Generalized periodontitis. Localized periodontitis. Clinic (signs) periodontitis. Emergency (first) Help with periodontitis.

Injuries of the maxillofacial area (chlo). Clinic (signs) injury of the maxillofacial region (chlo). Emergency (first) assistance in the injury of the maxillofacial area (chlo).

Eliminate open and closed face damage. For open wounds, the surveillance of bone fragments is characteristic maxillofacial region (chlo) Skulls in a wound surface. Closed damage includes bruises, hemorrhages, muscle breaks, tendons and nerves, bone fractures and novel jaws.

Etiology injuries of the maxillofacial region (chlo). Damage to the maxillofacial area (chlo)As a rule, are the result of a mechanical impact of a stupid or flat wounded item. The most frequent types of injuries: household (62%), transport (17%). Production is 12% (industrial and agricultural), street (5%) and sports (4%).

Pathogenesis of the injury of the maxillofacial region (chlo). Anatomical feature of the maxillofacial region is a powerful vascular network along with the presence of a large massif of loose subcutaneous fiber. This causes significant swelling and hemorrhages in the field of injury and the existing discrepancy between the size of the wound and the volume of bleeding. Face injuries are often combined with damage to the branches of the facial nerve and the parole salivary gland, and the injuries of the lower jaw with damage to large vessels and nerves of the larynx, pharynx.

Clinic (signs) An injury of the maxillofacial region (chlo)

Diagnostics of the injury of the maxillofacial region (chlo) It does not represent difficulties. Characteristic is the presence of the gaping of wounds and bleeding, pain, violation of the function of opening the mouth, food, respiration. Possible complications: shock, asphyxia, bleeding, closed or open brain injury.

Emergency (first) assistance in injury to the maxillofacial region (chlo)

In the presence of indications - Cutting signs of ODN and OSSN. In order to prevent the asphyxia of the wounded, laid face down and turn the head of the side. Produce the rehabilitation of the oral cavity. In the threat of obstructive asphyxia, an S-shaped duct is installed in the oral cavity. With soft tissue injuries impose a gulling bandage, me-sly - cold. Stopping bleeding is achieved with the help of a gulling bandage, tight tamponade wounds, imposing a hemostatic clamp or in an extreme setting - finger pressed Arteries. Aseptic bandage is superimposed on the wound. Hospitalization in a specialized institution.

Maxillofacial orthopedicsit is one of the sections of orthopedic dentistry and includes the clinic, diagnosis and treatment of damage to the maxillofacial region, resulting from injuries, injuries, operational interventions inflammatory processes, neoplasms. Orthopedic treatment can be independent or applied in combination with surgical methods.

Maxillofacial orthopedics consists of two parts: maxillofacial traumatology and maxillofacial prosthetics. In recent years, maxillofacial traumatology has become predominantly surgical discipline. Operational methods for fixing pieces of jaws: osteosynthesis for jaw fractures, inner-jaw fragments of fractures of lower jaw fragments, suspended crank-facial fixation in the upper jaw fractures, fixation with devices from alloy with "memory" forms - crowded many orthopedic devices.

The successes of the restoration surgery of the face had an impact on the section of maxillofacial prosthetics. The emergence of new methods and improvement existing ways Skin transplants, bone plastle of the lower jaw, plastics with congenital lips and the sky have significantly changed the testimony to orthopedic treatment methods.

Modern ideas about the testimony for the use of orthopedic methods for the treatment of damage to the maxillofacial region are due to the following circumstances.

The history of the maxillofacial orthopedics goes deep in millennia. Artificial ears, noses and eyes were discovered from Egyptian mummies. Ancient Chinese restored lost parts of the nose and ears using wax and various alloys. However, until the XVI century, there are no scientific information about the maxillofacial orthopedics.

For the first time, facial prostheses and the generalwork for the closure of the neh defect described Ambruz Pare (1575).

Pierre Foshar in 1728 recommended drilled heaven to strengthen prostheses. Kingsley (1880) described prosthetic structures to replace congenital and acquired sky defects, nose, orbit. Claude Martan (1889) in his prosthetic book provides a description of structures for replacing lost parts of the upper and lower jaws. It is the founder of direct prosthetics after resection of the upper jaw.

