Long-term results of the restoration of the mobility of the mandible after fractures and prolonged immobilization

Abstract

BACKGROUND: Fractures of the lower jaw accounts for up to 85% of the total number of fractures of the facial bones. Its damage leads to the formation of temporary and persistent functional disorders of the stomatognathic apparatus. Understanding the regularities of the processes of restoring the motor functions of the mandible and chewing apparatus is necessary for planning and improving rehabilitation programs in these patients.
 AIM: To examine the degree and rate of restoration of the amplitude of movements of the mandible in the long-term period of the rehabilitation stage of patients with mandibular fractures.
 MATERIAL AND METHODS: A prospective study was conducted on 40 patients with unilateral and bilateral mandibular fractures, who made up two groups depending on the volume of treatment according to current clinical protocols: group 1 included 22 people who underwent double-jaw splinting during treatment, and group 2 included 18 people who, according to indications, also underwent osteosynthesis of the mandible with subsequent intermaxillary immobilization in the postoperative period. One year after the removal of splinting structures, all mobile patients underwent a clinical assessment of the range of motions of the lower jaw.
 RESULTS: Even 1 year after the successful treatment of patients in the acute period of trauma, despite the implementation of myogymnastics in the rehabilitation period, the range of motions of the lower jaw remains limited. In group 1, after 1 year of observations, the average values correspond to the lower limits of the norms according to literature data: opening, 4.35 cm; with protrusion, 0.78 cm; laterotrusion with unilateral fractures in the damaged side, 0.95 cm; intact, 0.91; bilateral, the damaged side 1 (right), 0.86 cm, damaged side 2 (left), 0.86 cm. In group 2, during the observation period, these indicators remained significantly lower, not reaching the limits of the norm in any case. Moreover, in both groups, their values were significantly lower than those of the healthy volunteers
 CONCLUSIONS: Data obtained on the patterns of restoration of the range of motion of the lower jaw after sustaining a fracture and prolonged immobilization in the long-term justify the need to develop and conduct mandatory early comprehensive rehabilitation measures. Their clinical effectiveness should be confirmed from the standpoint of evidence-based medicine, which enables the comprehensive assessment of the function of the stomatognathic apparatus. This study established indicators that can be considered control criteria when performing relevant studies.