RU1799551C - Method for treating lower orbital region - Google Patents

Abstract

Usage: in medicine, namely in maxillofacial surgery. The purpose of the invention is to restore the innervation of the infraorbital region. The essence of the proposal consists in the decompression of the infraorbital nerve by isolating it with a groove of porous titanium nickelide, the walls of which are fastened to the bone fragments with shape-memory alloy brackets. The advantage of the proposal is to improve functional results. 5 ill.

Description

The invention relates to medicine, in particular to maxillofacial surgery, and can be used in ophthalmology, plastic surgery.

The purpose of the invention is the restoration of trophic tissue of the infraorbital region.

The goal is achieved in that when implementing the method of treating a lower ocular fracture, consisting in a skin incision in the region of the lower eyelid, reduction and fixation of bone fragments, a skin incision is made along the ciliary edge of the lower eyelid, the infraorbital nerve is decompressed by isolating it from surrounding tissues using a groove of porous titanium nickelide, fix fragments in the region of the lower orbital margin with nickel titanium brackets with shape memory.

The materiality and novelty of the characteristics, as well as the reliability of the achievement of the set goal, is confirmed by the following.

Performing a skin incision along the ciliary edge allows access to the infraorbital foramen and

audit the proximal infraorbital canal.

The formation of a destroyed infraorbital foramen and infraorbital canal with a shaped implant made of porous titanium nickelide eliminates compression of the lower orbital nerve. The porous structure of the implant creates the conditions for the growth of connective tissue into the implant, which ensures its stable fixation for the subsequent period.

The porous structure, ensuring uniform growth of connective tissue into the implant, eliminates, as shown by numerous experiments, the possibility of the formation of a fibrous capsule on the inner surface of the implant. Thus, secondary irritation of epineuris does not occur. In addition, the implant prevents the growth of fibrous tissue into the epineuria during the formation of secondary bone marrow.

Fixation of bone fragments with brackets of titanium nickelide, due to the shape memory effect, creates a constant clamp of wound surfaces and provides

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monthly fixation during the healing process. The use of a fixing device made of other metal leads to the formation of a thermocouple and the effect of galvanism in the tissues. Therefore, the use of single metal structures is a prerequisite.

Conformity of the proposed method to the criterion of creatures. the differences are due to the fact that the authors are not aware in the existing technical solutions of the use of a groove made of porous titanium nickelide to isolate the lower ocular nerve from surrounding tissues,

In FIG. 1 shows a cut line along the ciliary edge of the lower eyelid; in FIG. 2 - implants, with the help of which the isolation of the lower orbital nerve from the surrounding tissues is performed; in FIG. 3 - brackets of titanium nickelide used to fix implants and bone fragments; in FIG. 4 is a diagram of an operation in the frontal plane after implant placement; in FIG. 5 is a general view of the zygomatic-ocular fracture after decompression of the lower orbital nerve and fixation of bone fragments.

The method is carried out as follows. A skin incision is made (1) along the ciliary edge of the lower eyelid (Fig. 1). The underlying tissues are dissected strictly in the subcutaneous layer so as not to injure the vessels and the tarsal plate. Fragments are skeletonized in the region of the lower orbital margin. The periosteum is exfoliated to the level of the infraorbital foramen, the nature of the fracture is determined, the degree of compression of the inferior ophthalmic nerve 5, and the proximal part of the infraorbital canal is revised. Further tactics regarding the stage of decompression of the inferior ocular nerve are determined by the topographo-anatomical features of this area. Two clinical options are distinguished (Fig. 4).

In the first embodiment, when the proximal part of the infraorbital canal is clearly defined and the infraorbital nerve is affected by the bone walls of the latter, milling holes are drilled at the ends of the fragments in the plane of the inferior orbital nerve. The fragments are moved apart, an implant of porous titanium nickelide is introduced into the infraorbital canal in the form of a groove 2, which is fixed with mini brackets 4. Bone fragments are fixed with titanium nickelide brackets with shape memory (Fig. 5). The second option. Only the superior arch of the proximal infraorbital canal is determined topographically.

The inferior orbital nerve is suspended, as it were, and at the exit of the facial skull it is restrained by the walls of the infraorbital foramen. On both sides of the infraorbital foramen

a thin cortical plate is removed, two milling holes are drilled at the ends of the fragments.In accordance with the size of the bone defect and the diameter of the lower orbital nerve, an implant 3 is formed from the plate of porous titanium nickelide, which is placed into the bone bed after reposition of bone fragments and fixed with nickel-titanium brackets ( Fig. 4). The wound is washed with antiseptics, sutured in layers and drained.

Clinical example. Patient L., 13 years old, was admitted to the clinic on July 18, 88 with a diagnosis of traumatic deformity of the cheek-eye complex on the left, enophthalmos,

traumatic lesion of the lower orbital nerve. 07/26/08, under general anesthesia, an operation was performed: refraction and osteosynthesis of the zygomatic-orbital complex, plastic surgery of the lower wall of the orbit, decompression of the lower orbital nerve by isolating it from surrounding tissues using a groove made of porous titanium nickelide. The postoperative course is smooth, wound healing by primary intention. After 5

weeks after surgery, the restoration of pain and tactile sensitivity of the tissues of the infraorbital region was achieved.

The effectiveness of the proposed method for the treatment of lower orbital

The 5th fracture consists, in addition to the advantages claimed by the object of the invention, in creating more optimal conditions for the course of reparative processes in the nervous and bone tissue due to the decompression stage and stable fixation. Stable fixation of bone fragments in the postoperative period, due to others. 5 connecting the implant with the bone and thermomechanical memory of the brace is the prevention of secondary displacement and the formation of deformations of the facial skull. The element of physiological surgery in relation to the infraorbital nerve can reduce the time of inpatient treatment and thus improve the rehabilitation system of trauma patients.

Claims (1)

SUMMARY OF THE INVENTION A method for the treatment of inferior ocular fracture by cutting the skin in the eyelid, repositioning the bone fragments and fixing them with metal brackets, characterized in that, in order to restore the innervation of the infraorbital region, the infraorbital decompression is performed by isolating it with a groove from it, they will be fastened with bone fragments of brackish titanium nickelide, the walls of which are made of a shape-memory alloy. FIG. 1 FIG. 3