RU181723U1 - TWEEZERS FOR PREVENTION OF THE VASCULAR-NERVOUS BEAM OF THE LOWER JAW WITH ITS TRANSPOSITION AND WITH THE LATERALIZATION OF THE LOWER ALVEOLAR NERVE - Google Patents

Abstract

The utility model relates to medical equipment, namely to surgical instruments, in particular, to instruments and devices used in surgical dentistry for transposition of the neurovascular bundle of the lower jaw and lateralization of the lower alveolar nerve for placement of dental implants or for removal of filling material from the mandibular canal. Tweezers for the protection of the neurovascular bundle of the lower jaw during its transposition and lateralization of the lower alveolar nerve contains two rigidly united spring jaws diverging at an angle of 30 ° in the form of metal strips with a groove in the middle, connected together in one fixed end. The distal part of one of the branches, tapering in the form of a cone is equipped with two processes, is curved in the frontal plane in the form of a semi-ellipse and is equipped with a slot. The distal part of the second straight jaw narrows in such a way that during compression it forms tight contact with the inner surface of the processes. The technical result of using the proposed utility model is to increase the efficiency of surgical intervention for transposition of the neurovascular bundle of the lower jaw and lateralization of the lower alveolar nerve. 3 ill.

Description

The utility model relates to medical equipment, namely to surgical instruments, in particular, to instruments and devices used in surgical dentistry for transposition of the neurovascular bundle of the lower jaw and lateralization of the lower alveolar nerve for placement of dental implants or for removal of filling material from the mandibular canal .

In order to protect the neurovascular bundle of the lower jaw from damage during the installation of dental implants or when removing the filling material from the mandibular canal, instruments that are not convenient enough for this are currently used, which complicates the course of the operation and does not exclude the possibility of surgical injury.

From the prior art, a grooved probe is known - a metal strip with a groove and blunt edges, passing into an expanded plate with a slot in the middle. The grooved probe is used to protect against damage with a scalpel to deeper tissues during dissection of lamellar anatomical formations (fascia, aponeurosis, nerve).

Disadvantages: the device of the grooved probe does not allow to keep the neurovascular bundle of the lower jaw during lateralization of the lower alveolar nerve.

Volkman’s blunt hooks are known, which are a surgical instrument in the form of a fork, the teeth of which (sharp or blunt) are smoothly bent at an angle of more than 90 °, and the handle is equipped with a finger ring. Volkman's blunt hooks are designed to divert individual anatomical formations deep in the wound (vessels, tendons, nerves).

Disadvantages: stupid Volkman hooks do not allow reliable retention of the neurovascular bundle of the lower jaw during lateralization of the lower alveolar nerve, their device does not allow the manipulations necessary during surgical intervention (dissection of the connective tissue case, separation of blood vessels and lower alveolar nerve).

Billroth clamps are known - straight and curved, with notches on the lips, but without denticles, consisting of two branches connected by a screw that divides the branches into the working part (jaws) and the ring part. A step lock-cremallera near the rings fixes the clamp in a certain working position, provides compression of the vessel without the constant involvement of the surgeon's hands and allows you to adjust the strength of this pressure.

Advantages, disadvantages: Billroth clamps allow reliable fixation of the neurovascular bundle of the lower jaw during lateralization of the lower alveolar nerve, but do not allow manipulation with a clamped fragment of the neurovascular bundle.

(http://works.doklad.ru/view/Bgt78agMDyI.html Surgical Instruments. Classification of Surgical Instruments).

Known microsurgical tweezers, designed to delimit tissue when suturing the wound of the cornea and sclera, containing two springy branches with sponges and a tooth (USSR Author's Certificate for the invention SU 1326266 A1).

Advantages, disadvantages: Microsurgical tweezers allow you to grab and hold rather thin and delicate tissues, but do not allow you to manipulate a clamped fragment of the neurovascular bundle and does not protect it from operating injury.

Known tweezers-retainer containing spring-loaded jaws with working jaws, each having a longitudinal slot and a transverse groove on the inside, the longer working jaw being curved and its concave side facing the other jaw (USSR Copyright Certificate SU 1128942 A1).

