RU110966U1 - PLASTIC PLATE FOR FIXING INTRIOTIC ACCESS OF BREAKFAST IN THE AREA OF THE LOWER JAW - Google Patents

Abstract

 1. Plate for bone osteosynthesis of fragments in the region of the angle of the lower jaw, consisting of two fixing parts and an intermediate part, characterized in that the fixing parts are located in different planes at an angle of 140 °. ! 2. The plate according to claim 1, characterized in that one fixing part is 5 mm longer than the other. ! 3. The plate according to claim 1, characterized in that the intermediate part is located at an angle of 135 ° with respect to the distal part.

Description

The invention relates to medicine, namely to maxillofacial surgery and is intended for the surgical treatment of fractures of the lower jaw in the area of the angle by oral access.

A direct plate is known for osteosynthesis of bone fragments of the facial skeleton (1, 2).

The disadvantage of this plate is the complexity of intraoperative modeling when used in the treatment of intraoral access, the need to bend the plate in several planes at significant angles, which not only increases the time of surgery, but also creates the prerequisites for a fracture of the plate in the process of postoperative functioning.

Known L-shaped plates (1, 2, 4, 5), characterized by different angles of bending of the plate.

The disadvantage of these plates is the need to use buccal fixation, which creates additional trauma, the need to change the configuration of the plate during surgery.

The T-shaped and T-shaped double plates are known (1, 2). The disadvantage of these designs is the need to fix the plate in the immediate vicinity of the fracture gap, which can contribute to the development of postoperative suppuration of the bone wound in the fracture area, unstable fixation of fragments, loss of stability of the fixation structure in the postoperative period, and the mismatch of the shape of the plate of the anatomy of the lower jaw.

Known plate for maxillofacial surgery, which is an elastic flat shape with rounded corners. The plate may have a cruciform, T-shaped, triangular, rectilinear, arched shape, or the shape of a five-pointed star (3).

The disadvantage of the cruciform, triangular, arched and five-pointed plates is the inability to use them for intraoral fixation of fragments in the region of the angle of the lower jaw. The disadvantage of T-shaped, rectilinear plates is the need for their additional modeling, which leads to an increase in operation time and a weakening of the strength characteristics. In addition, it is often impossible to fulfill such a requirement as fixing the screws at right angles to the plane of the bone plate.

The closest analogue is the plate from the set for craniofacial surgery of the company Stryker (USA) (4). The plate has two locking arms with a length of 15 mm, located at an angle of 110 ° to the intermediate part, the length of which is 15 mm. The fixing parts are arranged in parallel planes. Each fixing part has two holes for the fixing screws.

The disadvantage of this plate is the need for additional modeling during the operation of the fixing parts and the intermediate part, the mismatch of the plate geometry with the anatomical features of the lower jaw angle region.

The purpose of creating a utility model is to ensure stable intraoral fixation of fragments in the region of the angle of the lower jaw without the need for additional significant modeling, delamination of the chewing muscle itself and the use of buccal fixation.

This goal is achieved in that the fixing parts are located in different planes at an angle of 140 °, one fixing part is 5 mm longer than the other, the intermediate part is located at an angle of 135 ° with respect to the distal part.

The utility model is illustrated by graphic material, which shows the proposed plate. Figure 1 shows a plate, a top view. Figure 2 is a plate, front view.

The proposed plate consists of locking arms 1 and 2 and the intermediate part 3. The distal locking arm 1 has a length of 15 mm, the medial locking arm 2 has a length of 20 mm. The planes of the fixing parts are located relative to each other at an angle of 140 °, while the medial shoulder 2 is located in the same plane with the intermediate part 3. On the distal shoulder there are two holes for the fixing screws 4 with a diameter of 2 mm each. Three holes of the same diameter are located on the medial shoulder. Both shoulders are connected by an intermediate part 3 10 mm long, located at an angle of 135 ° to the shoulders. The width of all elements of the plate is 5 mm, the thickness is 1 mm.

The plate is made of biologically inert titanium, characterized by sufficient mechanical strength.

The plate is used as follows.

After adequate pain relief is achieved, an incision is made along the pterygo-maxillary fold of the lower jaw with an extension of the incision along the transitional fold to the level of the 6th molar. Skeletonization and reposition of fragments is carried out. The plate is placed on the bone so that the distal shoulder 1 is located in the retro-molar space, and the medial shoulder 2 and the intermediate part are in the region of the oblique line of the lower jaw. Fixation by intraosseous self-tapping screws through holes 4 is carried out.

Clinical example 1.