Modern maxillofacial orthopedics, based on the rehabilitation principles of general traumatology and orthopedics, based on the achievement of clinical dentistry, plays a huge role in the system of dental care to the population.

• Dislocation of the teeth

Dislocation of the teeth- This is the displacement of the tooth as a result of acute injury. The teeth dislocation is accompanied by a periodontal break, circular bundles, gums. There are full dislocations, incomplete and framed. In history, there are always instructions for a specific reason that caused tooth dislocation: transport, household, sports, production injury, dental interventions.

What provokes damage to the maxillofacial area

• Fractures of teeth

• False joints

The reasons leading to the formation of false joints are divided into common and local. General include: dysfunction, avitaminosis, heavy, long-term diseases (tuberculosis, systemic blood diseases, endocrine disorders, etc.). With these states, compensatory-adaptive responses of the body are reduced, the reparaging regeneration of bone tissue is oppressed.

Among the local reasons are the most likely violations of the treatment method, the interposition of soft tissues, the defect of bone tissue and complication of the fracture of chronic inflammation of the bone.

• Contracture of the Lower Jaw

The contracture of the lower jaw may occur not only as a result of mechanical traumatic damage to the maxillary bones, soft tissues of the mouth and face, but also other reasons (ulcerative-necrotic processes in the oral cavity, chronic specific diseases, thermal and chemical burns, frostbite, besified by my sum, tumors, etc.). There is a contracture due to the injury of the maxillofacial region, when the lower jaw contracts arise as a result of improper primary processing of wounds, long-term interlayer fixation of jaw fractions, untimely applications medical physical education.

Pathogenesis (what happens?) During damage to the maxillofacial region

• Fractures of teeth

• Contracture of the Lower Jaw

The pathogenesis of the mandibular contractures can be represented as schemes. In the I scheme, the main pathogenetic link is the reflex-muscular mechanism, and in II - the formation of scar tissue and its negative actions on the function of the lower jaw.

Symptoms of damage to the maxillofacial region

The presence or absence of teeth on pieces of jaws, the condition of solid teeth tissues, shape, magnitude, the position of the teeth, the state of the periodontal, the mucous membrane of the mouth and soft tissues, which come into relationships with prosthetic devices is important.

Depending on these signs, the design of the orthopedic apparatus, the prosthesis varies significantly. They depend on the reliability of fixation of fragments, the stability of maxillofacial prostheses, which are the main factors of the favorable outcome of orthopedic treatment.

It is advisable to divide damage to the maxillofacial area to two groups: features indicating favorable and unfavorable conditions for orthopedic treatment.

The first group includes the following signs: the presence of teeth of teeth with full-fledged perodont during fractures; the presence of teeth with full-fledged perodont on both sides of the jaw defect; lack of scar changes in soft tissues of the mouth and the pruriety of the region; The integrity of the ENCH.

The second group of signs is: the absence on fragments of teeth jaws or the presence of teeth with patients with periodontal; pronounced scar changes in soft tissues of the mouth and the pruriety region (microstom), the absence of the bone base of the prosthetic bed with extensive jaw defects; Strategic violations of the structure and functions of the ENCH.

The predominance of signs of the second group narrows the testimony for orthopedic treatment and indicates the need to use comprehensive interventions: surgical and orthopedic.

When evaluating a clinical picture of damage, it is important to pay attention to the signs that help to establish a bite before damage. Such a need arises due to the fact that the displacements of fragments during jaw fractures can create the ratios of dental rows similar to the prenatical, open, cross-bite. For example, when the bilateral fracture of the lower jaw, fragments are shifted along the length and cause shortening the branches, the lower jaw shift occurs back and up with the simultaneous lowering of the chin. At the same time, the closure of the dental rows will be by type of proactation and open bite.