Advantages, disadvantages: tweezers-retainer provides atraumatic retention of a nerve of any size, but does not allow to freely manipulate a clamped fragment of the neurovascular bundle, including making incisions, incisions, and does not protect it from a drill or physiological dispenser when installing dental implants on the lower jaw or when removing filling material from the mandibular canal.

The closest in essence and chosen as a prototype is vascular tweezers, an instrument consisting of two springing jaws for gripping and holding tissue for a short time during surgery and other manipulations (electronic resource of the Big Medical Encyclopedia http: //be.org/index.php/ Tweezers)

Tweezers consists of two plates, welded or riveted at one end, from which the working branches (branches) of the tweezers diverge at a certain angle. The ends of the jaws (sponges) are the working part; they capture and hold a fabric or object. The tweezers jaws are tightly connected, so the lips converge without distortion. An important advantage of tweezers over the other tools listed above is that the force of action of the tweezers on the tissue is controlled by your fingertips and can be dosed.

Advantages of the prototype: vascular tweezers have a shorter thread and a longitudinal groove on one of the branches, which improves the conditions for holding the neurovascular bundle of the lower jaw. Vascular tweezers with narrow lips and a short (1.5-2.2 mm) thread can be used to sort the vascular walls.

The disadvantages of the prototype: vascular tweezers do not protect the neurovascular bundle of the lower jaw and surrounding soft tissue during surgical procedures necessary to prepare the bone bed when installing dental implants or when removing the filling material from the mandibular canal made using a drill or physiological dispenser, it is not recommended that they be held the neurovascular bundle for a long time due to excessive pressure that can cause tissue ischemia.

The technical problem solved by the proposed model is the development of tweezers to protect the neurovascular bundle of the lower jaw, which allows it to be held for a long time, put aside (transposition or lateralization), perform all the manipulations necessary during surgery, reliably protecting from operating injury without damage the freedom of manipulation with the help of a drill or physical dispenser when preparing the bone bed for the installation of dental implants or when removing the filling maxillary material from the mandibular canal.

The technical result from the use of the proposed utility model is to increase the effectiveness of surgical intervention for transposition of the neurovascular bundle of the lower jaw and lateralization of the lower alveolar nerve, increase the reliability and safety of surgical procedures associated with the installation of dental implants or removal of filling material (root sealant) from the mandibular canal made using a drill or physiospenser, allowing long-term manipulation and with the neurovascular bundle of the lower jaw without compression, minimizing the risk of surgical injury.

This result is achieved by the fact that in the forceps to protect the neurovascular bundle of the lower jaw during its transposition and lateralization of the lower alveolar nerve containing two rigidly connected springy branches, tapering in the form of a cone with a groove in the middle of the inner surface, the branches diverge at an angle of 30 °, the distal part of one of the branches is equipped with two processes, 5 mm long and 2 mm wide, located laterally at an angle of 60 ° to the length 5 mm from the end, curved in the frontal plane in the form of half the lime and is equipped with a 2/3 slot of its length 3 mm wide, and the distal part of the second straight branch narrows so that when compressed it forms a tight contact with the inner surface of the processes.

The utility model is illustrated by drawings, in which: in Fig.1 shows a pair of tweezers - side view; in Fig 2 - shows the distal part of the curved jaw with processes; on Fig 3 shows the distal parts of both branches in a closed state.

Tweezers to protect the neurovascular bundle of the lower jaw during its transposition and lateralization of the lower alveolar nerve contains (Fig. 1) two rigidly connected springy branches (1), diverging at an angle of 30 ° in the form of metal strips with a groove in the middle (2), connected together at one fixed end (3). The distal part of one of the branches, tapering in the form of a cone, is equipped with two processes (4), 6 mm long and 2 mm wide, located laterally at an angle of 60 ° to the length 5 mm from the end, curved in the frontal plane in the form of a semi-ellipse and provided with a slot (5) 2/3 of its length, 3 mm wide. The distal part of the second straight jaw narrows in such a way that upon compression forms tight contact with the inner surface of the processes (6).

The lateral processes (4) of the distal part of the curved jaw (Fig. 2) are located at an angle of 60 ° to the length plate at a distance of 5 mm from its end (7) and have a conical shape with flat side surfaces (8).

