ASSESSMENT OF THE NATURE OF THE JAW INJURY

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Abstract

Based on the analysis of forensic medical examinations conducted for jaw fractures, it was found that they occurred more often due to domestic trauma (fight) and sharply in a fall from a height. The most typical fracture lines are the neck of the articular process, the angle of the mandible, the mental foramen, and the midline. In the case of impact with a blunt, hard object in the region of the mandible, the mechanism of displacement of fractures under the influence of the traction of the masticatory muscles is characteristic. In all cases, the upper jaw fractures were open as well as unilateral and bilateral. In unilateral upper jaw fractures, the fracture line ran sagittally along the palatal suture. The displacement of bone fragments in the upper jaw fractures depends on the force and direction of the impact; on the weight of the fragments themselves; on the strength of the masticatory (wing) muscles traction.

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51

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

51-55

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

ABSTRACT

Based on the analysis of forensic medical examinations conducted for jaw fractures, it was found that they occurred
more often due to domestic trauma (fight) and sharply in a fall from a height. The most typical fracture lines are the
neck of the articular process, the angle of the mandible, the mental foramen, and the midline. In the case of impact
with a blunt, hard object in the region of the mandible, the mechanism of displacement of fractures under the
influence of the traction of the masticatory muscles is characteristic. In all cases, the upper jaw fractures were open
as well as unilateral and bilateral. In unilateral upper jaw fractures, the fracture line ran sagittally along the palatal
suture. The displacement of bone fragments in the upper jaw fractures depends on the force and direction of the
impact; on the weight of the fragments themselves; on the strength of the masticatory (wing) muscles traction.

KEYWORDS

Jaw fractures, types, mechanism of formation, forensic medical examination.

Research Article


ASSESSMENT OF THE NATURE OF THE JAW INJURY

Submission Date:

February 28, 2022,

Accepted Date:

March 20, 2022,

Published Date:

March 31, 2022 |

Crossref doi:

https://doi.org/10.37547/TAJMSPR/Volume04Issue03-10


Ibragimov Shahboz Ramazonovich

Assistant Professor, Department of Forensic Medicine and Medical Law, Tashkent State Institute of
Dentistry, Uzbekistan

Shavkat Eryigitovich Islamov

Associate Professor, Doctor of Medical Sciences, Department of Forensic Medicine and Pathological
Anatomy Samarkand State Medical Institute, Uzbekistan

Makhmatmuradova Nargiza Negmatullaevna

Assistant to the Department of Internal Medicine No. 4. Samarkand State Medical Institute, Uzbekistan

Journal

Website:

https://theamericanjou
rnals.com/index.php/ta
jmspr

Copyright:

Original

content from this work
may be used under the
terms of the creative
commons

attributes

4.0 licence.


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52

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

51-55

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

INTRODUCTION

At present, injuries to the maxillofacial bones account
for 2.5-4.5% of all skeletal bone injuries [9]. At the same
time, the most frequent injuries of the lower jaw are
caused by blunt objects, which, according to different
authors, account for 26% to 86% of all injuries of the
facial skeleton bones. Also, isolated upper jaw injuries
occur in 1.8-34% of all maxillofacial bone injuries [1,8].

It has been established that the most frequent causes
of injuries to the maxillofacial bones are: domestic
(64.4-95.5%), transport (3.7-13.3%) and sports (1.6-3.3%)
trauma [7,10].

Pashinian et al. in their analysis of the mechanism of
mandibular fractures (565 cases) found that the latter
were most frequently caused by domestic trauma
(85.7% of observations), transport (11.3%), sports (1.4%)
and industrial (1.1%) injuries [3]. In modern clinical
practice, modern methods of computer-assisted
diagnosis of jaw fractures are widely used along with
radiography [4,6].

It should be noted that the criteria for forensic
diagnosis of the mechanism of trauma fractures of the
upper and lower jaw bones have not been fully
developed to date, and the morphological signs of
these fractures, their nature and localisation have not
been established. This contributes to certain
difficulties in the forensic examination of such injuries
[2,5].