Knowing that for each type of bite is characterized by their signs of the physiological erase of teeth, it is possible to determine the type of bite from the victim to the injury. For example, with an orthoganotic bite of the bearer facets will be on the cutting and vestibular surfaces of the lower incisors, as well as on the sky surface of the upper incisors. When running, on the contrary, there is an erasing of the gear surface of the lower incisors and the vestibular surface of the upper incisors. For direct bite, flat facets of erasing are characterized only on the cutting surface of the upper and lower cutters, and with an open bite, the bearers will be absent. In addition, anamnestic data can also help correctly determine the type of bite to damage to the jaws.

• Dislocation of the teeth

The clinical picture of the dislocation is characterized by swelling of soft tissues, sometimes the gap around the tooth, displacement, tooth mobility, violation of occlusive relationships.

• Fractures of teeth

• Fractures of the lower jaw

Of all the bones of the facial skull, the lower jaw is most often damaged (up to 75-78%). Among the reasons in the first place are transport incidents, then household, manufacturing and sports injury.

The clinical picture of the lower jaw fractures, in addition to common symptoms (violation of the function, pain, deformation of the person, the disorder of occlusion, the mobility of the jaws in an unusual place, etc.), has a number of features depending on the type of fracture, the mechanism of displacement of fragments and the state of teeth. In the diagnosis of lower jaw fractures, it is important to allocate features indicating the possibility of choosing one or another method of immobilization: conservative, operational, combined.

The presence of sustainable teeth on jaw fragments; a slight displacement of them; Localization of the fracture in the area of \u200b\u200bthe angle, branches, a mumane process without displacement of fragments indicate the possibility of using a conservative method of immobilization. In other cases, there are indications for the use of operational and combined methods for fixing fragments.

• Contracture of the Lower Jaw

Clinically distinguishing unstable and persistent jaw contractures. According to the degree of disclosure of the number of contractors, they are divided into light (2-3 cm), medium (1 - 2 cm) and heavy (up to 1 cm).

Unstable contractures Most often there are reflex muscle. They occur during jaw fractures in places attaching muscles raising the lower jaw. As a result of irritation of the muscles receptor apparatus, the edges of fragments or spree products of damaged tissues occurs a sharp increase in muscle tone, which leads to the lower jaw contract

Scar contractures depending on which fabrics are amazed: the skin, mucous membrane or muscle is called dermatogenic, miogenic or mixed. In addition, temporary-corneous, boring, cheesecoule and intercelions distinguish contractures.

The division of contractures for reflex muscular and scar, although justified, but in some cases these processes do not exclude each other. Sometimes, with damage to the soft tissues and muscles, muscle hypertension goes into a persistent scar contract. Prevention of contracture development is quite a real and specific event. It includes:

• preventing the development of rough scarring by proper and timely processing of the wound (the maximum rapprochement of edges with the imposition of seams, big Defects tissue shows the crosslinking of the edge of the mucous membrane with the edges of the skin);
• timely immobilization of fragments as possible with the help of one-grain tire;
• timely interimal fixation of fragments in fractures in places of muscle attachment in order to prevent muscle hypertension;
• the use of early healing gymnastics.

Diagnosis of damage to the maxillofacial region

• Dislocation of the teeth

The diagnosis of the dislocation of the tooth is carried out on the basis of inspection, displacement of teeth, palpation and x-ray studies.

• Fractures of teeth

Fractures of the Alveolar Top Jaws with predominant localization in the field of the front teeth are most common. The reasons of them are traffic accidents, blows, falls.

The diagnosis of fractures is not very complex. The recognition of it is carried out on the basis of anamnesis, inspection, palpation, x-ray examination.

With a clinical examination of the patient, it should be remembered that the fractures of the alveolar process can be combined with damage to lips, cheeks, dislocation and fracture of teeth located on a born area.

Palpation and percussion of each tooth, the definition of its position and stability allows you to recognize damage. To determine the lesion of the vascular-nerve bundle of the teeth, the electroopodontographics are used. The final conclusion on the nature of the fracture can be made on the basis of radiographic data. It is important to set the selection direction of the breakfall. Fragments can be shifted by vertical, in the celestial, the vestibular direction, which depends on the direction of impact.