In the closed state (Fig. 3), the distal part of the curved jaw forceps forms a connection with the narrowed distal part of the straight jaw due to tight contact with the inner surface of the processes (9).

A comparative analysis of the features of the claimed solutions with the features of the prototype and analogues indicates the compliance of the claimed solutions with the criteria of "novelty" and "industrial applicability".

Tweezers to protect the neurovascular bundle of the lower jaw during its transposition and during lateralization of the lower alveolar nerve are used as follows.

During the operation, a bone window is formed on the lateral surface of the lower jaw with a dental cutter for access to the mandibular canal, its wall is opened with a spherical bur, making a longitudinal cut. After this, the selected neurovascular bundle is fixed with two thin tweezers, then it is captured by the developed tweezers, for which the distal part of the curved jaw is inserted into the mandibular canal, the whole bundle is withdrawn lateral to the mandibular canal, the connective tissue is dissected with a scalpel through a cut in the curved jaw, the probe separates the vessels and nerve, thereby weakening the tension of the allotted neurovascular bundle.

Then, from the side of the alveolar part of the lower jaw, with the help of a drill or a physiological dispenser, a bone bed is prepared for the installation of dental implants, dental implants are installed all their length until they come into contact with the bottom of the mandibular canal, and then the neurovascular bundle is fitted with the forceps developed in its new position lateral to the intraosseous surfaces of dental implants. The operation is completed by suturing.

The proposed tweezers can be used not only for the installation of dental implants, but also for other surgical interventions related to the transposition of the neurovascular bundle of the lower jaw and lateralization of the lower alveolar nerve, for example, to remove foreign bodies (filling material) removed during endodontic interventions through the root tooth canal in the mandibular canal.

It should be especially noted that the separation of the lower alveolar nerve and its accompanying vessels (artery and vein of the same name) by means of an atraumatic dissection of the connective tissue membrane with a scalpel through a slot in the jaw curved in the form of a semi-ellipse is important because it allows you to install a dental implant between the vessels and the nerve if necessary In addition, it allows you to remove even the smallest fragments of root sealants when they are removed into the mandibular canal at endodontic festivities on premolars and molars of the lower jaw.

The proposed tweezers were used during surgery: transposition of the neurovascular bundle of the lower jaw and lateralization of the lower alveolar nerve when dental implants were installed in 10 patients and 4 patients with neuritis of the lower alveolar nerve caused by the removal of filling material into the mandibular canal at the clinical base of the Department of Dentistry Federal State Budgetary Educational Institution of Higher Education "Stavropol State Medical University" Health Institute of Russia (FSBEI HE STMU of the Ministry of Health of the Russian Federation), dental clinics, limited liability company Research and Production Association Fitodent (LLC NPO Fitodent) and limited liability company Research and Production Association Apolonia (LLC NPO Apolonia), Stavropol.

The experience of using the claimed tool confirmed the persistent positive clinical effect of its use and the adequate transposition of the neurovascular bundle of the lower jaw and lateralization of the lower alveolar nerve when installing dental implants and when removing the filling material from the mandibular canal due to design features to avoid pressure and injury to blood vessels and nerve, ensuring their reliable fixation and the ability to perform the necessary surgical procedures throughout operations.

An example of a specific use.

Patient C, 55 years old, turned to the clinic of the Department of Dentistry, Federal State Budgetary Educational Establishment of Higher Education “Stavropol State Medical University” of the Ministry of Health of Russia with the goal of installing 3 dental implants in the lateral part of the lower jaw on the right. A preliminary diagnosis made on the basis of survey radiography and computer radiography: "partial secondary adentia of the lateral mandible on the right in the region of the extracted 35, 36 and 37 teeth", "the height of the alveolar part of the lower jaw over the mandibular canal is 4 mm, the height of the base of the body of the lower jaw under the mandibular canal in the area of the removed 35, 36 and 37 teeth -15 mm. "

The patient underwent surgery for lateralization of the lower alveolar nerve and transposition of the neurovascular bundle of the lower jaw to install 3 dental implants in the area of missing 35, 36 and 37 teeth. During the operation, to ensure lateralization of the nerve, as well as reliability and safety of fixation of the entire neurovascular bundle of the lower jaw during the formation of the receiving bone bed in the alveolar part of the lower jaw with the help of a physiological dispenser, we used developed tweezers, which allowed for long-term fixation of the neurovascular bundle of the lower jaw without squeezing it, minimizing the risk of operating injury.

