Sprains
mandible ranged from 1,5 to 5,7% of all dislocations; occurmoreoften in women
aged 20 to 40 years, since the ligaments of the joints is not enough
strong, and mandibular fossa of temporal bone has a shallow depth.
Front sprains
mechanism.
Occurrence of anterior dislocation relaxes ligament-capsular
apparatus, the deformation (hypertrophy) of the articular elements that change shape, size
and stascture interarticular drive. Habitual dislocation caused by a strain
jaws, teeth clamping anomaly (eg, anteroclusion with the loss of the molars).
Vynil mandibular anterior usually occurs due to excessive opening
your mouth when you yawn, cry, vomit, remove the teeth, biting a large chunk of food,
sometimes it is observed when probing the stomach, tracheal intubation, in a state
anesthesia during bronchoscopy. Depending on the frequency of sprains
divided into acute and habitual. Traumatic dislocation usually occurs as a result of
blow to the mandible: in the sagittal direction of the impact of lowered
chin is double-sided, and when stasck from the side - a unilateral dislocation
on the side of the strike.
Clinic fresh traumatic anterior dislocation.
anterior dislocation of the head characterized by a shift of the lower jaw forward with respect
to the articular tubercles of the temporal bone, causing his mouth open (especially
widely - at the bilateral dislocation), the chin is shifted downward and forward (at the bilateral
dislocation), the patient feelsmoreor less severe pain. It is difficult,
chewing is impossible, from the mouth drools as clamp lip hard, and sometimes
impossible. With unilateral dislocation of the chin with the central incisors and bridle
the lower lip moves in the healthy side, while half-open mouth, lips clamp
Can. Movement of the mandible can only be down with its mouth more
opens. In front of the ear is determined by the retraction of the trestle, and under the zygomatic arch
ahead of the articular tubercle of temporal bone - a diverticulum due to a shift heads
mandible in the subtemporal fossa.
Rear
Territory branch jaw gets obliquity, the angle of the jaw bonding with mastoid
outgrowth of the temporal bone. On radiographs of temporomandibular joint
in lateral projection shows that the dislocated head of the lower jaw is in front
articular tubercle of temporal bone.
Differential Diagnosis in front of fresh dislocation. Unilateral
anterior dislocation of the need to differentiate the unilateral fracture of the mandible,
in which there is no sign extension of the chin forward in a healthy direction.
Bilateral
anterior dislocation of the lower jaw must be differentiated from bilateral fracture
condylar processes or a branch of the mandible with displacement of fragments. It is recommended
consider the following seven attributes.
1. In both cases, open bite, but the dislocation of the chin and the entire front
Group teeth pushed forward, and at the turn they are shifted posteriorly. If dislocation
appearance of the patient's face - progenichesky, and at the turn - prognathic.
2. In a patient with a fractured jaw range of motion is greater and the restriction
mouth opening due to pain. If dislocation is possible only for some
additional opening of the mouth, although efforts to move the lower jaw, the patient
not experiencing significant pain.
3. At the turn of the rear edge of the branches of the lower jaw aremoresteeply
and the distal than in the dislocation.
4. On palpation of the upper rear edge of the branches of the jaw can detect deformation
it, and localized pain (in place of bone fracture), which is not in the patients with dislocation.
5. When fractures and dislocations no sense of mobility head of the mandible
palpation them through the ear canal, but in turn (without dislocation
articular head) there is no retraction of the trestle ahead.
6. X-ray diffraction at the turn, without a dislocation, the head of the lower
jaw is in its usual place, and when she goes dislocation of the articular
fossa and positioned in front of the articular tubercle.
7. At the turn, in contrast to the dislocation, the x-ray shadow is visible fracture gap.
Forecast
Acute dislocation of the favorable as to diagnose and resolve its most
patients easily.
Complications
Acute dislocation are the most likely relapse and habitual dislocations.
Removal of fresh anterior dislocation.
