RU105151U1 - METHOD FOR EXTRA-FOCAL-ROD OSTEOSYNTHESIS IN Upper Jaw Fractures ACCORDING TO THE LE-FORA-GEREN TYPE - Google Patents

Abstract

 Set for extra-focal-rod osteosynthesis in case of fractures of the upper jaw according to the LE-FOR-GEREN type, including a circular support, fixing a gypsum cap with two devices for fastening in the left and right temporal bones, an extraoral fixation device Zbarzha with fixation in the area of the neck of the ligature teeth wire, four connecting rods with metal clips, Vasiliev’s teeth and interdental rubber rods, characterized in that the system includes four additional remote rods, and erednyaya outrigger rod ends at the middle of the body of the zygomatic bone and the back at the level of the tragus of the outer ear, as well as two additional titanium rod for fixing to the front metal rods external retainers.

Description

The invention relates to medicine, in particular to maxillofacial surgery, can be used to provide assistance to victims, both with an isolated facial skeleton injury, and with combined injuries in the practice of disaster medicine, in the system of staged treatment of the wounded, as well as in trauma centers of various level.

A fracture of the upper jaw according to the LeFore-Guerin type is characterized by the fact that the fracture lines of the maxillary bones pass both in the horizontal and in the sagittal plane. More often represented by a combination of fractures of the upper jaw of the lower and middle types (Fig. 1).

The most commonly used methods are orthopedic: Fixation of fractures of the upper jaw with an extraoral fixation device by Y.M. Zbarzha and a modification of P.Z. Arzhantsev. The essence of the method is the reposition of fragments of the upper jaw on the splint - an arch that is fixed in the area of the necks of the teeth with ligature wire. Then put a supporting cotton fabric headband, after which the fragments are compared and fix the tire - the arc to the headband on 4 connecting rods.

Surgical and orthopedic: the Fiederspiel method of 1934 involves fixing a tooth splint fixed to the upper jaw to the head gypsum cap (with hook loops) using a thin stainless steel wire drawn through the thickness of the soft tissues of the cheeks. Steel wires are fixed at one end to the hook loops on the maxillary splint, and at the other with rubber rings (worn on wire hooks) to the arc on the head cap. By moving the hooks on the arc and thus changing the direction of the rubber traction, fragments of the upper jaw can be repaired at its most varied displacements.

The main disadvantages of the above methods is the inability to accurately reposition and correct bone fragments; the risk of secondary displacement of fragments with iatrogenic damage to the organ of vision; the need for repeated reconstructive operations due to persistent deformations of the facial skeleton; do not take into account the possibility of spiral computed tomography of damage to the facial skeleton.

Closest to the proposed solution are the used methods of extra focal osteosynthesis and fixation of bone fragments in fractures of the upper jaw using Kirschner spokes according to the method of M.A. Makienko in 1968 and fixation of fragments according to the Fidershpilya method of 1934, an apparatus for extraoral fixation of Y.M. Zbarzha (Field surgery: National leadership / under the editorship of I.Yu. Bykov, N.A. Efimenko, E.K.Gumanenko. - Moscow: "GEOTAR", 2009 - S.816 / 474-504 ; Military dentistry: textbook / under the editorship of G.I. Prohvatilov. - St. Petersburg: VMA, ELBI - St. Petersburg, 2008. - S.350-352.)

The disadvantages of existing techniques: the impossibility of accurate reposition of bone fragments (especially with "pressed" fractures) in the process of osteosynthesis and correction of the position of the fragments (static) after completion of osteosynthesis; a high probability of secondary displacement of fragments with iatrogenic damage to the organ of vision and the need for repeated reconstructive operations; do not take into account the results of spiral computed tomography of damage to the facial skeleton.

The aim of the invention is to increase the effectiveness of the treatment of fractures of the upper jaw by eliminating the disadvantages inherent in standard methods.

