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December 12, 2016 00:02

Contracture of the lower jaw : Causes, Symptoms , Diagnosis, Treatment

contracture of the lower jaw (lat contrahere -. To shrink, shrink) - a sharp restriction of mobility in the temporomandibular joint as a result of pathological changes of the soft tissue surrounding it and functionally related.

often contracture of the lower jaw is combined with intra-articular adhesions (ie. E. With ankylosis).

What causes contractures of the lower jaw?

contracture of the lower jaw occurs on the basis of changes in the skin, subcutaneous tissue surrounding the joint, in the masticatory muscles, fascia (parotid, temporal) in the nerve fibers of traumatic or inflammatory origin.

Rough fibrous and bony fusion of the front edge of the branches of the mandible or the coronoid process with the zygomatic arch or hill of the upper jaw may arise after the gunshot and neognestrelnyh damage temporal, zygomatic and buccal areas, as well as after the erroneous injection solutions (alcohol, formalin,acid, hydrogen peroxide and t. p.), causing necrosis soft tissue around the injection site

on the jaw.After necrosis of normal tissues are replaced by scar.

contractures on the basis of long-term adinamii head of the lower jaw when affixing the maxillary bone fragments of the mandible may be supplemented by scarring in the interior of the cheeks or lips, if at the same time with a broken jaw were damaged soft tissues of the face.

Neurogenic contracture of the lower jaw may develop on the basis of reflex pain reduction of masticatory muscles (caused pericoronitis, osteomyelitis, trauma needle muscle during anesthesia), spastic paralysis and hysteria.

Symptoms contractures of the lower jaw

If contracture of the lower jaw is always celebrated more or less pronounced reduction of the jaws.If it is based on an acute inflammation of the masticatory muscles (lockjaw on the basis of myositis), attempts to forcibly jaws breeding cause pain.

When persistent scarring and adhesions of bone reduction of the jaws can be particularly significant, but their breeding attempt in this case is not accompanied by sharp pain.Palpable it is sometimes possible to determine the rough scar contraction throughout the run-up to the mouth or in the retromolar region, in the area of ​​the zygomatic bone, the coronoid process.

In cases where the injury or inflammation occurred in adult man outwardly visible coarse facial asymmetry, as well as changes in the shape branch, condyle, angle and body of the mandible is not marked.If the disease has developed more in children or youthful age, by the time of the survey (adult), the doctor can detect (clinically and radiographically) gross anatomical abnormalities: hypoplasia of the branch and the body of the jaw, shifting her chin department in the affected side, etc..

Treatment of contractures of the lower jaw

treatment of contractures of the lower jaw to be pathogenic.If contracture of the lower jaw central origin, the patient is sent to the neurological department of the hospital to remove the primary etiologic factor (spastic lockjaw, hysteria).

If it inflammatory origin first remove the source of inflammation (kills the tooth reveal phlegmon or abscess) and then spend antibiotic, physiotherapy and mechanotherapy.The latter is desirable to implement apparatus Nikandrova M. A. and R. A. Dostal (1984) or D. Chernoff (1991) in which the source of pressure on the dental arch is air, i.e. pneumatic drive which has a thickness in a sleeping state2-3 mm.Chernov DV bring recommended operating pressure of the pipe introduced into the patient's mouth cavity within 1.5-2 kg / cm2 at a conservative treatment, we cicatricial contracture antiplaque and its etiology in inflammation.

contractures of the lower jaw caused by bone or bone-fibrous extensive spikes, adnations coronoid process, the front edge of the branches or cheek, is eliminated by excision, dissection of adhesions, and due to the presence of narrow scar nodules in the retromolar region - by plastic counter triangular flaps.

If bone adhesions between the lower jaw and the zygomatic arch bone and upper jaw can be guided by Table.12.

After surgery to prevent wrinkling and skin flap underneath scarring needs firstly, placing in the mouth therapeutic bus (stensovym with liner) for 2-3 weeks, daily for extracting its mouth toilet.Then, to make dentures.Secondly, in the postoperative period is necessary to implement a number of measures that prevent recurrence of contractures and strengthening the functional effect of the operation.These include active and passive mechanical therapy, starting with the first 8-10 days after the operation (preferably - under the leadership of methodologist).

Mechano can use standard cell phones and personal devices, which are manufactured in Dhu botehnicheskoy laboratory.This is more fully described below.

recommended physiotherapy treatments (radiation rays Bucca, ionogalvanizatsiya, diathermy), contributing to the prevention of the formation of rough scars and lidazy injection with a tendency to cicatricial contraction of the jaws.

After discharge from the hospital should continue mechanotherapy for 6 months - up to the final formation of connective tissue in the area of ​​the former wound surfaces.Periodically parallel with mechanotherapy should be carried out physical therapy.

At discharge, the patient must be equipped with a simple device - means for passive mechanotherapy (plastic screws, wedges, rubber spacers, etc.).

Excision of fibrous adhesions, osteotomy and arthroplasty at the base condyle using deepi-dermizirovannogo skin graft

The same operation at the level of the lower edge of the zygomatic arch with excision of bone-rumen conglomerate and modeling of the head of the lower jaw, interposition of the skindeepider-SCMs

flap dissection and excision of soft tissue scarring from the oral cavity;coronoid process resection, removal of bone adhesions (chisel, drill, wire cutters Luer);epidermizatsii wound split-skin grafting

dissection and excision of the scar and adhesions through the outer bone access, resection of the coronoid process.In the absence of scarring on the skin - operation through intraoral access with the mandatory transfer of the split skin graft

Excision of the entire conglomerate of scarring and adhesions of bone through intraoral access to the wide opening of the mouth;split skin graft transplant.Before the surgery, ligated external carotid artery

dissection and resection of bone and fibrous adhesions cheeks to provide a wide mouth opening and closing of the resulting defect in advance transplanted cheek Filatov stem, or the elimination of the defect Shaki skin arterialized flap

Good results in the treatment of the above-described methods were observed in 70.4% of patients: dehiscence of the mouth between their front teeth of the upper and lower jaws ranged 3-4.5 cm, and for individuals reached 5 cm at 19.2% the value of the person opening the mouth was up to 2.8 cm, and 10.4% - only to 2.cm. In the latter case had to do a second operation.

reasons for recurrence of contractures of the lower jaw are insufficient excision of scars during the operation, the application (for epidermizatsii wound) is not split, and the thin epidermal flap A. Yatsenko-Tiersh;necrosis of the transplanted skin flap;insufficiently active hydrotherapy, physiotherapy neglect prevention and treatment possibilities of occurrence of cicatricial nodules after surgery.

Relapses contractures of the lower jaw appear more frequently in children, especially in not operated under general anesthesia or potentiated anesthesia, and under ordinary local anesthesia when the surgeon can not perform the operation according to the rules.In addition, children do not carry out assignments for mechanical and physical therapy.Therefore, in children particularly important to the correct execution of the operation and purpose after the rough write (crackers, bagels, candy, apples, carrots, nuts, and so on. N.).