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Etiology, Classification, Frequency of Bone Defects and
Lower Jaw Deformation (Literature Review)
Introduction:
In peacetime, non-firearms of the lower jaw are usually observed. They arise as a result
of resection or disarticulation of the jaw (in connection with a benign or malignant tumor), its
lengthening when the underdevelopment is eliminated, after osteomyelitis or an overly extensive and
uneconomical sequestrectomy, after an accidental injury, etc. [6,9]. Among the many
causes
that lead
to the occurrence of defects in this localization, oncological pathology takes the first place,
while
malignant tumors account for up to
16% of cases, benign ones - up to 42.9% [10, 11, 12]. Traumatic
injuries, gunshot and non-gunshot wounds of the maxillofacial region, leading to defects of the lower
jaw of various lengths, occur in 28.5% of cases [7].
Among the deformities of the facial area of an acquired character, a very significant group is made up
of various forms of underdevelopment of the lower jaw. The values of this group, according to Kh.A.
Kalamkarova et al. (1981) is not determined by its quantitative representativeness, since such
deformities account for no more than 15% of acquired changes and about 3-5% of all deformities of
the lower jaw of different genesis. The authors note in this regard, sharp violations of socio-
psychological adaptation, changes in the proportion of the face, gross violations of chewing, speech
production, breathing and other functions, which determines the great social relevance of their
effective rehabilitation.
Deformation of the jaws of endocrine genesis are described in the works of Kalamkarov Kh.A. et al.
(1978), Belyakova Yu.A. (1983), where the authors characterize the deformities of the jaws as a whole
in diagnosed pathologies of the endocrine glands. They note that the classic forms of endocrinopathies
in patients are quite rare, and quantified erased species prevail, which, nevertheless, affect the shape,
growth rates of all parts of the skeleton, including the skull.
Feruz Ibodullaevich Tojiyev
Aziz Mukhammadovich Azimov
Mirzobek Bakhromovich Aralov
Received 19
th
May 2021,
Accepted 20
th
June 2021,
Online 14
th
July 2021
Department of Pediatric Oral and
Maxillofacial Surgery
Department of Orthodontics and Dental
Prosthetics
ABSTRACT
:
In peacetime, non-firearms of the lower jaw
are usually observed. They arise as a result of resection or
disarticulation of the jaw (in connection with a benign or
malignant tumor), its elongation in the elimination of
underdevelopment, after suffering osteomyelitis or overly
extensive and uneconomical sequestrectomy, after an
accidental trauma, etc. [6,9]. Among the many reasons that
lead to the occurrence of defects in this localization,
oncological pathology takes the first place, with malignant
tumors accounting for up to 16% of cases, benign ones - up
to 42.9% [10, 11, 12]. Traumatic injuries, gunshot and non-
gunshot wounds of the maxillofacial region, leading to
defects of the lower jaw of various lengths, occur in 28.5%
of cases [7].
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In the study of patients with defects and deformities of the lower jaw branch, they pay great attention
to generally accepted clinical methods: the study of complaints, life history and medical history,
general examination of the patient, anthropometry of the face and models, X-ray and functional
methods, i.e. [3.8]. Local factors and signs of jaw deformities are mainly studied. While the general
factors leading to metabolic disorders remain unexplored. The clinical picture of a defect in the lower
jaw depends on its localization and length, the presence of cicatricial joints between the fragments of
the jaw, the presence of teeth on bone fragments and antagonistic teeth on the upper jaw, intact skin in
adjacent areas, etc. [1,5].
In modern domestic and foreign literature, there is no unified classification of defects in the lower jaw
[2,7]. The most widespread among foreign experts in the etiology of all deformities of the skull and
maxillofacial area were the units of H.A. Kalamkarova et al. (1981).
A. Congenital deformities
1.
Caused by the influence of teratogenic factors: clefts; discrania of a sharp type; craniostenosis,
dysostosis, I-II branchial arch syndromes; dysplasia of the jaws; phakomatoses; congenital
endocrine lesions.
2.
Shown chromosomal diseases.
B. Acquired deformities.
1.
Endocrine and metabolic;
2.
Caused by functional changes;
3.
Post-traumatic.
4.
Caused by inflammatory and infectious agents.
5.
Caused by radiation.
The classification, which indicates the localization of the pathology developed by V.F.Rudko,
distinguishes the following types of defects in the lower jaw:
defects of the middle section of the div;
defects of the lateral parts of the div;
combined defects of the middle and lateral parts of the div;
branch and corner defects;
subtotal and total div defects;
lack of branches and div parts;
multiple defects.
B.L. Pavlov divides defects of the lower jaw into 3 classes and 8 subclasses:
Class I - end defects (with one free bone fragment);
Class II - defects along the jaw (with two free bone fragments);
Class III - double (bilateral) jaw defects (with three free bone fragments).
In grades I and II, the author identifies three subclasses: with preservation of the chin, with partial (up
to the middle) loss of it and with complete loss; and in the III class - two subclasses: with and without
preservation of the chin.
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These classifications do not take into account the presence of teeth on the fragments of the jaw,
scarring between the fragments, etc. Therefore, they cannot help the surgeon when choosing the
method of forming the bed for the seedling, the method of intraoral fixation of the fragments after the
operation, etc. In this regard, the classifications proposed by orthopedic dentists, who attach great
importance to the presence of teeth on the fragments of the lower jaw,
are advantageously
distinguished, since the task of fixing jaw fragments is solved and rest is provided to the transplant in
the postoperative period.