Patient K., 30 years old, was admitted to the clinic at the Chelyabinsk Medical Center SamGMU in an emergency with a diagnosis of Bilateral open angular fracture of the lower jaw with displacement of fragments.

Upon receipt of a complaint of pain in the injured area, malocclusion, inability to eat, a feeling of crunching, clicking in the area of the lower jaw on the right and left when swallowing, turning the head.

According to the patient, he got injured in a fight with unknown two days ago. Consciousness did not lose, nausea, vomiting was not. He noted bleeding of the fracture area. There were no injuries to the craniofacial area.

The patient was examined by a neurologist; no acute pathology of the central nervous system was found. After laboratory examinations, a decision was made on the surgical treatment of the patient under intravenous and local anesthesia.

In the operating room, after adequate pain relief was achieved, an incision was made along the pterygo-jaw fold of the lower jaw on the left with an extension of the incision along the transition fold of the lower jaw to the level of 3.6 tooth. The mucous membrane, submucosal layer, periosteum were dissected, fragments standing in a vicious position were skeletonized. Tooth 3.8 was removed about three years ago due to exacerbation of chronic periodontitis. After revision and rehabilitation of the fracture gap, the fragments under the control of the bite are repaired, in the correct position are fixed with a plate of our design and four intraosseous screws. The distal retaining arm 1 is laid down in the retro-molar region and fixed with two screws. Also, with two screws, through the medial and distal openings 4, the medial shoulder 2 is fixed along the external oblique line of the lower jaw. The stability of the fragments is achieved. After antiseptic treatment, the wound is sutured with a continuous suture from a polypropylene thread.

Similarly, an operation was performed from the opposite side.

As a result of the operation, the mobility of the fragments was eliminated, the bite was restored. In the postoperative period, a traditional treatment regimen was used. The postoperative period was uneventful. On the tenth day, the sutures were removed, the patient was discharged for outpatient monitoring.

Clinical example 2.

Patient D., 42 years old, was admitted to the clinic ChLH SamGMU with a diagnosis of Post-traumatic deformity of the lower jaw on the right in the corner.

Upon receipt of a complaint about the impossibility of chewing food due to malocclusion, facial asymmetry.

I got injured in an accident about six months ago. I was treated at the Department of Neurosurgery with a diagnosis of CCI. Bruise of the brain. After a rehabilitation course, surgical treatment is recommended in a specialized department of maxillofacial surgery.

On examination: the face is somewhat asymmetric due to deformation of the lower jaw. Opening the mouth is limited to two centimeters, the bite is broken, open. Fragments are motionless, palpation is painless.

After examination by a neurologist, CT scan of the bones of the facial skeleton, a decision was made to conduct surgical treatment of the patient under endotracheal anesthesia.

In the operating room under anesthesia, an intraoral incision was made as described above. Fragments fused together in a vicious position were skeletonized. An osteotomy of the lower jaw along bone marrow was performed. Fragments of the lower jaw under the control of the bite are repaired and fixed as described above. The wound after antiseptic treatment is sutured with a continuous suture with polypropylene thread.

As a result of the operation, the asymmetry of the patient’s face was completely eliminated, malocclusion was eliminated. The postoperative period was uneventful. The patient was discharged from the hospital on the tenth postoperative day after removal of the sutures.

The proposed plate is simple in design and use, reliable in functional terms, allows for stable fixation of fragments in the region of the angle of the lower jaw by intraoral access, without the use of additional buccal incisions and punctures, without damaging the masset of masticatory muscles, which reduces the time of surgery and the time of postoperative rehabilitation the patient.

The plate is possible and appropriate to use in the activities of the departments of maxillofacial surgery of medical institutions.

INFORMATION SOURCES:

1. Instruments and implants for surgery from titanium: catalog. - M., ZAO "Konmet", 2000. - p. 7-10.

2. Komelyagin D.Yu., Roginsky VV Set of titanium implants for craniofacial facial osteosynthesis: a guide for use. - M., ZAO "Konmet", 2001. - 18 p.

3. Aleshin N.A. Plate for maxillofacial surgery. A.S. No. 77539. - 2007.

4. Stryker catalog

5. Deltex: Company profile. Sterile osteosynthesis system for craniomaxillofacial and oral surgery. - London, Deltex, 2010.

Claims (3)

1. Plate for bone osteosynthesis of fragments in the region of the angle of the lower jaw, consisting of two fixing parts and an intermediate part, characterized in that the fixing parts are located in different planes at an angle of 140 °. 2. The plate according to claim 1, characterized in that one fixing part is 5 mm longer than the other. 3. The plate according to claim 1, characterized in that the intermediate part is located at an angle of 135 ° with respect to the distal part.