Treatment of fractures of the alveolar process is mainly con-servative. It includes a reposition of a fragment, fixing it and the treatment of damage to soft tissues and teeth.

• Fractures of the lower jaw

The clinical diagnosis of lower jaw fractures is complemented by radiography. According to radiographs obtained in the front and lateral projections, determine the degree of displacement of fragments, the presence of fragments, the location of the tooth in the fracture slot.

With the fractures of the model, the tomography of the ENCH gives valuable information. The most informative is a computed tomography that allows you to reproduce the detailed structure of the bones of the articular region and accurately identify the mutual location of fragments.

Treatment of damage to the maxillofacial region

Development Surgical treatment methodsEspecially neoplasms of the maxillofacial region, demanded wide use in the operating and postoperative period of orthopedic interventions. The radical treatment of malignant neoplasms of the maxillofacial region improves survival rates. After surgery, severe consequences remain in the form of extensive jaw and face defects. Sharp anatomy-functional disorders, disfiguring person, cause painful psychological suffering sick.

Very often, only the method of reducing surgery turns out to be ineffective. The tasks of restoring the face of the patient, the chewing, swallowing and the return of its serpent, as well as to fulfill other important social functions, as a rule, require the use of orthopedic treatment methods. Therefore, the joint work of dentists and orthopedists acts in a complex of rehabilitation activities to the forefront.

There are certain contraindications to the use of surgical methods for the treatment of jaw fractures and carrying out operations on the face. Usually this presence in patients with severe blood diseases, of cardio-vascular system, open form of tuberculosis of light, severe psycho-emotional disorders and other factors. In addition, such damage arises, the surgical treatment of which is impossible or ineffective. For example, during the defects of the alveolar process or part of the sky, the prosthetics of them are more efficient than the operational recovery. In these cases, it was shown the use of orthopedic measures as the main and permanent method of treatment.

The timing of restoration operations is different. Despite the inclination of surgeons to produce an operation as early as possible, it is necessary to withstand a certain time when the patient remains with a unreared defect or deformation in anticipation of surgical treatment, plastic surgery. The duration of this period can be from several months to 1 year or more. For example, rehabilitation operations in the defects of the face after tuberculous lupus, it is recommended to be carried out after the process eliminating the process, and this is about 1 year. In such a situation, orthopedic methods are shown as the main treatment for this period. For surgical treatment Patients with damage to the maxillofacial region often occur the tasks of auxiliary nature: the creation of support for soft tissues, closing the postoperative wound surface, feeding patients, etc. In these cases, the use of an orthopedic method as one of the auxiliary measures in complex treatment is shown.

Modern biomechanical studies of the methods for fixing the lumps of the lower jaws made it possible to establish that on-tooth tires compared to well-known revolt and intra-neighboring devices relate to retainers that most fully meet the conditions of the functional stability of bone fragments. Rubber tires should be considered as a complex retainer consisting of an artificial (tire) and a natural (tooth) clamps. High fixing abilities them are explained by the maximum area of \u200b\u200bcontact of the retainer with the bone due to the surface of the roots of the teeth, which is attached to the tire. These data are consistent with the successful results of widespread use of naude tire dentists in the treatment of jaw fractures. All this is another substantiation of indications for the use of orthopedic apparatuses for the treatment of damage to the maxillofacial area.

Orthopedic devices, their classification, mechanism

Treatment of damage to the maxillofacial region is carried out by conservative, operational and combined methods.

The main method conservative treatment are orthopedic devices. With their help, they solve the tasks of fixation, reposition of fragments, forming soft tissues and replacement of the defects of the maxillofacial region. In accordance with these tasks (functions), the devices are divided into fixing, repositioning, forming, replacing and combined. In cases where several functions are performed by one device, they are called combined.

At the place of attachment, the apparatuses are divided into intrarocratic (single-odd, double-eyed and intercelions), internal, inside-in-in-screw (maxillary, mandibular).

According to the design and method of manufacture, orthopedic devices can be divided into standard and individual (outside laboratory and laboratory manufacture).

