Stages of comprehensive conservative treatment
Patient care for jaw fractures is based on four mandatory stages, each of which is critical for restoring function and aesthetics.
- Reposition. This involves moving or aligning displaced facial bone fragments into their original position. If possible, reduction is performed at once. In complex cases when tissues cannot be aligned immediately, gradual reposition is used via elastic traction over several days.
- Immobilization. Direct fixation of the jaw to ensure consolidation. For a maxillary fracture or unilateral mandibular injury, the device is worn for 4–5 weeks. For bilateral mandibular trauma, the period increases to 5–6 weeks.
- Medical therapy. Aimed at preventing infectious and inflammatory processes. Patients are prescribed antibacterial, antihistamine, and anti-inflammatory drugs. For better healing, agents that stimulate immunity, improve tissue microcirculation and blood rheology, as well as drugs to optimize osteogenesis are used.
- Physiotherapy. Complements the conservative course, accelerating regeneration during the callus formation period.
The management of teeth whose fracture line runs directly through the bone gap requires special attention. The attending physician must evaluate the feasibility of preserving them and prescribe specific treatment.
Temporary (transportation) immobilization
Temporary methods of fragment fixation are used when a therapeutic appliance cannot be applied immediately. This often happens due to a lack of necessary conditions, a shortage of narrow specialists, or an acute lack of time (e.g., during mass admission of casualties from emergencies, accidents, or combat operations). In such conditions, the main task is to safely evacuate the victim to a specialized hospital.
An important relative contraindication to immediate full (therapeutic) immobilization is the extremely severe general somatic condition of the patient. Such life-threatening conditions include traumatic shock, intracranial hematomas, or coma.
Temporary fixation techniques are divided into two groups:
- Extraoral: application of a bandage, use of a chin sling, as well as improvised bandages from any available improvised materials.
- Intraoral: intermaxillary ligature dental wire binding techniques and the use of special splint-trays equipped with fixing "whiskers".
Permanent (therapeutic) immobilization
After the patient's condition stabilizes and they arrive at a specialized department, temporary structures are replaced with permanent ones. Such appliances are designed for long-term wear until complete bone fusion.
Permanent orthopedic structures are classified by their manufacturing method:
- Non-laboratory fabricated. These are structures that the physician can adapt and install directly in the dental chair. These include various standard dental splints, as well as custom splints made of metal or alternative materials.
- Laboratory fabricated. Require taking impressions and the work of a dental technician. These include the Weber splint (produced in a simple version or supplemented with an inclined plane), Vankevich and Vankevich-Stepanov appliances, Port supraocclusal construction, as well as various cap splint systems.
Risks of delayed treatment
Refusal of timely fixation or primary surgical debridement of wounds in combined facial skeleton injuries leads to severe complications. For instance, if a jaw injury is combined with the displacement of zygomatic fragments, the fragments can compress the coronoid process. This triggers the formation of coarse scars in soft tissues, eventually leading to mandibular contracture — the patient loses the ability to open their mouth normally.
Furthermore, the introduction of small bone fragments into the lumen of the maxillary sinus (sinus maxillaris) causes traumatic osteomyelitis and chronic sinusitis. Timely and competent splinting minimizes these risks and prevents permanent facial deformity.
Briefly: answers to topical questions
What types of custom dental wire splints exist for permanent immobilization?
The sources indicate the following splints for immobilization in facial skull fractures:
- Custom wire splints — the main method.
- Standard strap splints — used less frequently, mainly in adolescents.
- Smooth wire splints — applied to the dental arch of the upper or lower jaw.
- Cap dental-gingival splints — made of medical plastics.
Also, in preparation for certain methods of maxillary fixation, the source mentions a smooth arch bar splint and a splint with hook loops.
Class and exam questions
What is the difference between one-stage and gradual reposition?
One-stage reposition implies returning fragments to their place immediately in a single procedure. Gradual reposition is used when the rapid option is impossible, utilizing elastic traction that aligns the bones over several days.
Is it necessary to extract teeth located in the fracture line?
Not always. The doctor individually decides on the feasibility of preserving them and, if necessary, performs endodontic or other therapeutic intervention.
When is permanent immobilization contraindicated?
It has temporary relative contraindications in severe general conditions of the patient, such as traumatic shock, coma, or intracranial hematoma. In such cases, transport bandages are used.
What else to study on this topic
- Clinical presentation and classification of zygomatic bone fractures
- Mechanisms of fragment displacement in zygomatic arch fractures
- Differential diagnosis of maxillary fractures by Le Fort types
- Complications of nasal bone fractures and the risk of cerebrospinal fluid leak
- Signs of traumatic maxillary sinus injury (hemosinus)
Master the entire topic in the course "Surgical Dentistry"
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- Full textbook on "Jaw immobilization in fractures" and 866 more pages of the subject
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Other topics in the section "Chapter 11. Non-ballistic and ballistic facial injuries. Thermal and radiation lesions of the maxillofacial region (V.V. Afanasyev)"
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