Fractures of the Upper Jaw

If you have sustained a fractured jaw, your surgeon will assess the number of fractures, where they have occurred and whether you will require treatment. The treatment you will undergo involves a general anaesthetic.

Your surgeon will make an incision on the inside of your mouth through the gum above your upper teeth. The broken bones are then fixed and held in place with small metal plates and screws. The gum is stitched back into place with dissolvable stitches that can take a fortnight or even longer to fall out.

During the operation, it is often necessary to place wires or metal braces (arch bars: see below) around your teeth so that elastic bands can be attached to them to guide your bite back into the correct position after surgery. Occasionally, screws are inserted into the jawbone above the teeth instead of wires or metal braces. Your jaws will be able to open freely when you wake up from the surgery.

Occasionally, it is necessary to remove damaged or decayed teeth in and around the site of the fracture.

Arch bars are small strips of metal which are secured to teeth in order to encourage your jaws to heal in the correct alignment. These are placed to achieve the same bite as you had prior to your injury (in cases of trauma).

Arch bars are comparable to braces which are used to align teeth by an orthodontist, except they are placed by an oral and maxillofacial surgeon in order to align the jaws. The arch bars are secured to the teeth by wires which wrap around the teeth to hold the arch bars firmly in place. The secure fit of these arch bars is necessary to attain the ideal result. Elastic bands are then fitted between the top and lower jaws to manoeuvre the bite into the ideal position. They do not prevent you from opening your jaws.

The most common reason for fitting arch bars is following trauma of the mandible (lower jaw) or the midface (including top jaw). They may also be placed in some cases of orthognathic surgery (corrective surgery for jaw alignment or sleep apnoea), or following reconstruction after diseases of the jaws.

Arch bars have been used for many years. They may be used by themselves for closed reduction (treatment of bony injuries without cutting the tissues), or in conjunction with open reduction (cutting the tissues and surgical repositioning of the bones).

These appliances are temporary and the length of time required is dependent upon the purpose for their use. Typically trauma cases may require arch bars for two to four weeks before removal.

During the period you will require arch bars, several issues may arise:

• At the outset, the wires and arch bars may cause some local irritation and discomfort but the tissues usually adapt to this within several days.
• Oral hygiene can be more difficult, as the appliances tend to trap food debris. It is therefore essential that you brush your teeth frequently and meticulously whilst these are on. It will make the application of the elastics much simpler. You may also be advised to use an antiseptic mouth wash (such as chlorhexidine) on a regular basis.
• The arch bars are evident on smiling, but less so than regular braces.
• In rare cases, the jaws are wired together to prevent the mouth from opening. Special instructions will be given to you concerning dietary requirements.

The placement of the elastic bands between the mandibular (lower jaw) and maxillary (top jaw) arch bars is critical to their effectiveness. Failure to place these correctly will lead to an undesirable outcome.

Your surgeon will initially place the elastics for you, either at the time of surgery or within the days following. After providing you with a supply, they will then instruct you on how and where to place them.

A guide for placement of dental elastics for archbars:

• Grasp the elastic band with the tip of the tweezers.
• Loop the elastic over one of the ‘cleats’ or ‘hooks’ of the archbar on the top jaw. Do not confuse the cleats with the wires themselves. Ideally, you should not hook the elastic over the wires which are used to secure the arch bar to the teeth.
• With your mouth closed, loop the band over the corresponding cleat in the lower jaw. The elastic band should ideally be almost vertical and not angled between top and lower jaws.
• Return to the top jaw and pull the elastic forward to stretch it over a second cleat in the top jaw.
• In the same way, stretch the elastic over the lower jaw to secure it onto a second cleat.
• Place further elastics in a similar manner as instructed. Typically, an elastic should be placed on the other side of the jaw in a symmetric manner.

You should contact your surgeon if you experience any problems with your arch bars. Very rarely, the arch bars can cause complications with the teeth they are attached to. If you notice any darkening or significant pain following placement of these appliances, please advise your surgeon.

It is likely that you will experience some soreness which will be managed with pain relief. The discomfort is generally worse a few days after surgery, although it may take a couple of weeks to completely resolve.

You will also be given intravenous antibiotics whilst you are in hospital to ensure that your fractures heal without any infection. You may also be given oral antibiotics to take home with you. You will generally be required to stay overnight in hospital. The following day you will undergo an x-ray to check the position of your fractures prior to being discharged from hospital.

Although the plates and screws hold the fractures in place, it will still take approximately 4-6 weeks for your jaw to heal completely. During this time, a diet of soft foods is recommended.

It is also important that you keep your mouth as clean as possible for the first few weeks following surgery to prevent infection. It may be difficult to clean your teeth around the stitches due to tenderness in this site. It is advised to keep the area free from food debris by gently rinsing your mouth with a mouthwash or warm salt water.

If any wires, metal braces or screws are used to assist in guiding your bite into the proper position, they will be removed when your surgeon is satisfied that your fracture has healed.

Depending upon the type of work you perform, it me be necessary to take a couple of weeks off work and to avoid strenuous exercise during this time. It is important that you not drive or operate machinery 24 hours following a general anaesthetic.

• Infection is rare as you will be taking antibiotics.
• Bleeding from the incisions inside your mouth is uncommon. If the area does bleed this can usually be stopped by applying pressure over the site for at least 10 minutes with a swab.
• You may experience numbness and tingling over your top lip. The numbness may take several days to disappear.
• Occasionally teeth adjacent to the fracture site may be damaged by screws that are used.
• If your surgeon has inserted plates and screws in your jaw to hold it in position, these are not generally removed unless there are problems with infection. The metal that is used is titanium which does not alert metal detectors in airports.

A follow up appointment will be arranged for you so that your surgeon can monitor you for several months following treatment to ensure that your jaw heals well.

Removal of the arch bars is generally done in the clinic. This is usually a quick procedure with minimal discomfort. It does not typically require any analgesia, except in complicated cases.