RU1819575C - Sagittal split osteotomy method - Google Patents

Abstract

Usage: in medicine, namely in dentistry. The purpose of the invention is to reduce complications. The essence of the proposal is that the incision is made in an oblique direction above the front edge of the lower jaw branch, soft tissues and the neurovascular bundle are moved away from the jaw, an internal cortical plate is cut through the wound above the mandibular foramen from the posterior to the front edge of the jaw branch, completely peel the internal pterygoid muscle and move it forward by the amount of shift of the lower jaw. The advantage of the proposal is to improve functional results. 1 ill.

Description

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The claimed invention relates to medicine, namely to surgical dentistry, and can be used for the surgical treatment of lower prognathism. as well as lower retrognathia.

An object of the invention is to reduce complications.

 The drawing shows a device that implements the proposed method.

With a wide open mouth, a cut of the mucous membrane is made 2.5-3 cm long above the front edge of the jaw branch (a, b) from the inner surface of the coronoid process obliquely down to the upper part of the outer line to the level of the alveolar process. If the incision is less than 2.5 cm, the wound visibility worsens and bone dissection is more difficult to perform, and if the incision is more than 3 cm, soft tissue is unnecessarily injured. The soft tissues above the mandibular foramen together with the neurovascular bundle exfoliate and move away from the inner surface

branches of the lower jaw. The internal cortical plate and part of the cancellous bone of the bone are horizontally dissected above the mandibular opening from the posterior to the front edge of the lower jaw branch, and then down to the level of the third molar between the temporal crest and the front edge of the branch and parallel to this edge, connecting the cuts on the branch and body of the jaw made through an external wound. The horizontal cut is made almost to the depth of the outer cortical layer. The wound in the oral cavity is sutured with catgut.

Through the external wound, a thin wide chisel inserted into the lower bone cut and directed outside from the neurovascular bundle splits the jaw branch into the external and internal fragments so that the bit extends into a horizontal branch cut made through the wound in the mouth. At the same time, the maximum possible area is obtained.

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no jaw fragments. The body of the lower jaw moves a certain distance back. Excess bone sections along the anterior edge of the external fragment and the posterior edge of the internal fragment of the jaw are removed by boron. At the same time, the corners of the lower jaw are shaped correctly. Osteosynthesis of jaw fragments is performed with a wire suture. The internal pterygoid muscle is moved forward by a distance equal to the posterior shift of the lower jaw and is sutured together with the chewing muscle to the corner of the jaw (i. The wound is sutured in layers.

The proposed method facilitates and accelerates the technical execution of the stage of dissection of the inner cortical plate of the jaw branch above the mandibular foramen, prevents damage to the neurovascular bundle of the jaw in an unplanned place, and improves the conditions for fixing and fusion of jaw fragments.

A comparative analysis with the prototype shows that the claimed method is different. It is obtained from the known method in that an additional incision is made in the oral mucosa, through the wound into the bone, a bone is cut above the neurovascular bundle and a bone along the front edge of the jaw branch. The internal pterygoid muscle is completely exfoliated and moves forward by the amount of shift of the lower jaw. Thus, the claimed method meets the criteria of the invention. Novelty.

When comparing the known method of osteotomy of the branch of the lower jaw with the proposed method, it was found that the latter has significant advantages, consisting in a simpler and more reliable dissection of the bone over the neurovascular bundle and along the front edge of the branch of the lower jaw, in reducing the risk of damage to the vascular nerve bundle, in more accurate splitting of the branch into two fragments without the risk of its fracture in an unplanned place, in the possibility of obtaining the maximum area of bone wounds, which contributes to more quick and lasting fusion of jaw fragments. Complete detachment of the internal pterygoid muscle and its forward movement by the amount of shift of the lower jaw eliminates the action of the muscle that pushes the jaw forward, and thereby reduces the risk of disease recurrence. However, an additional incision in the mouth, facilitating and accelerating the dissection of the bone above the bundle and along the front

edge of the jaw branch, reduces the operation time by 10-15%. When studying other known methods of osteotomy of the lower jaw, the features that distinguish the claimed invention from the prototype were not detected, and therefore they provide this method with the criterion of Significant differences.

The drawing shows a cut line

in the mouth (a), a line for dissecting the bone through the intraoral wound (b) and moving the pterygoid muscle forward (c).

Example 1. The history of the disease 3794.

05/10/08. A.S., 20 years old. Diagnosis: lower drive. Operation (05.27.88): bilateral sagittal osteotomy of the angles and branches of the lower jaw. A typical submandibular incision was made, partially exfoliated.

masticatory muscle and completely internally pterygoid, cortical plate dissected along the posterior, lower, and outer edges of the angle and branch. An incision was made 3 cm long on the mucous membrane of the mouth over

the front edge of the lower jaw branch and the cortical plate above the neurovascular bundle and inward from the front edge of the jaw is dissected. The wound in the mouth was sutured with catgut. Through the external wound divided

branch and angle of the jaw into two fragments. Similar stages of the operation are done on the other side of the jaw. The body of the lower jaw is displaced backward by 11 mm. Excess bone was removed from jaw fragments, wire sutures were applied. The internal pterygoid muscle is displaced forward by 11 mm and sewn to the corner of the jaw along with the chewing muscle. External wounds sutured. After the operation, there were no complications, after 50 days,

after 8 and 22 months after the operation, there are no signs of sensitivity disturbance in the area of the lower alveolar nerve, there is no relapse of the disease, the aesthetic result of the operation is good.

Medical history 4361. 05/30/88. Sh.A., 18 years old. Diagnosis: lower degree I prognosis, cross bite. Operation (06/03/88): sagittal osteostomy of the angle and lower jaw branch on the right. Operation

performed exactly according to the method described in the previous clinical example. The postoperative period was uneventful; there were no disturbances in sensitivity in the lower alveolar region. 13 months after the operation, the aesthetic result of the operation is good, there is no relapse of the disease.

Medical history 5890. 08/01/89. M.YOM is 20 years old. Diagnosis: lower prognosis, upper micrognati. Operation (11.08.89): bilateral sigattal osteotomy of the angles and branches of the lower jaw. The steps of the operation are as described in the first example of clinical use. There were no complications in the postoperative period. The result of the operation is good. After 8 months after surgery, there is no recurrence of the disease. Compared with the base object of the present invention has the following advantages:

1) reduced operation time;

2) bone dissection is simplified on the inside and along the front edge of the jaw branch;

3) cleavage of the jaw branch into two fragments is facilitated;

4) the risk of damage to the neurovascular bundle is reduced;

5) jaw fragments grow faster and more firmly;

6) the risk of disease recurrence is reduced.

Claims (1)

SUMMARY OF THE INVENTION Method for sagittal osteotomy of carbohydrates and branches of the lower jaw by submandibular incision, splitting of the branches of the inner and outer fragments, displacement of the jaw body, excision of excess bone on the jaw fragments, characterized in that, in order to reduce complications of the mucous membrane of the oral cavity, the incision is performed in the oblique direction above the front edge of the lower jaw branch, soft tissues and the neurovascular bundle are moved away from the jaw, an internal cortical plate is cut through the wound above the mandibular opening With a hole from the back to the front edge of the jaw branch, the internal muscle is completely peeled off and it is moved forward by the amount of shift of the lower jaw.