RU2593235C1 - Manufacturing method of forming nasal stents in patients with congenital anomalies development and acquired deformations of maxillofacial area - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthopaedics, and can be used for correction of nose with congenital and acquired maxillofacial pathology. Obtaining casts of nasal passages and external nose, wherein cast nasal passages is obtained by adding thermo-plastic mass, uniformly rolled on metal rods and external nose cast is by applying thermoplastic mass on bone and cartilaginous portions of external nose section with highest point of nostrils on plaster model is cut off so that in case of single-sided congenital cleft upper lip and palate or acquired deformation of upper edge of maxillofacial area of defect was for 1.5-2 mm above healthy, and case of bilateral is dissected from two sides for not less than 2 mm. Then reinforcing element, which is metal wire is bent in form of ring with circumference equal to width of patient's nose columella. Ends of metal wire are left free and of equal length. Then ring is applied to middle of nasal columella of cast model, and free ends of metal wire are bent at right angle and introduced into nasal passages of cast model with possibility of maximum proximity to nasal septum on plaster model. Then lumen of nasal passages of cast model is filled with liquid plastic with its subsequent polymerisation, after which obtained plastic blank is removed from plaster model with subsequent execution of air through holes of maximum possible diameter in blank considering fact that thickness of walls forming nasal stent is not more than 1 mm.

EFFECT: method enables improving aesthetic effect when using forming nasal stents, providing free nasal breathing using forming nasal stents in children with congenital double-sided cleft lip, alveolar process and palate.

1 cl, 9 dwg, 4 ex

Description

The invention relates to medicine, namely to orthopedics, and can be used to correct nose deformities in congenital and acquired pathologies of the maxillofacial region, that is, in children and adults with congenital single and bilateral cleft lip, alveolar bone and palate; after rhinoplasty and rhinocheiloplasty, removal of tumors in the nose, as well as in healthy children and adults after a nose injury.

Known devices for the formation of the cartilage of the nose in the pre - and postoperative period after chelorinoplasty. For these purposes, a non-individualized plastic ball is used that is inserted into one nasal passage and having the form of a bulb or lamp without an air hole inside, without taking into account the position of the nasal septum and the mucous membrane of the nasal passages.

The disadvantages of analogues are:

Nasal stents do not reflect the individual anatomy of the nasal passages, the shape of the cartilage of the external nose, as well as its vestibule, cause excessive expansion and excessive extension of the nasal cartilage in width, the uneven pressure exerted by them does not provide a physiological nasal type of breathing, in addition, there is a constant need for additional fix nasal stents with extraoral elastic devices, which greatly complicates their use and wearing [1-8].

Based on the closest technical essence, as a prototype, we have chosen a method for manufacturing a nasal stent in children with congenital clefts of the lip and palate, which consists in first making a reinforcing element, which is a steel round wire with a diameter of 0.914 mm (0.036 ounces), which is bent in the form swan neck, ending the bend with a curl loop. The bend shape in the form of the swan neck of the reinforcing element of the nasal stent is obtained by bending the wire, which is first directed forward and then back. In the manufacture of the reinforcing element of the nasal stent, its template is a malleable soft strip of wax, which at one end connects to the labial edge of the surface of the intraoral apparatus on the one hand, and the other enters 3-4 mm into the nasal passage.

The reinforcing element of the nasal stent ends with a loop-curl, which is directly located in the lumen of the nasal passage. In the lumen of the nasal passage, the nasal stent is represented by a loop-curl and a portion of plastic located in the form of two lobes and resembling a “kidney” in shape. The reinforcing element extends from the nasal stent to the outside and continues into the base of the intraoral acrylic plate. To hold the nasal stent together with the intraoral acrylic plate attached to it, an integral element, in addition to numerous extraoral bandages, is the retention shoulder in the form of a “button” outside the oral cavity, located at an angle of 40 ° to the intraoral plate.

In the case of bilateral congenital cleft lip and palate, the stages of manufacture of the nasal stent are identical, only two nasal stents are made for each nasal passage together with two retention arms holding them. The right and left nasal stents are interconnected by a horizontal jumper. Numerous extraoral dressings are used to fix the nasal stent and the intraoral plate attached to it. The nasal stent for both single and double-sided defects is a continuation and inseparable part of the intraoral acrylic plate [9].

The disadvantages of the method selected as a prototype are:

- lack of consideration of the individual anatomy of the nasal passages and the shape of the cartilage of the nose of patients;

- difficulty in nasal breathing in children with bilateral congenital cleft lip, alveolar ridge and palate due to lack of lumen of the nasal passages in the plastic nasal stent, which leads to discomfort of the child and often refusal to wear a nasal stent;

- the manufacture is inevitably associated with the introduction of additional fixing elements for nasal stents into the constructive design in the form of several dressings, patches and retaining shoulders, which can often cause irritation, inflammation of the soft tissues and mucous membrane of the nasal passages, as well as trauma and violation of the integrity of the patient’s skin, which it will complicate wearing and increase the duration of treatment not only of the nasal stents, but also of the associated intraoral plate;

- the lack of assessment of the function of nasal breathing in dynamics, since the design of the prototype device does not include air holes;

- the lack of the possibility of long-term wearing and further modeling of the nasal stent as the child grows;

- insufficiently high aesthetic result when using shaping nasal stents, which requires further rhinoplasty;

- the inability to prevent narrowing of the lumen of the nasal passages and deviation of the nasal septum when using nasal stents.

