CHOICE OF TREATMENT TACTICS FOR AN OPEN FRACTURE OF THE LOWER JAW ANGLE WITH THE PRESENCE OF A TOOTH IN THE FRACTURE GAP

Abstract

The aim. Increase the effectiveness of treatment of patients with open fractures of the lower jaw with the presence of a tooth in the fracture gap. Materials and methods. Clinical examination methods (objective examination), x-ray examination methods (computed tomography), functional method (EOD), laboratory methods (general blood analysis, biochemical blood analysis, general urinalysis, blood analysis). 50 patients were examined and treated. In the treatment, a device for determining the mechanical parameters of the bone No. 150086 dated 12.29.2022 was used. The surgical treatment was carried out for 6 months on the basis of KMKL No. 12, SCLV No. 2 in Kyiv from 10.01.2019 to 03.01.2020. There were 35 men and 15 women among the patients of all groups. The age of the patients ranged from 18 to 60, group I. In 25 patients with the diagnosis: One-sided fracture of the angle of the lower jaw was found (group I). 15 patients have a bilateral fracture of the angle of the lower jaw (group II). 10 patients had a double fracture of the lower jaw (group III). A positive symptom of direct and indirect stress in the areas of the fracture was noted in all 50 patients. Scientific novelty. The effect of different positions of the tooth in the gap of various fractures of the lower jaw on the effectiveness of fixation was revealed. Determining the optimal area of the bone for applying bone fixators using a device for determining the mechanical parameters of the bone № 150086 dated 12.30.2021. Conclusions. If the tooth remains in the area of the mandibular fracture, it is used as a support and improves the fixation of the fragments, which in turn reduces the risk of oral fluid entering the wound and at the same time better consolidation of the fragments occurs. Complications occurred in 4 patients with preserved teeth in the fracture line. Namely, 2 teeth (48.38), where the course of the fracture line passes through the hole of the tooth and 2 teeth (37.47), the fracture line passes obliquely through the hole of the tooth. The teeth were treated endodontically after trauma without rupture of the neurovascular bundle. One of the important factors remains treatment of the oral cavity and sanitation of the teeth – these are important factors that make the regeneration process of wounds in ACL faster. Thus, the decision to remove or save teeth in the fracture line should be made on the basis of the clinical picture with the calculation of modern research. After repositioning and immobilization of fragments of the lower jaw, it is necessary to create conditions for the processes of reparative osteogenesis. The basis of success is the achievement of the maximum diastasis of the bone wound and alignment of fragments, which allows to make the bite as natural as possible in the future and to restore it.