Fixing devices

There are many designs of fixing devices. They are the main means of conservative treatment of damage to the maxillofacial area. Most of them are used in the treatment of jaw fractures and only separate - with bone plastic.

For the primary healing of bone fractures, it is necessary to ensure the functional stability of fragments. Fixation strength depends on the design of the apparatus, its fixing ability. Considering the orthopedic device as a biotechnical system, there are two main parts in it: a pinning and actual fixing. The latter provides the connection of the entire design of the apparatus with the bone. For example, the covered portion of the naudent wire tire is represented by a wire, curved along the shape of a dental arc, and a ligature wire for fastening the wire arc to the teeth. The actual fixing part of the design is the teeth that ensure the connection of the coverage part with the bone. Obviously, the locking ability of this design will depend on the stability of the tooth compounds with the bone, the remoteness of the teeth with respect to the fracture line, the density of the wire arc to the teeth, the arc location on the teeth (in the cutting edge or chewing surface of the teeth, the equator, the neck of the teeth) .

In the mobility of the teeth, the sharp atrophy of the alveolar bone to ensure the reliable stability of fragments of ruded tires is not possible due to the imperfection of the actual fixing part of the structure of the device.

In such cases, the use of busthese tires is shown in which the fixing ability of the structure is enhanced by increasing the area of \u200b\u200bfitting the covered part in the form of the scope of the gum and the alveolar process. With a complete loss of teeth, the intrastallyolar part (the fixator) in the device is absent, the tire is located on alveolar processes in the form of a base plate. By connecting the basic plates of the upper and lower jaws, they receive a monoblock. However, the fixing capacity of such devices is extremely low.

From the point of view of biomechanics, the most optimal design is the omnant wire solder bus. It is attached on rings or on complete artificial metal crowns. A good fixing ability of this tire is explained by a reliable, almost fixed connection of all elements of the design. The blue arc is soldered to the ring or to a metal crown, which, with the help of phosphate cement, is fixed on the support teeth. With the ligaturn binding of aluminum wire arc, such a reliable connection is impossible to achieve. As the tension, the ligature tension weakens, the strength of the compound of the covered arc decreases. Ligature annoys a gum dutch. In addition, there is a cluster of food residues and their rotting, which disrupts the hygiene of the oral cavity and leads to periodontal diseases. These changes can be one of the reasons for complications arising from orthopedic treatment of jaw fractures. Soldering tires are deprived of these shortcomings.

With the introduction of fast-hardening plastics, many different designs of naubular tires appeared. However, according to their fixing abilities, they are inferior to solder tires on a very important parameter - the quality of the compounds of the covered part of the apparatus with supporting teeth. A gap remains between the surface of the tooth and plastics, which is the extensive for food residues and microbes. Prolonged use of such tires is contraindicated.

The designs of the ompeted tires are constantly improved. Entering executive loops in the covered wire aluminum arc, are trying to create a bummer compression in the treatment of lower jaw fractures.

The real possibility of immobilization with the creation of a compression of fragments of a naudent tire appeared with the introduction of alloys with the "memory" effect of the form. A rolled tire on rings or crowns from a wire with thermomechanical "memory" allows not only to strengthen fragments, but also maintain a constant pressure between the ends of fragments.

The fixing devices used in bone-plastic operations are a rude construction consisting of a system of paved crowns, connecting lock sleeves, rods.

Energy devices consist of chinfulness (plaster, plastic, standard or individual) and head cap (marlevic, plaster, standard belt or ribbon strips). The chinful rush is connected to the head cap using a bandage or elastic thrust.

In-in-in-in-wing devices consist of intrarocoles with inner levers and head caps, which are interconnected by elastic tag or rigid locking fixtures.

AST. Tweeting devices

There are a simultaneous and gradual reposition. The one-time reposition is carried out by manually, and gradual - hardware.

In cases where manual ways are not able to compare fraud, they use repositioning devices. The mechanism of their action is based on the principles of extracting, pressure on shifted fragments. Repositioning devices can be mechanical and functional action. Mechanical acting repurating devices consist of 2 parts - support and valid. The reference part serves crowns, kappa, rings, basic plates, head cap.