The technical result of the invention is:

- personification of the manufacturing method, taking into account the individual anatomy of the nasal passages and the shape of the cartilage of the patients nose, which will improve the aesthetic result when using shaping nasal stents, as well as significantly reduce the risk of repeated rhinoplasty in the future;

- the possibility of further correction of the design of the nasal stent taking into account the growth of the maxillofacial region of the child;

- ensuring free nasal breathing when using formative nasal stents in children with bilateral congenital cleft lip, alveolar bone and palate;

- ensuring the absence of fixing elements for nasal stents in the form of dressings and hooks, which eliminates irritation, maceration, uneven pressure and trauma to the patient’s mucous membrane and surrounding soft tissues, and also improves the patient’s adaptation to nasal stents, which will facilitate their long-term wear, in comparison with the prototype method, which ultimately will reduce the time and material costs associated with the manufacture of nasal stents;

- the ability to assess the function of nasal breathing in dynamics;

- the possibility of preventing narrowing of the lumen of the nasal passages

and deviations of the nasal septum when using shaping nasal stents.

The technical result is achieved by the fact that a method of manufacturing a shaping nasal stent in children with congenital malformations and acquired deformations of the maxillofacial region consists in obtaining casts of the nasal passages and the external nose, moreover, an impression of the nasal passages is obtained by introducing a thermoplastic mass on them onto metal rods, and the impression of the external nose - by applying a thermoplastic mass on the bony and cartilaginous parts of the external nose. Not more than 10 seconds after the application of the thermoplastic mass, it is removed in a single block and immersed in water at a temperature of 5-10 ° C. Then get a gypsum model of the nasal passages and the external nose by mixing 320 g of gypsum powder with 100 ml of water. The section with the highest point of the nostrils located on it on the gypsum model is cut off so that with a unilateral congenital cleft of the upper lip and palate or acquired deformations of the maxillofacial region, the upper edge of the defect side is 1.5-2 mm higher than the healthy one, and with bilateral it is cut off two sides not less than 2 mm. After that, the reinforcing element, which is a metal wire, is bent in the form of a ring with a diameter equal to the width of the columella of the patient’s nose, and the ends of the metal wire are left free and of the same length, after which the ring is applied to the middle of the columella of the gypsum model, and the free ends of the metal wire are bent at a right angle and injected into the nasal passages of the gypsum model with the possibility of maximum proximity to the nasal septum on the gypsum model, then fill the lumen of the nasal passages of the gypsum model liquid plastic and then polymerizing, after which the resulting plastic preform is removed from the plaster model and then performing the preform vozduhoprovodyaschih maximum diameter of the through holes, but the thickness of the walls of the forming nasal stent is not more than 1 mm.

The method is as follows

Casts of the nasal passages and the external nose are obtained, moreover, a cast of the nasal passages is obtained by introducing a thermoplastic mass into them on the metal rods, and an impression of the external nose is obtained by applying a thermoplastic mass to the bony and cartilaginous parts of the external nose. The Master thermoplastic impression mass is heated by adding boiled water at a temperature of 90-100 ° C for 3 minutes in a plastic heat-resistant bowl to achieve a soft plastic consistency, which is checked with a spatula. The heated portion of the thermoplastic mass is rolled out on a metal rod in a uniform layer to form a blunt cone. In the nasal passages, alternately with movements similar to the winding of a watch, in the clockwise direction, the thermoplastic mass on the metal rods is gently inserted, which at the time of introduction into the nasal passage acquires a temperature of not more than 50 ° C. A temperature of not more than 50 ° C provides sufficient softness and suppleness of the impression thermoplastic mass, which is necessary for an accurate impression, and is comfortable for a patient who experiences sensations similar to a warm moist compress. After a few seconds required for instant hardening, the thermoplastic mass on the metal rods is removed from the nasal passages, checking the quality of the impression, and lowered into a bowl of cold water with a temperature of 10 ° C for final hardening. Then the nasal passages are taken out of cold water and again carefully checked for the integrity and quality of the displayed anatomical surface of the nasal passages. After checking the casts of the nasal passages, they are again introduced into the nasal passages already hardened and left there. To obtain a single impression of the nasal passages in conjunction with the bone and cartilage of the external nose, it is necessary to apply the warmed thermoplastic mass in the sequence obtained in the nasal passages obtained in a certain sequence and in a clockwise direction. A thermoplastic mass in the form of a strip 30 mm wide, heated to a temperature of not more than 50 ° C, is applied, starting from the nose, continuing along the back of the nose to its tip, then moving on to the columella of the nose to the base of the nose, and down to the upper border of the upper lip, turning clockwise arrow to the right side, completely encircling the right wing of the nose, rising again to the back of the nose and going around it, moving to the left side, going down to the left wing of the nose and ending on the left side at the base of the nose. After a complete revolution of the thermoplastic mass around the external nose, it is left for no more than 10 seconds on its surfaces. After 10 seconds, grasping on the opposite ends of the metal rods on both sides with the index and middle fingers of the right hand with light swaying movements up and down, they take out a single impression, consisting of casts of the nasal passages and the external nose, immediately immersing in water at a temperature of 5-10 ° C for 2 minutes for final hardening, FIG. 1 shows a single cast of the external nose and nasal passages after final hardening. After that, a single cast of the nasal passages and the external nose is removed from the water and placed on a gauze napkin until it dries completely. While the cast is drying, medical plaster is prepared to obtain an exact copy of the cast of the nasal passages and the external nose, i.e. her plaster model. After thoroughly mixing 100 ml of water and 320 g of gypsum powder, the gypsum mixture in the resulting consistency of liquid sour cream on a spatula is added in small portions to the impression of the nasal passages and the external nose, which is located on the dental vibrating table to avoid the formation of pores in the future gypsum model. The gypsum mixture is introduced in excess on all the inner surfaces of the impression of the nasal passages and the external nose with the final portions of the gypsum mixture, forming a hood. After this, the impression is immediately turned over and placed with the inner surface down on a smooth glass surface for the subsequent process of setting gypsum. After 40 minutes, the impression together with the set gypsum is placed in a heat-resistant bowl with boiled water, heated at least 90-95 ° C for 2 minutes to separate the gypsum model from the thermoplastic impression mass. After the plaster model is completely separated from the remnants of the thermoplastic impression mass, the exact plaster copy of the outer nose and nasal passages is ready (Fig. 2). The gypsum model is thoroughly dried, then ground and polished, smoothing the surface roughness. The section with the highest point of the nostrils located on it on the gypsum model is cut off so that with a unilateral congenital cleft of the upper lip and palate or acquired deformations of the maxillofacial region, the upper edge of the defect side is 1.5-2 mm higher than the healthy one, and with bilateral it is cut off two sides not less than 2 mm. In FIG. Figure 3 shows a gypsum model with lines drawn on it for modeling (cutting off the area with the highest point of the nostril located on it).

