Diagnosis and treatment of injuries of the lower alveolar nerve in nonincendiary fractures of the lower jaw

Abstract

Aim - to systematize injuries of the lower alveolar nerve in fractures of the lower jaw and to develop schemes for their diagnosis and treatment.

Materials and methods. Examination and treatment of 280 patients with fractures of the lower jaw aged from 15 to 67 years were carried out. All patients during hospitalization and in the course of treatment underwent a general clinical examination, radiography of the lower jaw, computer tomography and color stereolithography, contact thermometry, electroodontodiagnostics, electrophysiological parameters of areas of soft tissues innervated by the trigeminal nerve were studied using the «DIN- 1». Tactile, pain and temperature sensitivity of the skin and mucous membrane of the alveolar process was determined, which was measured and evaluated according to Neimark (1981).

Results. According to the results of the analysis, it was found that among the injuries of the lower alveolar nerve in the examined subjects, contusion occurred in 28.6%, stretching - in 39.3%, incomplete (partial) rupture - in 32.1%. It has been proven that among the well-known clinical signs and complaints of patients with a fracture of the lower jaw basis, there are no pathognomonic symptoms that can be used for the differential diagnosis of contusion, stretching and incomplete rupture of the lower alveolar nerve. Indirectly, the severity of lower alveolar nerve injuries can be judged by the degree of displacement of the fragments of the jaws. It was found that patients with fractures of the lower jaw during hospitalization have significantly different indicators of conductivity and resistance of the mandibular branch of the trigeminal nerve, which are directly dependent on the severity of lower alveolar nerve injuries. Proposed treatment schemes for patients depending on the severity of lower alveolar nerve injuries using electrical stimulation of the nerve and intravenous injections of corvitin.

Conclusions. Determination of electrophysiological indicators of the mandibular nerve (conductivity and resistance) at the mental point of measurement on the side of the fracture is an objective test for diagnosing the severity of lower alveolar nerve injuries. The scheme of treatment of patients with basis lower jaw fractures proposed by us allows to shorten the period of treatment and rehabilitation of patients by 10 days - 2 months, depending on the severity of lower alveolar nerve injuries.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the local ethics committee of the institutions mentioned in the work. Parents' informed consent was obtained for children's participation in the study.

The authors declare no conflict of interest.