The aim of the study was to identify the types and
nature of the formation of injuries of the upper and
lower jaws.

MATERIALS AND METHODS

A retrospective analysis of 36 forensic medical
examination reports conducted in the outpatient
department of the Tashkent City Branch of the
Republican Scientific and Practical Center of Forensic
Medicine in 2019-2020 was conducted as material.
Medical documents (case histories) were also
analysed, as all the persons examined had been treated
as inpatients. Generally accepted research methods
were used - macroscopic, radiological, statistical
research methods.

STUDY RESULTS

Blunt trauma to the jaw was determined in all cases
studied. There were 28 males (77.78%) aged 16 to 60
years and 8 females (22.22%) aged 18 to 52 years. In this
case, fractures of the lower jaw constituted about
66.67% of all fractures of the facial bones. According to
the victims and the circumstances of the case, the most
frequent fractures of the lower jaw were sustained in a
fight and rarely in a fall from a height. The following
types of fractures of the lower jaw were identified:
Open (16.67%) and closed (83.33%); complete (77.78%)
and incomplete (22.22%); single (72.22%), double
(19.44%), multiple (8.33%); unilateral (80.56%) and
bilateral (19.44%); linear (86.11%) and comminuted
(13.89%); with (22.22%) and without (77.78%)
dislocation; straight (88.89%) and indirect (11.11%).

There was disruption of oral mucosal and skin integrity
in open mandibular fractures, i.e. all fractures in the
dentition line were open. Bilateral mandibular
fractures were characterised by the presence of two
fracture lines on opposite sides. In the case of an
incomplete fracture (fracture), the integrity of the
cortical plate on one side was observed to be intact.


background image

53

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

51-55

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

The most typical fracture lines were the neck of the
articular process, the angle of the mandible, the mental
foramen, and the midline.

A mandibular fracture was accompanied by trauma to
the soft tissues of the maxillofacial region (abrasions,
contusions, haematomas, wounds). Sometimes the
diagnosis of a mandibular fracture was difficult due to
swelling. Pain, "step" and "crepitation" symptoms
detected by palpation on the edge of the lower jaw,
and indirect loading symptoms were noted.
Examination of the oral cavity revealed malocclusion,
alveolar mucosal tears, and tooth mobility. X-rays in the
straight (nasolabial) and lateral projections revealed a
disruption in the integrity of the lower jaw bone. It
should be noted that fractures in the region of the
mandibular condyle were detected using tomography
or zonography of the temporomandibular joints,
sometimes using computer diagnostics.

When a blunt, hard object strikes the mandibular
region, the mechanism of fracture displacement under
the influence of masticatory muscle traction is
characteristic. In particular, with a unilateral fracture of
the jaw, the larger fracture moves downwards and
inwards, and the smaller fracture moves inwards and
to the side of the fracture. With bilateral fractures in
the mandibular region or in the region of the div of
the lower jaw, the central fragment moves inwards and
downwards, which can lead to serious life-threatening
complications (tongue root protrusion, asphyxiation).

Fractures of the upper jaw were always open,

as the integrity of the oral mucosa was compromised.
The LeForet classification of maxillofacial fractures is
now widely used and distinguishes between the
following types:

1.

Le Fore I (mandibular fracture) - the fracture line of
the maxilla runs horizontally over the alveolar
process, from the base of the sternum to the

pterygoid process of the main bone. It usually
fractures the floor of the maxillary sinus and breaks
the base of the nasal septum;

2.

Le Fore II (midline fracture). This fracture line runs
transversely through the nasal dorsum, medial
wall, floor, and mandibular margin, and extends
through the zygomatic jaw suture to the pterygoid
process of the main bone. This fracture is often
referred to as a suborbital or pyramidal fracture
because it involves a maxillofacial separation
where the upper jaw, along with the nasal bones,
separates from the zygomatic bones and the base
of the skull;

3.