The convenience and efficiency of using the developed tweezers due to its design features, including a slot in a jaw curved in the form of a semi-ellipse, through which the connective tissue membrane of the neurovascular bundle for subsequent lateralization of the lower alveolar nerve is confirmed, is confirmed.

The total duration of the operation was 2 hours 30 minutes. The postoperative period was uneventful. Electrophysiological studies of the skin in the region of the lower third of the face and lower lip on the right showed values indicating the absence of impaired blood supply and innervation, the electrical excitability of these zones was 35 and 28 μA, respectively (the indices of the non-operated side of the jaw were 35 and 30 μA, respectively). An X-ray examination 1 year after the operation on lateralization of the lower alveolar nerve and transposition of the neurovascular bundle of the lower jaw for the installation of 3 dental implants in the area of missing 35, 36 and 37 teeth showed that the process of osseointegration proceeds according to the osteoid type, indicators of electroexcitability of the facial skin in areas of the operated half of the lower jaw of patient S. are within the physiological norm (25-35 μA).

An example of a specific use.

Patient K., 35 years old, was sent from a private dental office to the clinic of the Department of Dentistry FSBEI HE "Stavropol State Medical University" of the Ministry of Health of Russia with a diagnosis of a foreign body in the mandibular canal and neuritis of the lower alveolar nerve caused by the removal of filling material (root sealant ) in the mandibular canal ”after an unsuccessful endodontic intervention for filling 46 teeth of the lower jaw on the left. A preliminary diagnosis made upon admission of patient K. is confirmed on the basis of an additional X-ray examination - survey radiography and computer radiography.

The patient underwent surgery to remove the filling material (root sealant) from the mandibular canal, which required the transposition of the neurovascular bundle of the lower jaw and lateralization of the lower alveolar nerve for a long time. All medical manipulations were carried out using the developed tweezers, which confirmed its high efficiency, allowing you to remove all fragments of root sealant intimately soldered to the connective tissue membrane of the neurovascular bundle. This result was obtained due to the design features of the developed tweezers, which significantly distinguish it from the prototype, including additional processes that allow atraumatic fixation and retraction of the neurovascular bundle and a cut in the jaw portion curved as a semi-ellipse through which fragments of root sealant were evacuated.

The total duration of the operation was 2 hours 20 minutes. The postoperative period was uneventful. Electrophysiological studies of the skin in the region of the lower third of the face and lower lip on the left, as well as the electroodontodiagnosis (EDI) of the pulp of the neighboring intact 45 tooth showed values indicating the absence of blood supply and innervation disturbances, the electrical excitability of these zones was 35, 25 and 8 μA, respectively (indices of the non-operated side jaws were 35, 30, and 6 μA, respectively).

Thus, the proposed tweezers for the protection of the neurovascular bundle of the lower jaw during its transposition and lateralization of the lower alveolar nerve provides reliable and safe fixation of the entire neurovascular bundle of the lower jaw without compression during surgical procedures performed using a drill or physiological dispenser, minimizing the operating an injury.

Information sources

1. Surgical instruments. Classification of surgical instruments http://works.doklad.ru/view/Bgt78agMDyI.html

2. USSR copyright certificate for the invention of SU 1326266 A1

3. USSR copyright certificate for the invention of SU 1128942 A1

4. The electronic resource of the Big Medical Encyclopedia http://bme.org/index.php/ Tweezers

Claims (1)

Tweezers to protect the neurovascular bundle of the lower jaw during its transposition and lateralization of the lower alveolar nerve, containing two rigidly connected springy branches, tapering in the form of a cone with a groove in the middle of the inner surface, characterized in that the branches diverge at an angle of 30 °, the distal part of one of the branch has two processes, 5 mm long and 2 mm wide, located laterally at an angle of 60 ° to the length, 5 mm from its end, curved in the frontal plane in the form of a semi-ellipse and provided with a slot 2/3 of its length 3 mm wide, and the distal part of the straight jaw narrows in such a way that when compressed it forms tight contact with the inner surface of the processes.

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