Therapy of the jaw fracture | The broken jaw

Therapy of the jaw fracture

The treatment of fractures of the jaw is divided into a conservative, closed and a surgical, open procedure. In the past, upper and lower jaws were therapeutically bound together with wires until the fracture had healed. However, since this severely restricted the quality of life by preventing the patient from speaking and eating, new therapeutic methods were quickly developed.

In the case of maxillary fractures, open surgical treatment is usually always necessary to fix the upper jaw back to the base of the skull. In the case of lower jaw fractures, it depends on whether a fracture is displaced or the fragments are still in their normal position. In the case of displaced fragments, a surgical procedure is always the therapy of choice.

In the case of fractures that are not dislocated or only fractures of the mandible, conservative treatment is indicated. If the lower jaw is only fractured, the only therapy is to rest. In the case of fractures, the practitioner decides whether a splint bandage is placed by wire or whether orthodontic appliances such as an activator must be worn.

Conservatively, splinting is the most popular therapy method. In the case of displaced fragments after a fracture, comminuted fractures and multiple fractures, an open surgical procedure is unavoidable. Contraindications for surgery are alcohol dependency, pregnancy and cramps.

A distinction is made between two different procedures in surgical therapy: Today, plate osteosynthesis is the predominant procedure, which is increasingly replacing traction screw osteosynthesis due to the success of the therapy.

• In plate osteosynthesis, the bone pieces are fixed to each other by plates. The plates prevent the bone pieces from moving.

  In addition, the plates prevent rotational mobility in particular. As a rule, plate osteosynthesis leads to good healing of the fracture. The metal material can be removed after at least 12 months.

  However, it is usually waited 12 to 18 months to remove it.

• In lag screw osteosynthesis, one piece of bone is drilled out so far that a screw can be inserted into this hole. A smaller hole is drilled in the other fragment and a thread is cut into it. Tension is applied to the fragments when the screw is inserted and the two pieces are fixed together.

Splinting is the treatment of choice for conservative procedures.

This splinting is used when the fragments are not displaced and are in the normal position. In this case, the teeth are fixed by an archwire splint so that they cannot be misloaded and the fracture can regenerate. Since this form of conservative treatment does not sufficiently fix the fracture for greater mechanical loads, an additional splint or plaster cast is usually applied so that the fracture does not reopen.