The acting part of the apparatus are devices that develop certain efforts: rubber rings, elastic bracket, screws. In the functionally active repositioning device, the abbreviation force is used to reposition the muscles, which is transmitted through the guide planes to fragile, shifting them in the right direction. A classic example of such an apparatus is Tire Vankevich. With closed jaws, it serves as a fixing device for fractures lower jaws With impressive fragments.

Forming devices

These devices are designed to temporarily maintain the face form, creating a rigid support, prevent scar changes in soft tissues and their consequences (displacement of fragments due to tightening forces, deformation of the prosthetic bed, etc.). Forming devices are applied to restoration surgical interventions and in the process of them.

According to the design, the devices can be very diverse depending on the area of \u200b\u200bdamage and its anatomy-physiological features. In the design of the forming apparatus, you can select the formative part of the fixing devices.

Replacement devices (prostheses)

The prostheses used in the maxillofacial orthopedics can be divided into zubalavolar, jaws, facial, combined. In the resection of the jaws, prostheses are used, which are called post-tech. Distinguish direct, nearest and remote prosthetics. It is legitimately dividing prostheses to operating and postoperative.

Dental prosthetics is inextricably linked with maxillofacial prosthetics. The achievements of the clinic, materials science, the technologies for the manufacture of dentures have a positive effect on the development of maxillofacial prosthetics. For example, the methods of restoration of defects of the dentition of solid-grade-grade prostheses have been used in the structures of resection prostheses, prostheses that restore sewoalveolar defects.

Applications also include orthopedic devices used in the defects of the sky. This is primarily a protective plate - used during plastic sky, obtutors are used with innate and acquired sky defects.

Combined devices

For reposition, fixation, formation and substitution, a single design is capable of reliably solving all tasks. An example of such a design is a device consisting of paved crowns with levers, fixing locking devices and forming plate.

Dental, zubalavolar and maxillary prostheses, except for the replacement function, often serve as a formative apparatus.

The results of orthopedic treatment of maxillofacial damage largely depend on the reliability of fixing the devices.

When solving this task, follow the following rules:

• maximum use as a support that preserved natural teeth, connecting them into blocks using the known teeth shining methods;
• maximum use of the retention properties of the Alveo of Large processes, bone fragments, soft tissues, leather, cartilage, limiting the defect (for example, preserved, even with total resections of the upper jaw, the skin-carting part of the lower nasal stroke and part of the soft sky serve as a good support for strengthening the prosthesis);
• apply operational ways to strengthen prostheses and devices in the absence of conditions for fixing them by the conservative way;
• use as a support for orthopedic apparatuses the head and upper part of the body if the possibilities of intrarocratic fixation are exhausted;
• use external supports (for example, an upper jaw exhaust system through blocks when the patient's horizontal is on the bed).

Clames, rings, crowns, telescopic crowns, kappa, ligature binding, springs, magnets, glasses, prashoid bandage, corsets can be used as fixing accessories of maxillofacial devices. The correct choice and application of these devices adequately clinical situations make it possible to succeed in orthopedic treatment of damage to the maxillofacial region.

Orthopedic methods of treatment during the injuries of the maxillofacial region

Dislocation and fractures of teeth

• Dislocation of the teeth

Treatment of complete dislocation Combined (tooth replant with subsequent fic sacium), and the incomplete dislocation is conservative. With fresh cases of incomplete dislocation, the tooth is finished with their fingers and strengthen it in the alveoli, fixing with the use of a ride tire. As a result of the late refueling of the dislocation or sublifting, the tooth remains in the wrong position (rotation around the axis, the gentlepan, vestibular position). In such cases, orthodontic intervention is required.

• Fractures of teeth

The previously mentioned factors can cause both teeth fractures. In addition, enamel hypoplasia, caries teeth often create conditions for the fracture of the teeth. Fractures of roots can occur from corrosion of metal pins.

Clinical diagnostics include: history, inspection of soft tissues of lip and cheeks, teeth, manual study of teeth, alveolar processes. To clarify the diagnosis and the preparation of the treatment plan, it is necessary to carry out x-ray studies of the alveolar process, the electron contraction.

