3-5.
(reduction of a fracture) and immobilization (fixation) of the parts for about 6 to 8 weeks
until a union between the bony parts takes place. Reduction of the fracture may be
either closed or opened. In a closed reduction, the bone segments are manipulated
back into position without surgically exposing the bone. Usually, arch bars and wires
are used for fixation. In an opened reduction, the fractured bone segments are
surgically exposed, which allows the fracture to be reduced exactly because of
unobstructed, direct vision. In opened reductions, fixation generally is accomplished by
drilling holes on either side of the fracture and using wire or metal plates to hold the
segments in close approximation. Careful postoperative care is needed. Patient
instruction in proper diet is essential because often the teeth are immobilized in the
closed position, called intermaxillary fixation (the jaws being wired together). A dental
liquid or soft diet is used because it is a high protein and high carbohydrate diet that
provides the nutrients necessary for the healing of fractured bones.
3-6.
DISLOCATION OF THE JAW
In a dislocation of the mandible, the head of the condyle is displaced from its
normal relationship with the glenoid fossa. The condylar head slips down and out of the
glenoid fossa and in front of the articular tubercle or eminence. The patient is unable to
close his mouth. Often, there is pain, discomfort, and swelling. Dislocation of the jaws
may be caused by a blow, yawning, laughing excessively, or otherwise opening the
mouth too wide. In all cases, the dental officer or some other trained person should be
summoned immediately. It is essential to restore the joint to its normal position as
rapidly as possible. This is done by placing the thumbs in the posterior sulcus of the
mandible in the region of the molar teeth and pressing downward and backward to slip
the condyle under the articular tubercle. Since the jaw is likely to slip back into place
quickly, it is essential to prevent the anterior teeth from being traumatically fractured.
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3-6