Le Fore III (upper level fracture). This fracture line
runs transversely through the nasal dorsum,
medial wall, fundus and external wall of the eye
cavity, through the superior external margin of the
eye cavity, and on through the zygomatic arch and
pterygoid process of the main bone. This fracture
is often referred to as a subbasal fracture, since it
is a complete craniofacial separation, i.e. the upper
jaw and nasal and zygomatic bones are separated
from the base of the skull. Le Fore III fractures are
usually accompanied by cranial trauma and often
by a fracture of the skull base, i.e. an open cranial
injury.

According to the results obtained, upper jaw fractures
were unilateral and bilateral 75% and 25%, respectively.
Bilateral fractures were symmetrical and asymmetrical.
In unilateral maxillary fractures, the fracture line was
sagittal to the palatal suture. It should be noted that
displacement of bone fragments in upper jaw fractures
depends on the force and direction of impact; on the
weight of the fragments themselves; on the strength
of the masticatory (wing) muscles. The upper jaw is
usually displaced to the bottom and back, so that an
open bite (occlusion in the region of the maxillary teeth
only), an oblique bite or a false protrusion occur.


background image

54

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

51-55

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

Examination revealed the following main symptoms
characteristic of upper jaw fracture - injuries (bruises,
haematomas, wounds) of soft tissues of head and face;
pronounced edema of both eyes, bleeding into the
tissue around the eyes and into conjunctiva (symptom
of glasses); lengthening and flattening of the midface;
bite disorder, mucous membrane tears (often along
midline of palate), submucosal bleeding along the
transitional fold.

The history of bleeding from the nose, mouth and ears
is characteristic. Licorrhoea (double stain symptom);
anaesthesia or paresthesia of the upper lip, nasal wing
and suborbital area, diplopia or double vision; pain,
crepitus and stepping stone when palpating the bridge
of the nose, lower orbital margin and upper outer edge
of the orbit as well as along the zygomatic arch and in
the malar-alveolar ridge; mobility of the upper jaw (as
a reliable sign of a fracture) that can be palpated and
the "cracked pot" symptom on percussion of the upper
jaw teeth. In the case of an embedded maxillary
fracture, there may be no mobility of the upper jaw.

X-rays of the upper jaw were used to examine the
appendicular sinuses and zygomatic bones in the naso-
parietal (semi-axial) projection with the mouth open.
The most informative X-rays of the middle face in the
axial view, X-ray of the facial skeleton bones in the
nasolabial projection and orthopantomogram were
the most informative. In cases of upper jaw fractures,
we determined the disruption of the integrity of the
bone tissue at the junction of the upper jaw with other
bones of the facial skeleton, as well as darkening of the
maxillary sinuses due to hemosynus. In complicated
cases, computer tomography of head is highly
informative and allows diagnosing injuries of both
facial and cerebral cranial tissues.

CONCLUSIONS

Thus, the obtained data testify to the fact that men of
working age predominated among the examined
subjects in forensic medical practice. Lower jaw
fractures were more often caused by domestic trauma
(fights) and sharply by falls from heights. The most
typical fracture lines were the neck of the articular
process, the angle of the mandible, the mental
foramen and the midline. In the case of impact with a
blunt, hard object in the mandibular region, the
mechanism of fracture displacement due to the
traction of the masticatory muscles is characteristic.

Consequently, in all cases, the upper jaw fractures
were open, as well as unilateral and bilateral. Bilateral
fractures were symmetrical and asymmetrical. In
unilateral upper jaw fractures, the fracture line ran
sagittally along the palatal suture. The displacement of
bone fragments in upper jaw fractures depends on the
force and direction of the impact; on the weight of the
fragments themselves; and on the strength of the
masticatory (wing) muscles.

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The American Journal of Medical Sciences and Pharmaceutical Research
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04

I

SSUE

03

Pages:

51-55

SJIF

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(2022:

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IF

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The USA Journals

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