Then, according to the plaster model of the nose and nasal passages, a reinforcing element for nasal stents is bent, which is a metal steel wire with a diameter of 0.8 m, which is bent in the form of a ring with a circle equal to the width of the columella of the patient’s nose, universal crampon orthodontic forceps. After bending the circle, a reinforcing element is applied to the gypsum model of the nose and nasal passages exactly in the center of the columella of the nose on the gypsum model, and the entrance to the nasal passages is marked with a waterproof marker on both sides, while the ends of the metal wire are left free and of the same length. The marks obtained on the reinforcing element are exact reference points along which a bend at a right angle will be applied to enable the positioning of the ends of the metal wire in the lumen of the nasal passages. With universal krampon orthodontic forceps, the free ends of the metal wire are bent at right angles, placing the cheeks of the forceps with one side on the edge of the ring in the area of the columella, and the other exactly at the mark at the entrance to the nasal passages. After bending the wire with universal krampon forceps at a right angle, the ends of the wire are inserted into the nasal passages of the gypsum model with maximum proximity to the nasal septum on the gypsum model. The ends of the metal wire are cut in length in accordance with the individual nasal passages of the patient in each clinical case, but with a wire margin of 5 mm, necessary to bend the ends under 90 ° after final fitting of the reinforcing element in height and width, which contributes to increasing the ability to hold plastic dough during the polymerization process, as well as improving the stabilization of nasal stents with long-term wear.

The position of the ends of the metal wire is adjusted with crampon forceps in height and width until they fully correspond to the configuration of the nasal passages, as well as relative to the nasal septum on the gypsum model. After correction of the reinforcing element, it is fitted and finally checked on the plaster model. In FIG. Figure 4 shows a reinforcing element in the form of a ring in the region of the columella of the nose and its two free ends, obtained by bending the wire and immersed in the nasal passages of the gypsum model.

After that, the gypsum model is covered with an insulating varnish and left for 15 minutes until the varnish dries.

While the insulating coating on the gypsum model dries, they begin to prepare the plastic for molding (packaging). In a porcelain or glass container, Redont-Colir plastic is mixed in a volume of 20 g of powder and monomer until it is saturated, and a few drops of red dye concentrate are added to the mixture to enhance the aesthetic properties of future nasal stents. Then the components are thoroughly mixed until a homogeneous state of consistency similar to "liquid sour cream". After the insulating varnish has completely dried, a reinforcing element for nasal stents is attached to the gypsum model, the compliance with the anatomical landmarks is checked, and then the reinforcing element ring is finally fixed with the molten portion of the wax in order to avoid balancing during the application of plastic dough.

On the spatula, plastic dough is introduced layer-by-layer in small portions into the lumen of both nasal passages, placing the gypsum model in a vertical plane to prevent the plastic from returning. The introduction of the test takes place in layers and evenly along the walls and bottom of the nasal passages until they are completely filled. To obtain a homogeneous structure, as well as preventing the formation of pores, at the end of making plastic dough, it is advisable to make several holes with a spatula in several places of the nasal passages, and then re-fill the empty area in the plastic dough with a small new portion of the dough. After the nasal passages are completely filled with a plastic test, the position of the reinforcing element is checked, the ring of which should be strictly in the center of the columella of the gypsum model of the nose and not displaced. After this, the gypsum model together with the plastic test located inside the lumen of the nasal passages is placed for polymerization in the polymerizer under a pressure of 3 atm and t ° = 25 ° C for 20-30 minutes. After polymerization is completed, the ends of the reinforcing element are completely immersed inside the plastic base. In FIG. 5 shows a gypsum model immediately after polymerisation of the plastic. After polymerization is completed, the gypsum model together with the plastic blank of the nasal stents located in the lumen of the nasal passages is cut to half from the base of the base so that the plastic blank can be gently pulled out of the lumen of the nasal passages of the gypsum model while holding the reinforcing ring with forceps item. In FIG. 6 depicts a plastic blank of a nasal stent immediately after removal from the gypsum model.

