RU1805917C - Method of treatment for maxiliofacial fractures - Google Patents

Abstract

Usage: in medicine, namely in maxillofacial surgery. The purpose of the invention is to shorten the operation time. The essence of the invention lies in the fact that the fixation of bone fragments is carried out by intrabat access by applying the staples directly to the soft tissues of the oral cavity without dissection, with the staples placed intracostally and the shoulders of the staple on the periosteum. An advantage of the invention is in improving functional results.

Description

The invention relates to medicine, specifically to maxillofacial surgery and can be used in traumatology, orthopedics, otorhinolaryngology and relates to methods for treating jaw fractures to restore their anatomical integrity, preserve chewing, breathing, speech formation function and shorten the time of surgery.

The purpose of the invention is to reduce the time of surgery, fixation of bone fragments is carried out by oral access by applying staples directly to soft tissues of the oral cavity without dissection, with staples placed intracostally and the shoulders of the staple on the periosteum.

This goal is achieved by the fact that the reposition and fixation of bone fragments is carried out by oral access, by applying staples directly to soft tissues of the oral cavity without dissection, with the legs of the staples placed intracostally into the drilled transmucosal bone canals, and the shoulders of the staples lying on

mucous membrane, located on the periosteum, by sequentially immersing them in the maxillary soft tissues due to compression created by the bracket. The effect obtained with this method of treating jaw fractures can significantly reduce the time of surgery and simplify surgical intervention by reducing the volume, minimal anesthesia, less trauma to soft tissues without a pronounced disturbance of lymph and blood supply. A reduction in the duration of the hospital period for treating patients with jaw fractures is achieved by reducing the time of hospitalization of patients, due to the absence of an operative wound that does not require removal of sutures and other procedures, such as dressing, and the beginning of early outpatient treatment of patients.

The essence of the method is as follows.

Under local anesthesia, bimanual bone fragments are repaired to the anatomically correct position, which verifies

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matching teeth to bite. If there is a tooth in the fracture line, it is removed, the hole and the damaged mucous membrane are sutured tightly. Based on the analysis of radiographs and clinical data, 1.5 cm indent from the fracture line, transmucosal bone milling holes are made perpendicular to the bone surface. A device with a shape memory effect. In the form of a bracket, it is cooled in refrigerant, its shoulders are parted to the distance corresponding to the distance between the holes in the bone fragments, the legs of the bracket are parted 90 ° to the shoulders of the bracket. After the manipulations, the legs of the staple are inserted into the prepared holes, while the shoulders of the staple are firmly pressed against the mucous membrane. Under the influence of the body temperature to which the bracket is heated, the legs and shoulders of the staples tend to their original, predetermined position, while the legs are jammed in the bone holes, creating transverse compression, and the staple shoulders, in turn, create longitudinal compression, tightening the bone fragments to each other along the fracture line. Thus, in the early postoperative period, the legs of the fixation device are intraosseous, and the shoulders are located on the mucous membrane, subsequently, the shoulders of the device are cut through the maxillary soft tissues and immersed to the bone, due to the compression effect of the device. Due to the physiological characteristics of the mucous membrane, its epitalization subsequently takes place in a short time. Monitoring the state of bone fragments and the course of reparative processes in the bone is carried out using x-ray methods.

An example of a specific implementation of the method of treating a fracture of the lower jaw: Patient., 49 years old No. of medical history 2613 was admitted to the clinic of maxillofacial surgery, Clinical Hospital No. 1, Novokuznetsk, where, after the examination, the diagnosis was made: a fracture of the lower jaw along the 6 damaged tooth on the left, with displacement of bone fragments (Fig. 5, a - x-ray of the lower jaw on the left, the patient upon admission), bruise and hematoma of soft tissues of the face. In urgent order, the patient underwent an operation osteosynthesis according to the proposed method. During surgery, the following techniques were performed:

1. Conducting anesthesia according to Weissblat on the left. (A solution of novocaine 2% - 10.0 ml.), ..

2, Removal of the roots of the 6th tooth, revision of the bone wound with antiseptic treatment and subsequent suturing of the tooth socket with catgut.

3. Bimanual reposition of bone fragments and verification of their correct standing by comparing the teeth of the upper and lower jaws in the bite.

4. Application of transmucosal bony milling canals in opposite bone fragments, at a distance from each other, corresponding to the dimensions of the deformed staple in the cold head.

5. Installing a device with memory 5 in the form of a bracket for compression osteosynthesis. .

6. Fixation of bone fragments with a shape-memory bracket, for which the legs of the staple can be inserted into the prepared transmucosal milling channels in the bone tissue, and the shoulders are pressed firmly against the mucous membrane with a finger for 30-40 s, while fixation is carried out by shape memory effect.

7. Control of reposition and fixation of oblique fragments of the lower jaw by repeated matching of teeth in the bite.

Directly in the postoperative period was examined radiologically. On the radiograph No. 3649, patient B,

0 after surgery, the cost of bone fragments is quite satisfactory, the brace is at. the correct position. Additional immobilization was not carried out. Upon external examination, the braces of the bracket lie on the mucous membrane, the surrounding mucous membrane is calm, there is no mobility of fragments, outside. there is no malocclusion. By the end of the 2nd day, a similar picture is preserved; upon examination, the braces of the braces are immersed in the maxillary soft tissues and are not visually detected in the oral cavity. On the 7th day, when examining soft tissues, the mucous membrane at the place of insertion of the staple is epithelized, visually no staple is seen in the oral cavity, there is no mobility of fragments, the bite is preserved. On the 8th day, a large one was discharged for outpatient aftercare in the rehabilitation room of the dental clinic.

0 Form of invention

A method of treating jaw fractures by reposition and fixation of fragments using a staple, characterized in that, in order to reduce the time of surgery.

5, bone fragments are fixed by intraoral access by applying staples directly to soft tissues of the oral cavity without cutting them, with staples placed intraosseously and the shoulders of the staples on the periosteum.