According to the classification of K. S. Yadrova, gunshot defects are divided into three groups:
with unstable displacement of fragments (without a shortened scar or with a slight shortening of it);
with persistent displacement of fragments (with a shortened scar);
improperly fused fractures with loss of bone substance of the lower jaw (with shortening of the jaw).
Each of these groups is divided, in turn, into the following subgroups:
a single defect in the anterior part of the div of the lower jaw;
a single defect of the lateral part of the div of the lower jaw;
a single defect of a branch or branch with a part of the div of the lower jaw;
double defect of the lower jaw.
This classification, which is close to the classification of V.F.Rudko, also does not reflect the presence
or absence of teeth on the fragments of the jaw div.
It is simply impossible to draw up a comprehensive classification of mandibular defects that would be
immense and convenient to apply in practice [10,17]. Therefore, the diagnosis should indicate only the
main characterological features of the defect: its origin, localization and length (in centimeters or with
orientation to the teeth). As for the rest of the features of the lower jaw defect, which appear in various
classifications and are undoubtedly of great importance, they must be indicated, but not in the
diagnosis, but when describing the local status: cicatricial convergence of fragments with each other,
cicatricial contracture of a short fragment (branches jaw), the presence of an incomplete osteomyelitis
process, the number and stability of teeth on each fragment and on the upper jaw (dental formula,
detailed in the text), the presence of a skin defect in the div and branches of the jaw, scar
deformations of tongue, vestibule and bottom of the oral cavity [11, 12]. Defects of the jaw resulting
from gunshot injuries are often combined with scarring of the tongue and the bottom of the oral cavity,
which makes speech very difficult. The surgeon should study well the state of soft tissues in the area
of the mandibular defect in order to determine in advance whether they are sufficient to create a full-
fledged graft bed [1,3]. The ends of the jaw fragments can be sharp or sawtooth sclerosed spines (with
a bridge thrown between them, as it were). These spines are covered with rough scars, which can be
difficult to separate from the bone without damaging the mucous membrane of the oral cavity. There is
evidence that in a false joint of the lower jaw with a bone defect, a zone of newly formed bone beams
is histologically determined, which are, as it were, a continuation of the old beams of the spongy layer.
The neoplasm of these beams occurs in a metaplastic, and partly osteoblastic. This process is not
sufficiently pronounced, therefore, the callus between even relatively closely spaced fragments stops
in its development, which ultimately leads to non-union of fragments and the formation of the so-
called "false" joint [6,16].
There are foreign classification schemes for the development of deformations, based on
embryological, pathogenetic, morphological features, which, nevertheless, do not reflect the entire
variety of jaw ratios. For our research, it seems more appropriate to use the working classification of
jaw deformities. Proposed by V.M. Bezrukov (1981) and based on the classification of Kh.A.
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Kalamkarov and the WHO International Classification. Thus, all studies are aimed at studying the
types and local treatment of deformities, but the possibilities of preventing maxillofacial deformities
with various causes and timing of damage to the growth zones of the lower jaw have not been
sufficiently determined. Therefore, on the basis of the above, many issues of diagnosis, clinical picture
and treatment of patients with the these defects and deformities require further study in order to
develop a unified modern system of their medical rehabilitation.
In the literature sources, there is enough information about the frequency of congenital and acquired
defects and deformities of the lower jaws, the anatomical and functional characteristics of the
maxillofacial region of patients. The most difficult for reasons and forms of development of jaw
deformities are I-II branchial arch syndromes (hemifacial microsomia, otocraniostenosis), which are
one of the most common congenital malformations of the facial region [8]. Their frequency ranges
from 0.02 to 4% [4,6]. Developmental disorders of the maxillomandibular jaw occur from 1: 3500 to
1: 5600 [2,4,9]. Studies by Grabb (1965) and Poswillo have established that the frequency of gill arch
syndrome I-II is from 1: 3500 to 1: 5642 births. According to G.A. Kotova, patients with congenital
malformations related to the I-II branchial arch syndromes account for 11% of all malformations of
tissues and organs of the maxillofacial region. As a rule, these complex craniofacial deformities can be
corrected only in the course of complex treatment with the involvement of a number of specialists.
The number of patients with lesions of the lower jaw osteomyelitis, tumors, as well as its traumatic
injuries are from 12.4 to 64.1% according to the literature [7].
Defects and deformities of the lower jaw, lower micrognathia occur in 19.7-54.4% of patients after
inflammatory diseases, injuries [9,13]. In such patients, in adolescence, the formation of the same type
of combined deformity of the supporting and soft tissues is noted. In particular, deformity of the entire
lower jaw, ankylosis of the temporomandibular joint, defects of the branch, condylar and coronary
processes, asymmetric lower micrognathia, underdevelopment of the upper jaw, zygomatic bone and
arch, as well as the temporal bone were noted. The asymmetry of the lower jaw was present in all three
planes. The severity of the deformation depends on the age at which the disease was suffered and as
most researchers mention in their publications [5,8]. It should be noted that jaw deformities are
common and are multifactorial in etiology.
Conclusion
. None of the existing classifications fully reveals the essence of the pathological process
in the skeletal system as a whole. Therefore, the search for informative methods for diagnosing this
pathology continues to attract the interest of a wide range of researchers.
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