After removing the plastic blank of the nasal stent from the gypsum model, the surfaces of the plastic are ground and polished. Then proceed to the formation of air-through holes. Starting from the small diameter of the diamond spherical bur, 0.9 mm, a plastic base is prepared on both sides, starting from the center of the circle. The holes are made from two opposite sides: from the side of the external nasal passage and from the opposite end of the workpiece so that a tunnel is obtained. Then use a spherical diamond bur of a larger diameter. Then, air-boring openings of maximum diameter are formed with a conical diamond bur with a rounded tip with a diameter of 1.2 mm so that the wall thickness of the forming nasal stent is not more than 1 mm.

The salient features of the proposed method and the causal relationship between them and the achieved result:

- casts of the nasal passages and the external nose are obtained, and casts of the nasal passages are obtained by introducing a thermoplastic mass into them on the metal rods, and the impression of the external nose is obtained by applying thermal mass on the surface of the bone-cartilaginous sections of the nose.

The presence of metal rods in the thermoplastic mass provides the necessary shape of the casts of the nasal passages, as well as the resistance of the obtained casts to deformation during their removal.

The application of thermomass on the surface of the bone and cartilage of the nose allows you to get a cast of the outer nose, identical to the shape of the outer nose of the patient.

- Not more than 10 seconds after the application of the thermoplastic mass, it is removed in a single block and at a temperature of 5-10 ° C the imprint obtained is immersed in water for no more than 5 minutes.

10 s is a sufficient total total time necessary for obtaining casts: 2 s for each nasal passage, 6 s are necessary for applying and hardening the thermoplastic mass on the surfaces of the osteo-cartilaginous parts of the nose, as well as for connecting the thermoplastic cooling on the bone and cartilaginous parts of the nose masses with previously obtained casts of nasal passages on metal rods.

The thermoplastic mass is removed in a single unit to achieve maximum proximity of the obtained impression to the anatomical shape of the nasal passages.

The temperature regime of 5-10 ° C when immersing the obtained impression in water is selected taking into account the fact that a lower or higher temperature regime is a risk of deformation of the obtained impression.

- Get a gypsum model of the nasal passages and the external nose by mixing 320 g of gypsum powder with 100 ml of water, since this weight ratio of water and gypsum powder was obtained experimentally and is optimal for obtaining a quality gypsum model.

- The area with the highest point of the nostrils located on it on the gypsum model is cut off so that with a unilateral congenital cleft of the upper lip and palate or acquired deformations of the maxillofacial region, the upper edge of the defect side is 1.5-2 mm higher than the healthy one, and with bilateral ones, it is cut off on both sides by at least 2 mm.

When the upper edge of the nostril of the gypsum model is cut off, the finished nasal stent will turn out exactly the same numerical value by which it was performed, which is necessary for shaping and modeling the skin-cartilaginous frame of the nose. These numerical ratios were obtained on the basis of accumulated clinical experience and long-term observations. With unilateral congenital defects, the wing and cartilage of the nose are deformed on the affected side, which are lowered, sagged, flattened, shifted to the side, like the nasal septum, which deviates towards the defect along with the narrowed lumen of the nasal passages. Consequently, with unilateral congenital clefts on the affected side, in the manufacture of nasal stents, it is advisable to carry out hyper correction on one side more (i.e., on the affected side) in view of the underdevelopment of the skin and cartilaginous skeleton of the nose, asymmetric muscle action and the presence of scar tissue [10- 13]. In case of bilateral congenital cleft lip and palate, the cartilage of the nose is deformed on both sides; therefore, the support of the skin-cartilaginous frame of the nose must be provided symmetrically on both sides and their further development is also symmetrical, thus producing a gradual increase in height sufficient and effective to stimulate growth and modeling forms of cartilage [14-17].

- Then the reinforcing element, which is a metal wire, is bent in the form of a ring with a circle equal to the width of the columella of the patient’s nose, and the ends of the metal wire are left free and of equal length, after which the ring is applied to the middle of the columella of the gypsum model, and the free ends of the metal wire are bent at a right angle and injected into the nasal passages of the gypsum model with the possibility of maximum proximity to the nasal septum.

The metal wire is bent in the form of a ring with a diameter equal to the width of the columella of the patient’s nose, in order to be able to introduce into the lumen of the formed ring of cheeks forceps-round-nose pliers for the purpose of further activation, i.e., correction of the position of future stents in the vertical plane.

The ends of the metal wire are left free and of the same length for the purpose of their subsequent introduction into the nasal passages of the gypsum model.

A ring is applied to the middle of the columella nose of the gypsum model to center future nasal stents.

The free ends of the metal wire are bent at right angles to match the anatomical structure of the nasal passages. The ends of the metal wire bent at right angles are inserted into the nasal passages of the gypsum model with the possibility of maximum proximity to the nasal septum on the gypsum model to enable subsequent correction of the position and shape of the nasal septum in the patient.

- Then the nasal passages of the gypsum model are completely filled with liquid plastic followed by polymerization, after which the resulting plastic preform is removed from the gypsum model. The lumen of the nasal passages of the gypsum model is completely filled with liquid plastic in order to repeat the shape of the nasal passages. The polymerization of liquid plastic located in the nasal passages of the gypsum model is necessary to obtain a homogeneous composition, strength and durability of the product.

- With the subsequent implementation in the resulting plastic billet of air-conducting through holes of the maximum possible diameter, taking into account the fact that the wall thickness of the nasal stent is not more than 1 mm.

The implementation of the resulting plastic billet air-conducting through holes provides normal nasal breathing. The maximum possible diameter creates the most physiological passage of air through the nasal cavity. The wall thickness of the nasal stent is not more than 1 mm, providing the maximum possible diameter of the air-conducting through holes, is sufficient for the formation of the cartilage of the nose, especially in the vertical plane. In FIG. 7, 8, 9 depict shaping nasal stents in patients.