The fractures of the teeth are in the area of \u200b\u200bthe crown, the root, crowns and the root, isolated cement micropapirers, when the cement areas with attached (sharpetee) fibers are peeled from dentin root. The most common fractures of the tooth crowns within the enamel, enamel and dentin with the autopsy of the pulp are found. The fracture line can be transverse, oblique and longitudinal. If the fracture line is transverse or oblique, passing closer to the cutting or chewing surface, fragile, as a rule, is lost. In these cases, the restoration of the tooth is shown by prosthetics by tabs, artificial crowns. When opening the pulp, orthopedic measures are carried out after the appropriate therapeutic preparation of the tooth.

For fractures in the neck of the tooth, often arising from the peanant caries, often connected with a loosely embracing neck of the tooth with an artificial crown, shows the removal of a broken part and recovery with the help of a cult pantle tab and an artificial crown.

The fracture of the root is clinically manifested by the mobility of the tooth, pain when pricked. On radiographs of the teeth, the fracture line is clearly visible. Sometimes, in order to trace the fracture line throughout the length, you need to have X-ray pictures obtained in various projections.

The main method of treating the root fractures is to strengthen the tooth with the use of a ride tire. Healing of teeth fractures occurs after 1 1/2 months. Allocate 4 types of fracture healing.

Type A.: Fragments are closely compared with each other, the healing is completed with the mineralization of the tissue of the tooth root.

Type in: Healing occurs with the formation of pseudoarthrosis. The slot along the fracture line is filled with a connective tissue. On the radiograph, a unusual strip is visible between fragments.

Type S.: between fragments are growing connective tissue and bone tissue. The radiograph is visible to the bone between fragments.

Type D.: The gap between fragments is filled with gra-native cloth: either of the inflamed pulp, or from the gum tissue. The type of healing depends on the position of fragments, immobilization of the teeth, the vitality of the pulp.

• Fractures of alveolar process

The treatment of fractures of the alveolar process is mainly conservative. It includes a reposition of a fragment, fixing it and the treatment of damage to soft tissues and teeth.

The reposition of a fragment with fresh fractures can be carried out by manual in a manual method, with solar fractures - by the bloody reposition or using orthopedic devices. When displaced the born alveolar process with teeth in the pacific direction, the reposit can be made using a separating pavement plate with a screw. The mechanism of action of the apparatus is to gradually move the fragment due to the pressure of the screw. The same task can be solved by applying an orthodontic device by stretching the fragment to the wire arc. In the same way, it is possible to reposition a vertically displaced fragment.

When displaced a fragment in the vestibular side, the reposit can be carried out using an orthodontic device, in particular the vestibular sliding arc, reinforced on the indigenous teeth.

Fixment of a fragment can be carried out by any rude bus: bent, wire, solder wire on crowns or rings, from fast-ridewinking plastics.

• Top Jaw Body Fractures

Unmixed fractures of the upper jaw are described in textbooks on surgical dentistry. Clinical features And the principles of treatment are given in accordance with the classification of lephora, based on localization of fractures along lines corresponding to weak places. Orthopedic treatment of the upper jaw fractures lies in the repositions of the upper jaw and immobilization it in-in-in-in-wing vehicle.

With the first type (le form i), when manual way is able to establish the upper jaw to the correct position, for immobilization of fragments can be used inside-in-screw devices with support on the head: an all-bent wire tire (according to Ya. M. Zbaraj), a dust tire with In stock levers, solder tire with inner levers. The choice of the design of the intrarotrian part of the apparatus depends on the presence of teeth and state of periodontal. In the presence of a large amount of stable teeth, the intrauterine part of the apparatus can be made in the form of a wire jubble tire, and with the multiple absence of teeth or mobility of the existing teeth - in the form of a busthese tire. In the toothless areas of the dentition, the bubble tire will fully consist of a plastic basis with the prints of antagonist teeth. In the multiple or complete absence of teeth are shown operational methods Treatment.

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