Method of Hippocrates.
patient seated on a low chair or stool with his back to the back of a chair or wall
(To the occipital region of the head had a strong support). The lower jaw
patients should be somewhat higher (up to 10 cm) top-level lowered
limbs facing patients of a dentist. This requirement
allows the physician to achieve complete relaxation of the masticatory muscles of patients with
minimal effort.
Rising
face-to-patient, physician enveloping the thumbs of both hands with gauze wipes
or the ends of towels and set them right and left on the chewing surfaces
molar teeth (in the absence of them - on the alveolar processes), the other four
fingers, he grabs the bottom jaw to dislocate. Slowly and gently pressing
thumbs down, and the rest up (chin), seeking fatigue
and relaxation of masticatory muscles and forcibly displace the head of the mandible
down - somewhat below the level of the articular tubercle. After that, gradually shifting
jaw back to joint heads plunged into articular fossa. Return
heads in normal position is accompanied by a characteristic clicking sound (for
by quickly slipping them bumps in the articular fossa) and a reflex contraction
jaws.
Therefore,
displacing the jaw posteriorly, the physician must quickly move both thumbs
both hands toward the cheeks (in the vestibular space) to avoid
bite them. When bilateral dislocation of both heads simultaneously reduce a
or first one and then the other side.
method of Hippocrates - PV Hodoovicha.
Because the wrapped cloth thumbs are cumbersome and
they dulled the sense of touch, PV Khodorovich invited to enter the thumbs
in the buccal cavity and apply them to the outer oblique line of mandible on
high level of molars so that the nail phalanx held
retromolyarnye fossa (triangles) and their ends rested on the front edge
branches of the jaw. Forefinger cover corners, and the rest - the body
jaw. The introduction of the heads of the mandible in the articular fossa thumbs
physician in this case can not infringe upon between the teeth of a patient, so they remain
in retromolyarnyh pits before the end of manipulation.
in the process of removing bilateral dislocation of the right to only one articular head
mandible and the position of the other remain wrong (sprained), physician
should continue to reduce a her way with unilateral dislocation.
Keep in mind that themoredeveloped physically sick or more
He is excited, the longer it does not come fatigue of masticatory muscles and the more
the time required to reposition the lower jaw.
expressed pain in the sprawling joint capsule, ligamentous apparatus
and masticatory muscles of the right lower jaw is rather difficult. In such cases,
should first conduct regional anesthesia by Berchet - MD Dubov,
and if this can be done, then drive back to slowly head jaw
distracting the patient.
elimination of dislocation to immobilize the lower jaw (10-15 days) with
praschevidnoy bandage or a standard plastic sling with elastic
traction to the head slippers. During this immobilization the patient must take
powdered food.
method GL Blekhman - J. D. Gershoni.
Outcomes
Treatment depends on the success of the pathogenetic
treating the underlying disease.
Rear sprains
mechanism of occurrence, clinical features, treatment.
Dislocation mandible posterior to occur as a result of impact to the chin at the moment
small diversion jaw when removing lower molar teeth with
great strength, with spasmodic yawning. As a result, the head of the lower jaw is set
between the mandibular fossa and mastoid temporal bone at the bottom
wall of the bony part of auditory tube. Sometimes the give way forward
(Bone), wall of external auditory canal, which is manifested by the following features:
2)
inability to open his mouth;
3) displacement of the chin posteriorly;
4) breach of contact between the molars antagonists due to the fact that the lower
incisors rest against the mucous membrane of the soft palate. When macroglossia back sprain
may lead to retraction of the tongue and shortness of breath.
technique removing the rear dislocation.
thumbs injected into the buccal cavity and prevent the outer surface
alveolar processes of the wisdom teeth and the oblique lines of the jaw. Rest
fingers cover the body of the jaw. Pressure from the thumbs down and by extension
the lower jaw forward articular head set and the correct position.
After the elimination of dislocation apply retaining bandage on 2,5-3 weeks.
Treatment outcomes are usually favorable, in some cases remains a
stiffness in the joints.