Examples of specific performance of the method

Example 1

Patient P., 3 months 15 days. Diagnosis: "Congenital left-sided (unilateral) cleft of the upper lip and palate." For the manufacture of nasal stents, casts of the nasal passages and the external nose were obtained. An impression of the nasal passages was obtained by heating the Master thermoplastic mass with boiled water at a temperature of 99 ° C for 3 minutes until a soft plastic consistency was reached, then the thermoplastic mass was rolled out uniformly on metal rods and introduced into each nasal passage at a temperature of 2 seconds at a temperature 40 ° C, after which the casts from the nasal passages were removed and immersed in water at a temperature of 8 ° C. After the final hardening of the nasal passages, they were reintroduced into the nasal passages and checked for compliance with the anatomical structure of the passages. Then, to obtain an impression of the external nose together with the impression of the nasal passages, i.e. a single impression, a heated portion of the thermoplastic mass was applied at a temperature of 40 ° C in the form of a strip in a circle, starting with the nose bridge clockwise, ending a full revolution on the opposite side of the nose, then left on its surfaces for 5 seconds until it hardens. After that, a single impression from the external nose and nasal passages was taken and immediately immersed in water at a temperature of 8 ° C for 2 minutes until the final hardening. After the mold was dried, its exact gypsum model was obtained by mixing 100 ml of water and 320 g of powder and left for 40 minutes until it was completely cooled. After 40 minutes, the gypsum model completely solidified, after which it was released from the remnants of the thermoplastic mass by immersing it in a heat-resistant bowl with water at a temperature of 99 ° C. After drying the gypsum model, grinding and polishing it, the upper border of the left external nasal passage in the gypsum model was cut 1.8 mm higher than the right external nasal passage. After that, the metal steel wire with a diameter of 0.8 mm was bent according to the gypsum model in the form of a ring with a circle equal to the width of the nose columella, with universal crown-shaped orthodontic forceps. They marked the entrance to the nasal passages with a waterproof marker, then they bent and introduced the free ends of the metal wire at a right angle, placing the cheeks of the forceps with one side on the edge of the ring in the area of the columella, and the other exactly at the mark at the entrance to the nasal passages. The ends of the metal wire bent at right angles to the ring were inserted into the nasal passages of the gypsum model with maximum proximity to the nasal septum. Then the ends of the metal wire were cut by 2.3 mm to match the length of the nasal passages, after the final fitting of the ends of the metal wire to the height and width of the nasal passages, a bend of 90 ° C was applied to the spare wire length of 5 mm and the excess was cut by 2.6 mm. After that, the gypsum model was coated with Isokol-69 insulating varnish and left until the separation varnish completely dried. The ring of the reinforcing element of the nasal stent was fixed in the central position by a molten portion of the wax to avoid displacement before filling the plastic test into the lumen of the nasal passages. After preparing a plastic test of the consistency of “liquid sour cream”, obtained by mixing 20 ml of liquid with 40 g of polymer powder in a porcelain bowl together with 4 drops of red dye of Redont-Colir plastic, it was applied layerwise in small portions to the nasal lumen on a metal spatula moves. After that, the gypsum model, together with the plastic test, located inside the nasal passages, was placed in the polymerizer under a pressure of 3 atm and t ° = 25 ° C for 20 minutes for polymerization. Then, through the cut in the gypsum model, from the base of the plinth, the plastic blank of the nose stents was removed and polished and polished, and then air holes were formed, starting from the center of the circle with a spherical diamond bur of 0.9 mm in diameter, the plastic base was prepared from two ends to obtain the tunnel. After that, a 2.3 mm diameter carbide taper cutter formed the walls of the nasal stent of uniform thickness of 1 mm. The lumen and surfaces of the nasal stent were sanded and polished.

Example 2

Patient S., 1 year 3 months. Diagnosis: "Congenital bilateral cleft of the upper lip and palate." For the manufacture of nasal stents, casts of the nasal passages and the external nose were obtained. An impression of the nasal passages was obtained by heating the Master thermoplastic mass with boiled water at a temperature of 90 ° C for 3 minutes until a soft plastic consistency was reached, then the thermoplastic mass was rolled uniformly on metal rods and at a temperature of 45 ° C it was alternately introduced for 2 seconds into each nasal passage, after which casts from the nasal passages were removed and immersed in water at a temperature of 5 ° C. After the final hardening of the nasal casts, they were reintroduced into the nasal passages and checked for compliance with the anatomical structure of the passages. Further, to obtain a single impression of the external nose and nasal passages, a heated portion of the thermoplastic mass was applied at a temperature of 45 ° C in the form of a strip, starting from the nose clockwise, ending a full revolution on the opposite side of the nose, then left on the surfaces of the nose for 6 seconds until it hardens . After that, a single impression from the external nose and nasal passages was taken and immediately immersed in water at a temperature of 5 ° C for 2 minutes until the final hardening.

From the mold that was dried after immersion in water, its exact gypsum model was obtained by mixing 100 ml of water and 320 g of gypsum powder, which was left for 40 minutes until it was completely cooled, after which it was released from the remnants of the thermoplastic mass by immersion in a heat-resistant bowl with water at a temperature of 100 ° C.

The gypsum model was left to dry, after which it was polished to smooth out several rough areas. On the gypsum model, a section of 5 mm with the uppermost point located on it was cut 2.6 mm symmetrically on both sides.

