Classification of posttraumatic complications of maxillofacial area. Orthopedic methods of unreal joints treatment and b

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

2. 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).

3. 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.

4. 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%.

5. 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.

6. 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.

7. 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.

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

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. . 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. Treatment At a shift of fragments to the middle line without vertical motions I. M. Oxman suggests to apply removable plane prosthetic appliance without a hinge. Imprints from every fragment of tooth are taken for this purpose. Only lateral parts of prosthetic appliances with cusps or gum splints and ramps are made on models and carefully placed in a mouth. Lateral parts of base with ramps allow setting of fragments in correct position at closing of jaws at a bite. Liquid gypsum is filled inside mouth cavity without an imprint spoon which fills up the defect synchronously recovering the forehands of plastic splints, and also cut the surfaces of foreteeth of supramaxilla. Get an imprint from a supramaxilla. The front part is weld to lateral parts with the use of made models eamps are sawed from a prosthetic appliance because they are not needed. Made prosthetic appliance substitutes a defect and serves as a cross-bar between jaws, preventing their rapprochement at opening.

20. Treatment At a large defects of lower jaw it is expedient to make prosthetic appliance in three stages. After implementation of two already mentioned, CO (CR) is determined with the help of waxen roller on prepared base and conduct a positioning of teeth. Then a base in the cavity of mouth is checked up and complete making of prosthetic appliance takes place. The choice of prosthetic appliance construction is determined by a clinical picture (in accordance with the classification of I.Oxman). At the 1st group with the cyst defect of 1 -2 sm irremovable bridge prosthetic appliance can be made with a plenty of supporting teeth (2-3 on every fragment).

21. Treatment At the cyst defect more than 2 sm., presence of enough teeth with a healthy paradontium on fragments, insignificant mobility of fragments and their correct position, irremovable joint prosthetic appliances named after Oxman are applicable. Construction consists of two parts united between itself by a hinge with vertical mobility. It is necessary for making: preparation of teeth, making the pressed crowns on the supporting teeth of fragments, their correction inside the mouth cavity and taking off an imprints, pouring off a model on which intermediate part is designed. Than two hinges are made. In the middle of shells from stainless steel with diameter of 2,5-3 mm, solder bars of 3-4 mm. long and diameter of 0,5-1 mm, cutting lateral surfaces. In waxen intermediate part shells of hinge in the distance of 3 mm on both the sides of cut, above the unreal joint. Beeswax is substituted by a metal.

22. In cases which belong to the II group, when there are 1-2 teeth on bone fragments, removable joint prosthetic appliances are advised (I.Oxman, E.Gavrilov. B. Vaynshteyn, V.Kurlyansky). The most mobile form of prosthetic appliance parts connection between itself is spherical (singe- or double joint) connection. They are most effective at a shift of fragments in vertical direction. A small number of teeth is on a jaw, considerable amplitude of fragments shift, localization of unreal joint in a frontal or lateral department serve as a testimony for removable prosthetic appliance making with a of hinge-joint (E.Gavrilov, B.Vaynshteyn).

23. Joint prosthetic appliance named after Gavrilov is a removable prosthetic appliance which consists of 2 parts united by a hinge from a wire. A loop is entered into 1st part in a horizontal plane in type of a ring, and a loop in the type of triangle, welded in a vertical plane, unites with it. The size of the triangle limits motions of fragments at vertical, and the ring – in a horizontal plane in relation one to one. Firstly ordinary prosthetic appliance with the clasp fixing is made. A sawing line on prosthetic appliance is set according to placing of unreal joint. From the tongue side of a prosthetic appliance lodges are formed under false teeth on full length of hinge loops. The last conclude and cover with a plastic. Then prosthetic appliance is cut on the set line, a hinge is freed with the bur help. Before the scission of prosthetic appliance a control model is poured off, as at breakage. In our department his modification is offered Ustimenko – Yarovenko in the type of poured shank and poured cusp.

24. A hinge named after Vaynshteyn is a twisted spring which connects both parts of prosthetic appliance. Firstly removable prosthetic appliance with the multicusp fixing is made, then it is cut in the area of unreal joint and in the butt end of prosthetic appliance parts, the twisted springs are melted. With the purpose of prevention mucous tunic limitations and piling up of a meal, springs are stowed in a nipple tube. At the localization of unreal joint in the area of lower joint corner, and if one tooth is saved on smaller fragment, onearthral hinge of I. Oxman is applicable, hinge of the third type, amortizational cusp of V. Kurlyandsky.

25. Prosthetic appliance with an onearthral co-articulation named after Oxman. Prepared prosthetic appliance is sawed in a place of unreal joint. The shank with free ending in a sphere shape is melted into a bigger part of prosthetic appliance, in smaller part - small opened box (from a steel shell), which has a lid, pulled out on slots. A small box is filled with amalgam and parts of prosthetic appliance are united. Prosthetic appliance is entered into the mouth cavity and patient does motion of lower jaw, speaks. As a result of this a bed is created in amalgam for a marble which answers the changes of fragments of jaw during a function. At the bilateral presence of unreal joints prosthetic appliance named after Oxman with double joint co-articulation is made. Thus, length of bar and diameter of marble has an important role, with their increase, there is an increased in mobility of prosthetic appliance.

26. Apparates for unreal joints treatment

27. Apparates for unreal joints treatment

28. Apparates for unreal joints treatment

29. Apparates for unreal joints treatment

30. Apparates for unreal joints treatment

31. Apparates for reposition fragments

32. Apparates for reposition fragments

33. Apparates for reposition fragments

34. Apparates for reposition fragments

35. Apparates for reposition fragments

36. Apparates for reposition fragments

37. Thank you for attention!