The mandibular contractures are characterized by the reduction of the jaws due to pathological changes in the soft tissues of the face. In most cases, a similar pathology is an acquired disease.
Jaw contracture : classification and causes
This pathology arises as a result of traumatic and inflammatory changes in the joints of the subcutaneous tissue, the skin itself, nerve fibers, chewing muscles, parotid-temporal fixation. Depending on the severity of the course and manifestations of the disease, several types of contractures of the lower jaw are distinguished. These include temporary (unstable) and persistent pathological processes, as well as congenital and acquired during the life of the patient.
Unstable
Temporary contractures are expressed in the weakness of the masticatory muscles. Most often manifested in the form of complications due to prolonged fixation of the jaw (for example, after wearing tires) or as a consequence of the inflammatory process in the tissues of the jaw.
Persistent
Persistent pathologies are caused by deformation of the lower part of the face due to scarring of soft tissues or inflammatory processes. For example, after receiving a gunshot wound to the face, injuring the bones of the skull, fractures, burns, as well as transferred inflammation of the periomandibular tissues.
The appearance of cicatricial contracture of the lower jaw is often associated with diseases such as ulcerative stomatitis, syphilis, ulcerative necrotic gingivitis.
As a result of changes in soft tissues, a restriction of the mobility of the lower part of the face develops, which leads to a significant deterioration in the quality of life of the patient, up to a serious deformation of the facial skeleton, especially if scars form immediately in several periandibular areas.
The contracture of the lower jaw after anesthesia may occur due to a violation of the technique of the procedure. In this case, the disease belongs to a number of inflammatory.
There are three degrees of contracture of the lower jaw:
- The first is the patient’s opening is weakly limited. The distance between the surfaces of the central teeth of the upper and lower jaw is 3-4 cm.
- The second is the limitation of opening the mouth within 1-1.5 cm.
- Third - the mouth opens no more than 1 cm.
Congenital and acquired pathologies
Congenital changes in the tissues of the jaw and skeleton bones are quite rare. Acquired pathologies of a permanent and temporary nature that arise as a result of weakening of the facial masticatory muscles deserve much more attention. In some patients, the development of contracture of the lower jaw is due to spasticity (tension) of the muscles against the background of hysterical conditions. In such cases, a person develops temporary facial paralysis associated with muscle tension in the lower face.
Characteristic symptoms
As a result of contracture of the lower jaw, the patient may experience some of the following symptoms:
- speech impairment;
- difficulty in chewing food;
- increased interdental spaces, especially in the front row (teeth are arranged in a fan-shaped manner);
- deformation of the jaw bones;
- underdevelopment of the lower jaw of the patient in comparison with the upper;
- noticeable displacement of the lower jaw when opening the mouth.
How are contractures treated?
To eliminate mandibular pathologies, a surgical intervention is used to restore the elasticity of facial tissues, as well as the motor functions of deformed muscles.
The operation is performed under general anesthesia by excision of the scar tissue or a longitudinal section of the scar, followed by its replacement with healthy tissue taken from areas adjacent to the scar or other parts of the patient's body.
Scars of small size are successfully eliminated using the Limberg method (the use of triangular flaps).
To treat contracture of the lower jaw caused by the formation of flat scars, a complete excision of the scar tissue is performed. The wounds formed as a result of excision are covered with thin patches of skin taken from the surface of the patient's body.
In cases where the removal of the scar leads to large-scale losses of soft tissues, leading to exposure of the masticatory muscles of the patient's face, the Filatov method is used to compensate for the lost areas. This is a plastic method consisting in the transplantation of a flap of a patient's skin rolled up by a tube excised along with subcutaneous tissue (Filatovsky stalk). This method is often used for deformations caused by deep scarring in the tissues of the skin, subcutaneous tissue, muscles and mucous membranes of the oral cavity.
In cases of surgical removal of lower jaw deformation caused by scarring in the masticatory muscles, they are cut off from the lower jaw. In the presence of multiple scars formed in adjacent tissues, in some cases it is impossible to achieve the result of self-opening the patient's mouth. In such situations, the surgeon introduces a special screw expander. The muscle cut off at the time of the operation grows to the branch of the lower jaw in a new place. The success of the restoration of lost muscle functions in the future depends on correctly selected rehabilitation methods and the quality of the treatment exercises prescribed by the rehabilitologist.
Inflammatory contracture of the lower jaw is treated by eliminating the source of the infectious process. In the postoperative period, mandatory rehabilitation measures are carried out, including mechanical and physiotherapy, as well as therapeutic exercises.
The value of gymnastics
In terms of restoring the lost functions of the jaw, the primary place is given to physical therapy not only in the early postoperative period, but also in the treatment of contractures caused by injuries and diseases. The final result of the surgery performed by the surgeon largely depends on the quality of rehabilitation measures, correctly selected therapeutic exercises for developing the jaw muscles.
You can perform the exercises yourself in front of the mirror or in a group of patients suffering from such disorders, under the guidance and supervision of an instructor.
A set of exercises for recovery
Gymnastics, as a rule, consists of several successively performed parts:
- An introductory or preparatory part, consisting of general hygiene exercises performed within about ten minutes.
- A special part of the lesson includes exercises selected individually for each patient in accordance with the clinical picture of the disease. A special set of exercises, depending on the nature of the course of the postoperative period, is introduced already on the eighth day after surgery, in severe cases - on the twelfth day after surgery and at a later date.
- The final stage, like the introductory part, consists of general exercises.
A special set of exercises can consist of such movements as:
- Movement of the lower jaw and head in different directions.
- Mimic movements performed to restore the functions of the facial muscles, for example exercises for the cheeks and lips (inflating the cheeks, stretching the lips in the form of a smile or a tube, performing a grin and other movements).
To consolidate the result, it is recommended not to stop classes after discharge and undergoing postoperative rehabilitation measures. Repeating exercises at home is necessary constantly.
Preventive measures
As a rule, the prognosis of the result of operations to eliminate the causes of contracture is favorable. However, to prevent relapse, doctors recommend continuing rehabilitation after discharge from the hospital, in particular, undergoing treatment on special devices within six months after discharge from the hospital (mechanotherapy), performing medical exercises prescribed by the doctor, and undergoing a second course of physiotherapy.
If all the indications are observed, the probability of relapse is significantly reduced, and the final result of the operation improves in more than 50% of cases.
Usually the pathological process does not resume, with the exception of cases of incomplete removal of scar tissue.
Most often, young patients undergoing local anesthesia, which does not completely eliminate the cause of contracture, are prone to the renewal of contracture of the lower jaw. In some cases, children who avoid compliance with prescribed rehabilitation measures are subject to relapse. In the treatment of such pathologies in children, it is important to perform the operation qualitatively the first time, after which immediately recommend to the patient the intake of rough food (hard fruits, raw vegetables, crackers, nuts or candy sweets), which contributes to the development of jaw muscles.