After that, the metal steel wire with a diameter of 0.8 mm was bent according to the gypsum model in the form of a ring equal to the width of the nose columella, with universal crown-shaped orthodontic forceps, while the ends of the metal wire were left free and of the same length. At the entrance to the nasal passages on the medial surface of the nostrils on the gypsum model, a reference mark was placed, according to which universal crampon forceps were bent at right angles to introduce the ends of the metal wire into the lumen of the nasal passages. The ends of the metal wire were finally corrected with crampon forceps in height and width of the nasal passages. A bend of 90 ° was applied to a spare wire length of 5 mm and the excess was cut by 2.0 mm. Further, the gypsum model was coated with Isolok-69 insulating varnish and left until the separation varnish completely dried. The ring of the reinforcing element of the nasal stent was fixed in a central position by a molten portion of wax. Plastic dough in the consistency of “liquid sour cream”, obtained by mixing 20 ml of liquid with 40 g of polymer powder in a porcelain bowl together with 4 drops of red dye of Redont-Colir plastic, was put into layers of the nasal passages on a metal spatula. After that, the gypsum model together with the plastic dough was placed in the polymerizer under a pressure of 3 atm and t ° = 25 ° C for 25 minutes for polymerization. After polymerization through the incision in the gypsum model from the base and the weakening of the lateral wall of the gypsum model, the plastic blank of the nose stents was removed, its grinding and polishing were performed. After this, air holes were formed, starting from the center of the circle with a spherical diamond bur of 0.9 mm in diameter, and then a plastic base was prepared from the two ends to produce a tunnel with a cone-shaped diamond diameter of 1.2 mm. After that, a 2.3 mm diameter carbide taper cutter formed the walls of the nasal stent of uniform thickness of 1 mm. The lumen and all surfaces of the nasal stent were sanded and polished.

Example 3

Patient K., 8 years old. Diagnosis: Malignant neoplasm of the nasal cavity. For the manufacture of nasal stents in the postoperative period, casts of the nasal passages and the external nose were obtained. An impression of the nasal passages was obtained by heating the Master thermoplastic mass with boiled water at a temperature of 93 ° C for 3 minutes until a soft plastic consistency was reached, then the thermoplastic mass was rolled out uniformly on metal rods and at a temperature of 50 ° C it was alternately introduced for 2 seconds into each nasal passage, after which casts from the nasal passages were removed and immersed in water at a temperature of 6 ° C. After the final hardening of the nasal passages, they were reintroduced into the nasal passages and checked for full compliance with the internal structure of the passages. Further, to obtain a single impression of the external nose and nasal passages, a heated portion of the thermoplastic mass was applied at a temperature of 50 ° C in the form of a strip, starting from the nose clockwise, ending a full revolution on the opposite side of the nose, then left on the surfaces of the nose for 6 seconds until it hardens . After that, a single impression from the external nose and nasal passages was taken and immediately immersed in water at a temperature of 6 ° C for 2 minutes until the final hardening.

From the mold that was dried after immersion in water, its exact gypsum model was obtained by mixing 100 ml of water and 320 g of gypsum powder, which was left for 40 minutes until it was completely cooled, after which it was released from the remnants of the thermoplastic mass by immersion in a heat-resistant bowl with water at a temperature of 96 ° C. The gypsum model was left to dry, after which a section of 5.6 mm with the highest point located on it was cut off 2.0 mm symmetrically on both sides. After that, the metal steel wire 0.8 mm in diameter was bent according to the gypsum model in the form of a ring with a diameter equal to the width of the nose columella, universal crampon orthodontic forceps, while the ends of the metal wire were left free and of the same length of 20 mm. At the entrance to the nasal passages on the medial surface of the nostrils on the gypsum model, a reference mark was placed, according to which universal crampon forceps were bent at right angles to introduce the ends of the metal wire into the lumen of the nasal passages. The ends of the metal wire were finally corrected with crampon forceps in height and width of the nasal passages. A bend at 90 ° was applied to a spare wire length of 5 mm and the excess was cut by 3.5 mm. Further, the gypsum model was coated with Isolok-69 insulating varnish and left until the separation varnish completely dried. The ring of the reinforcing element of the nasal stent was fixed in a central position by a molten portion of wax. Plastic dough in the consistency of “liquid sour cream” obtained by mixing 20 ml of liquid with 40 g of polymer powder in a porcelain bowl, along with 5 drops of red dye of Redont-Colir plastic, was put into layers of the nasal passages on a metal spatula. After that, the gypsum model, together with the plastic dough, was placed in a polymerizer under a pressure of 3 atm and t ° = 25 ° C for 25 minutes for polymerization. After polymerization through the incision in the gypsum model from the base and the weakening of the lateral wall of the gypsum model, the plastic blank of the nose stents was removed, its grinding and polishing were performed. After this, air holes were formed, starting from the center of the circle with a spherical diamond bur of 0.9 mm in diameter, and then a plastic base was prepared from the two ends to produce a tunnel with a cone-shaped diamond diameter of 1.2 mm. After that, a 2.3 mm diameter carbide taper cutter formed the walls of the nasal stent of uniform thickness of 1 mm. The lumen and all surfaces of the nasal stent were sanded and polished.

Example 4

Patient M., 23 years old. Diagnosis: Fracture of the bones of the nose.