This goal is achieved by the fact that in the method of extra-focal-rod osteosynthesis for fractures of the upper jaw according to the type of LE-FOR-GEREN performed by applying a circular gypsum support cap with two extension rods to the arch of the skull for fastening in the left and right temporal bones, in intact bodies of the zygomatic bones are drilled holes into which are inserted titanium rods with a diameter of 3 mm, a length of 60 mm with a length of the section containing the thread, 15 mm, with their subsequent fixation to the front extension bar (figure 2), the tire of the extra-oral fixation device Zbarga with fixation in the area of the neck of the teeth with a ligature wire, as well as fixation of the toothbrush to the posterior extension rods of the circular gypsum support cap and to two titanium rods inserted into the bodies of the zygomatic bones by means of metal beams and retainers, followed by interdental fixation the imposition of interdental rubber rods on the hook loops of Vasiliev's tooth tires (Figs. 3, 4), preliminarily carry out diagnostics using computed tomography, then the devices are performed To mount in the form of two extension rods, the front outrigger rod ends at the middle of the body of the zygomatic bone and the back at the level of the tragus of the external ear; Before applying the tire of the extraoral fixation device Zbarg in the intact bodies of the right and left cheek bones, holes are drilled into which titanium rods are inserted, which are fixed to the front extension rods with metal clips.

The invention is illustrated figure 1-5. Figure 1 shows the nature of the fracture of the upper jaw type LeFore - Guerin; figure 2 presents the first stage of applying the supporting circular gypsum cap on the cranial vault with its subsequent fixation to the zygomatic bones; figure 3 and 4 presents the final view after fixing the fracture of the upper jaw in a direct and lateral projection. Figure 5 presents the tire of the apparatus of extraoral fixation Rudko.

Extra-focal rod osteosynthesis is performed as follows: for the victim, in order to clarify the nature of the lesions and draw up a surgical intervention plan, perform a spiral computed tomography of the facial skeleton with subsequent reconstruction in DDD mode.

Before performing extra focal osteosynthesis, Vasiliev's teeth (not shown) are superimposed on the upper and lower jaws.

First step. A circular supporting gypsum cap 1 with two extension rods 2 is applied to the cranial vault in the region of the left and right temporal bones. The front extension bar 2 ends at the level of the mid-body of the zygomatic bone, the posterior at the level of the tragus of the outer ear. In the intact bodies of the zygomatic bones, which serve as a “supporting platform” for osteosynthesis, holes are drilled with a mini-drill D - 2.1 mm, into which titanium rods 3 are subsequently inserted with a diameter of 3 mm, a length of 60 mm and a length of a section containing a thread of 15 mm. The rods 3 are fixed to the front extension rods 2 with metal clips 4.

Second phase. The tire of the extraoral fixation device Rudko 5, shown in Fig. 5, is superimposed on the upper jaw, which is fixed in the region of the necks of the teeth with ligature wire. With an insufficient number of teeth on the upper jaw less than 6 (3 in the intervals from 1.1-1.5 to 2.1-2.5), an arch for soft palate is made on an arc of rapidly hardening plastic (protocryl material).

The third stage. The splint is fixed to the rear extension rods 2 of the circular supporting gypsum cap 1 on the 2 connecting beams 6 by means of metal clips 4, in the front section the tire is fixed to the mini-rods 3 inserted into the zygomatic bones on two metal beams 6 by means of metal clips 4.

At the end of extrafocal osteosynthesis, interdental fixation is performed in the orthognotic bite by applying interdental rubber rods to the hook loops of Vasiliev's teeth.

This technique provides a rigid controlled fixation of fragments of the middle zone of the facial skeleton, prevents secondary displacement of fragments and prevents secondary damage to the organ of vision, reduces the number of infectious complications and improves functional and cosmetic treatment results.

Claims (1)

Set for extra-focal-rod osteosynthesis in case of fractures of the upper jaw according to the LE-FOR-GEREN type, including a circular support, fixing a gypsum cap with two devices for fastening in the left and right temporal bones, an extraoral fixation device Zbarzha with fixation in the area of the neck of the ligature teeth wire, four connecting rods with metal clips, Vasiliev’s teeth and interdental rubber rods, characterized in that the system includes four additional remote rods, and erednyaya outrigger rod ends at the middle of the body of the zygomatic bone and the back at the level of the tragus of the outer ear, as well as two additional titanium rod for fixing to the front metal rods external retainers.