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Mandible contracture


The contracture of a mandible is the data of jaws caused by pathological changes and disturbances of elastic properties of the soft tissues of maxillofacial area which are functionally connected with a temporal nizhnechelyuetnym a joint.

Mandible contracture reasons:

On character of a current and etiology distinguish unstable and resistant contractures. Unstable contractures mostly are result of weakening of masseters after long carrying tires with intermaxillary rubber draft, and also at inflammatory processes in the soft tissues surrounding a mandible. Resistant contractures of a mandible are caused by development of cicatricial deformations in fabrics of maxillofacial area after gunshot wounds of the person, a transport injury of a facial skeleton, changes of a coronal shoot of a mandible and zygoma, burns and inflammatory processes of okolochelyustny area.

Cicatricial changes of a mucous membrane of an oral cavity can result from ulcer and necrotic stomatitis, gummous syphilis, a noma, burns, an injury. Considerable restriction of opening of a mouth is connected with the hems located between the upper and lower arch of a threshold of an oral cavity and also on a mucous membrane in the field of a first line of a branch of a jaw. These hems often are soldered to a mandible branch. Quite often, especially after gunshot wounds, burns electric current and nomas, cicatricial changes develop at the same time in all okolochelyustny fabrics that leads to dysfunction of bodies and sharp deformation of a facial skeleton.

Mandible contracture symptoms:

At a contracture of a mandible the speech and meal are violated. Teeth, especially front, adopt the fan-shaped provision. Quite often deformation of upper and lower jaws takes place. If the contracture came in a growth period of a facial skeleton, then the mandible lags behind in development a little, but its deformation is not so considerable, as at an anchylosis.

Treatment of a contracture of a mandible:

Elimination of the data of jaws, recovery of mobility and elasticity of soft tissues of a facial skeleton at a contracture of a mandible is reached by surgical treatment with use in the postoperative period of methods of mechanotherapy, remedial gymnastics and physical therapy. Surgical intervention should be carried out under the general anesthesia. At the same time make excision of hems or a longitudinal section with closing of a wound surface with fabrics, adjacent to defect or taken from other body parts. Small cicatricial styazheniye manage to be eliminated with use of triangular rags across Limberg. The favorable long-term results in many respects depend on radicalism of removal of hems. At the same time it is necessary to reach the maximum disclosure of a mouth. The formed defects replace with elastic soft tissues. In early terms after operation reasonablly actively to use physiotherapy exercises and a mekhanoterayopiya. At the contracture caused by Cicatricial deformations of skin and hypodermic cellulose, the formed defect after excision of hems is closed the triangular rags moved from surrounding fabrics or the yazykoobrazny rags on a leg borrowed from adjacent submaxillary area, a neck, etc. At extensive defects soft тканей^ the hems which are formed after excision at which a large amount of plastic material is required it is reasonable to use bucket-handle graft fabrics. Superficial hems of a mucous membrane in the field of a corner of a mouth and cheeks eliminate with a longitudinal section them and movement of the counter triangular      mucous grafts    and    a submucosal layer found on both sides of defect.

In the presence of flat hems on a mucous membrane and in a submucosal layer of the cheeks causing resistant data of jaws it is enough to dissect away cicatricial tyazh throughout from the place of their attachment to an alveolar shoot of upper and lower jaws and to achieve full opening of a mouth. The wound surfaces formed at the same time should be closed the split skin rags taken by a dermatome or the acute razor. Change of rags is made on the stensovy inserts or gauze rollers impregnated with an iodoform. The inserts covered with an epidermizirovanny surface of a skin transplant enter into postoperative defect, on a mucous membrane over inserts impose silk seams or fix them by means of removable prostheses. On 8 — after operation seams remove the 9th day, take stensovy or gauze inserts and appoint active physiotherapy exercises.

Excision of massive and deep hems in cheeks quite often leads to a masseter exposure. At the same time it is possible to receive the favorable long-term results only after compensation of defect bucket-handle graft fabrics.

Plastic material of a Filatov's pedicle graft is widely used also at the cicatricial deformations which are at the same time extending to skin, a hypodermic kletyochatka, muscles, a mucous membrane of an oral cavity and a submucosal layer.

At the contracture caused by existence of hems in a chewing or medial alate muscle their cutting off from a mandible branch is shown by a submaxillary doyostup. Because of hems in surrounding fabrics sometimes not. it is possible to reach independent opening of a mouth. In these cases apply the screw mouth gag who enter between painters. At the time of violent opening of a mouth carry out manual inspection of a wound and a scalpel cut cicatricial tyazh of a masseter in the cross direction. The cicatricial changed medial alate muscle should be separated from an internal surface of a corner and a branch of a mandible by means of the curved raspatory. Having reached the maximum dehiscence of a mouth between painters on the party of operation, enter a rubber strut. The strut should be removed on 6 — the 7th day after operation and to start active remedial gymnastics. The dissected-away muscle grows on the new place to a mandible branch.

At bone unions of a coronal shoot with a zygoma make a resection of a coronal shoot. Depending on distribution of hems use quick access from the arc-shaped section in the field of a corner of a jaw or subjugal access. The jaw branch exposure from the arc-shaped section is begun with amotio of soft tissues together with a periosteum on an outside surface of a branch, and then on a mandible, internal to a cutting exposure. After the coronal shoot is naked, a scalpel and scissors cut a sinew of a temporal muscle. Plan the line on which the bone resection will be made, by a drill do openings at distance of 0,5 — 1 cm one from another, then a chisel cross the basis of a shoot and delete it. It is necessary to strike with the hammer a chisel not strongly not to damage fabric, the located knutr from a coronal shoot. On soft tissues put stitches from a catgut, on skin — deaf seams from polyamide thread.

At podokulovy access carry out a section 3 cm long on bottom edge of a malar, without reaching 1 ohm an ear trestle. From this section perpendicularly down do the second section, by length of 3 cm too. The triangular piece of leather is otseparovyvat and take away knaruzh. Then a scalpel cut a masseter from a malar, in the stupid way get into depth of a wound and bare mandible cutting, a first line of a condylar shoot and the basis of coronal. After cutting off of a sinew of a temporal muscle a chisel cut the basis of a coronal shoot and it delete the dissected-away end. Divorced soft tissues return in former situation and a skin wound sew up tightly. Operation is finished with introduction of a rubber strut on the sick party between side teeth. Terms of removal of a strut and carrying out physiotherapy exercises the same, as at an ulotomy in a muscle.

The forecast at complex treatment of contractures of a mandible favorable.

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