For the manufacture of nasal stents, casts of the nasal passages and the external nose were obtained. An impression of the nasal passages was obtained by heating the Master thermoplastic mass with boiled water at a temperature of 100 ° C for 3 minutes until a soft plastic consistency was reached, then the thermoplastic mass was rolled out uniformly on metal rods and alternately introduced into each nasal passage for 2 seconds at a temperature 47 ° C, after which the casts from the nasal passages were removed and immersed in water at a temperature of 10 ° C. After the final hardening of the casts of the nasal passages, they were carefully checked for deformation, and after matching the anatomical structure, they were again inserted into the nasal passages. Further, to obtain a single impression of the external nose and nasal passages, a heated portion of the thermoplastic mass was applied at a temperature of 48 ° C in the form of a strip, starting from the nose, circling the cartilage of the nose in a clockwise direction, ending a full revolution on the opposite side of the nose, after which it was left on the surfaces of the nose for 6 seconds before hardening. After that, a single impression from the external nose and nasal passages was taken and immediately immersed in water at a temperature of 10 ° C for 2 minutes until the final hardening.

From the mold that was dried after immersion in water, its exact gypsum model was obtained by mixing 100 ml of water and 320 g of gypsum powder, which was left for 40 minutes until it was completely cooled, after which it was released from the remnants of the thermoplastic mass by immersion in a heat-resistant bowl with water at a temperature of 98 ° C. After drying, the gypsum model was polished to smooth several rough areas. On the plaster model, the area with the highest point of the nostrils located on it was cut off 3.2 mm symmetrically on both sides. After that, the metal steel wire 0.8 mm in diameter was bent according to the gypsum model in the form of a ring with a diameter equal to the width of the nose columella, universal crampon orthodontic forceps, while the ends of the metal wire were left free and of the same length of 20 mm. At the entrance to the nasal passages along the medial border of the nostrils on the gypsum model, a reference mark was placed on both sides, according to which universal crampon forceps were bent from both sides at a right angle, necessary to introduce the ends of the metal wire into the lumen of the nasal passages. The ends of the metal wire were finally corrected with crampon forceps in height and width of the nasal passages. A bend of 90 ° was applied to a spare wire length of 5 mm and the excess was cut by 2.0 mm. Further, the gypsum model was coated with Isolok-69 insulating varnish and left until the separation varnish completely dried. The ring of the reinforcing element of the nasal stent was fixed in a central position by a molten portion of wax. Plastic dough in the consistency of “liquid sour cream”, obtained by mixing 20 ml of liquid with 40 g of polymer powder in a porcelain bowl together with 4 drops of red dye of Redont-Colir plastic, was introduced layerwise into the nasal passages on a metal spatula. After that, the gypsum model, together with the plastic dough, was placed in the polymerizer under a pressure of 3 atm and t ° = 25 ° C for 20 minutes for polymerization. After polymerization through a cut in a plaster model from the base, the plastic blank of the nasal stents was carefully removed, its grinding and polishing were performed. After this, air holes were formed, starting from the center of the circle with a spherical diamond bur of 0.9 mm diameter, and then a conical diamond bur with a diameter of 1.2 mm, the plastic base was dissected counterclockwise from two ends until a tunnel was received inside the nose stent. After that, a 2.3 mm diameter carbide taper cutter formed the walls of the nasal stent of uniform thickness of 1 mm. The lumen and all surfaces of the nasal stent were sanded and polished.

Thus, the claimed method allows, in contrast to the prototype method:

- to personify the method of manufacturing the shaping nasal stents taking into account the individual anatomy of the nasal passages and the shape of the cartilage of the patients nose, which improves the aesthetic result when using the shaping nasal stents, and also reduces the risk of repeated operations in the future by 80%, in contrast to the prototype method, in which the risk of repeated surgical interventions is reduced by 60% [9, 15].

- carry out further correction of the design of the nasal stent, taking into account the age of the child;

- normalize free nasal breathing when using formative nasal stents in children with bilateral congenital cleft lip, alveolar bone and palate;

- to ensure the absence of fixing elements for nasal stents in the form of dressings and hooks, which eliminates irritation, maceration, uneven pressure and trauma to the patient’s mucous membrane and surrounding soft tissues, and also increases the patient’s adaptation to nasal stents, which contributes to their long-term wear, that is, more 7 years, compared with the prototype method, which ultimately reduces the time and material costs associated with the manufacture of nasal stents;

- evaluate the function of nasal breathing in dynamics;

- to prevent the narrowing of the lumen of the nasal passages and deviation of the nasal septum when using shaping nasal stents.

Bibliography

1. Nagraj Ν., Nagarjuna M., Desai Α., Gandedkar Ν., Jayade V., Gopalakrishnan K. Doble-loop technique using titanium alloy wire for fabrication of nasal stents in nasoalveolar molding therapy for cleft lip and palate patients // The Cleft Palate- Craniofacial Journal. - 2015. - Vol. 52. - P. 246-249.

2. Spengler A.L., Chavaria C., Teichgraeber J.F., Gaterno J., Xia J.J. Pre surgical Nasoalveolar molding therapy for the treatment of bilateral cleft lip and palate: A preliminary study // Cleft Palate Craniofac J. - 2006. - Vol. 43 (3). - P. 321-328.

3. Murthy P.S., Deshmukh S., Bhagyalakshmi Α., Srilatha K. Pre surgical nasoalveolar molding: Changing Paradigms in Early cleft lip and palate rehabilitation // Journal of International Oral Health - 2013. - Vol. 5 (2). - P. 70-80.

4. Maull D.J., Grayson B.H., Cutting C. B., Brecht L. L., Brookstein F. L., Khorrambadi D., Webb J. A., Hurwitz D. J. Long term effects of Nasoalveolar molding on three dimensional nasal shape in unilateral clefts // Cleft palate Craniofac J. - 1999. - Vol. 36 (5). - P. 391-397.

5. Yang S., Stelnicki E.J., Lee M.N. Use of nasoalveolar molding appliance to direct growth in newborn patient with complete unilateral cleft lip and palate // Pediatr Dent. - 2003. - Vol. 25 (3). -P. 253-256.

6. Grayson B.H., Santiago P.E., Brecht L.E., Cutting C. B. Presurgical nasoalveolar molding in infants with cleft lip and palate // Cleft Palate Craniofac J. - 1999. - Vol. 36 (6). - P. 486-498.

7. Grayson B.H., P. R. Presurgical nasoalveolar molding treatment in cleft lip and palate patients // Indian Journal of Plastic Surgery. - 2009. - Vol. 42. - P. 56-61.

8. Bennun R. D., Figueroa A.A. Dynamic Presurgical Nasal Remodeling With Unilateral and Bilateral Cleft Lip and Palate: Modification to the Original Technique // Cleft Palate-Craniofacial Journal. - 2006. - Vol. 43. - P. 639-648.

9. Grayson B.H., Maull D. Nasoalveolar molding for infants born with clefts of the lip, alveolus, and palate // Seminars in plastic surgery. - 2005. - Vol. 19, number 4. - P. 294-301.

10. Pfeifer T, Grayson B, Cutting C. Nasoalveolar molding and gingivoperiosteoplasty versus alveolar bone graft: an outcome analysis of costs in the treatment of unilateral cleft alveolus // Cleft Palate Craniofac J. - 2002. - Vol. 39. - P. 26-29.

11. McComb H. Primary correction of unilateral cleft lip nasal deformity: a 10-year review // Plast Reconstr Surg. - 1985. - Vol. 75. - P. 791-799.

12. Gutsan, A.E. Congenital clefts of the upper lip and palate, ed. doctor of medical sciences Botezatu G.A. / A.E. Gutsan. - Chisinau: STIINZA, 1980. - 144 p.

13. Rubezhova IS, Orthopedic and orthodontic treatment of patients with congenital cleft of the upper lip and palate in the conditions of the dispensary center: abstract. dis. Doctors of medical sciences. Leningrad, 1989.

14. Dubov M.D. Congenital cleft lip and palate. / M.D. Oaks. - Leningrad: MEDGIZ, 1960 .-- 144 p.

15. Gubskaya A.N. Secondary deformations of the maxillofacial region with congenital clefts of the lip and palate. / A.N. Gubskaya. - Tashkent: MEDICINE, 1975 .-- 103 p.

16. Proceedings of the enlarged plenary session and the 1st visiting session of the Central Scientific Research Institute of Scientific Research under the editorial board of authors. / Evdokimov A.I., Dmitrieva B.C., Rybakov A.I., Lurie T.M., Fomicheva E.U. - Moscow: MEDICINE, 1964 .-- 311 p. Lee S., Grayson B., Cutting C. The need for surgical columella lengthening and nasal width revision before the age of bone grafting in patients with bilateral cleft lip following presurgical nasal molding and columella lengthening. Scottsdale: American Cleft Palate-Craniofacial Association; 1999. In: Program and Abstracts of the 56th Annual Session of the American Cleft Palate-Craniofacial Association.

17. Lee C, Grayson B., Cutting C. The need for surgical columella lengthening and nasal width revision before the age of bone grafting in patients with bilateral cleft lip following presurgical nasal molding and columella lengthening. Scottsdale: American Cleft Palate-Craniofacial Association; 1999. In: Program and Abstracts of the 56th Annual Session of the American Cleft Palate-Craniofacial Association.

Claims (1)

A method of manufacturing a shaping nasal stent in patients with congenital malformations and acquired deformations of the maxillofacial region, including the manufacture of a reinforcing element, which is a steel round wire, with its subsequent bending, characterized in that the casts of the nasal passages and the external nose are obtained, moreover, a nasal impression moves are obtained by introducing into them a thermoplastic mass uniformly rolled on metal rods, and the impression of the outer nose - by applying a thermoplastic mass on the bony and cartilaginous parts of the external nose, no more than 10 seconds after the application of the thermoplastic mass, it is removed in a single block and immersed in water at a temperature of 5-10 ° C, then a gypsum model of the nasal passages and the external nose is obtained by mixing 320 g of gypsum powder with 100 ml of water; the section with the highest point of the nostrils located on it on the gypsum model is cut off so that with a unilateral congenital cleft of the upper lip and palate or acquired deformations of the maxillofacial region, the upper edge of the defect side is 1.5-2 mm higher than the healthy one, and with bilateral it is cut off with two sides not less than 2 mm; then the reinforcing element, which is a metal wire, is bent in the form of a ring with a circle equal to the width of the patient’s nose columella, and the ends of the metal wire are left free and of equal length, after which the ring is applied to the middle of the nose of the gypsum model’s columella, and the free ends of the metal wire are bent under right angle and injected into the nasal passages of the gypsum model with the possibility of maximum proximity to the nasal septum on the gypsum model, then the lumen of the nasal passages of the gypsum model is filled with dkoy plastic with subsequent polymerization, after which the resulting plastic preform is removed from the plaster model and then performing the preform vozduhoprovodyaschih through holes with a diameter as possible given that the wall thickness of the forming nasal stent is not more than 1 mm.

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