RU2113833C1 - Method of temporal immobilization of fragments at mandibular fractures and device for its implementation - Google Patents

Abstract

FIELD: medicine, surgical stomatology, traumatology. SUBSTANCE: method deals with applying belt casts with interrupted grooves along their length upon vestibular and lingual surfaces of mandibular teeth followed by their tight fixation to each other via interdental spaces with the help of metal dowels. EFFECT: higher efficiency to obtain improved fixation of fragments, more simplified method to be used at mandibular fractures beyond a dental row as constant curative immobilization of fragments. 2 cl, 3 dwg

Description

 The invention relates to medicine, namely to dentistry and traumatology, and can be used for reposition and fixation of fragments of the lower jaw with mass admission of patients.

 Numerous methods are known for temporarily immobilizing fragments of the lower jaw when standard slings or sling-like dressings are used that are fixed to the cranial vault and various types of wire interdental binding are combined with them [1, 2].

 Their common disadvantage is that they do not provide sufficient reposition and immobilization of fragments and this does not eliminate the pain syndrome during transportation, swallowing and speech; they function for a short time due to the significant load on the supporting teeth, require the presence of at least four pairs of stable teeth - antagonists of a good anatomical shape, quite laborious.

 Also known is the proposed Ivy ligature intermaxillary binding method [3], selected as a prototype. According to the prototype method, the ligature wire is doubled and twisting its free ends, make a loop at the inflection point. Then both free ends of the wire are inserted from the vestibular side into the interdental space and return them again on the eve of the oral cavity, covering each of them with an adjacent tooth. The free ends of the wire are twisted together, placing the twisted end of the wire with the interdental space next to the loop, closer to the occlusive surface of the teeth.

 The same ligature bandage is applied in the area of two teeth - antagonists. Both dressings are fixed to each other with a separate wire drawn through the loops of the ligature dressings, in the state of correct closing of the teeth. The same wire structure is performed on the other side of the fracture line and supplemented with extraoral fixation of the lower jaw.

 This method of immobilization is used for two to three days, and then it must be replaced by some method of permanent fixation of fragments due to the danger of loosening of the supporting teeth.

 The method is quite complicated and requires a certain qualification and skill.

 With concomitant traumatic brain injury, there is a risk of aspiration asphyxiation due to severe intermaxillary fixation.

 The method does not create accurate reposition and rigid fixation of fragments, but only reduces their mobility.

 The problem solved by the invention is to simplify the method, include in the area of fixation of all existing on the fragments of teeth, ensuring reliable reduction and fixation of fragments.

 The invention consists in the following.

 On the vestibular and oral surface of the teeth of the lower jaw, rigid tape tires are applied with an intermittent slot along their length and they are fixedly fixed to each other through the interdental spaces using metal pins (the principle of fastening is shown in figure 1). A general view of the superimposed tire with details of its oral and vestibular surfaces is shown in FIG. An instrument for fixing the tire with pins and a schematic illustration of the fixing step are shown in FIG.

 The results of an experimental test of the rigidity of fixation of fragments of the claimed methods in comparison with the most common methods of fixation.

 To determine the resistance to cantilever bending, the lower jaw from the corpses of the deceased as a result of injuries or acute heart failure was used.

 In 4 series of experiments, after vertical osteotomy at the gap level with 4 and 5 teeth, bone fragments were fixed in the following ways: 1 - ligature tooth binding (5 preparations); 2 - with tires. S.S. Tigerstedt (5 drugs); 3 - Vasilyev’s tape tires (5 preparations); 4 - the proposed method (5 drugs).

 Each drug was tested for resistance to cantilever bending in the sagittal plane in the device MIP-100-2. For this bonding between themselves, the fragments were placed in a special fixator and the medial fragment was loaded at the level of 1, 2 teeth for the appearance of deformation of the joint. The magnitude of the deforming force was recorded on the scale of the device, the distance between the fragments was measured with a caliper.

 When testing at the indicated stand, the discrepancy between the fragments at a distance of 1 mm occurred with the application of force (in Newtons): 1 series - 4H, 2 series - 8H, 3 series - 11H, 4 series - 18H; the divergence of fragments of 2 mm occurred: 1 series - 4,2Н, 2 series - 8, 5Н, 3 series - 12Н, 4 series - 20Н; the discrepancy of fragments of 4 mm occurred: 1 series - 5N; Series 2 - 9H, Series 3 - 13H, Series 4 - 25H.

 The tests carried out made it possible to establish that the greatest bond strength of fragments is ensured by applying the proposed fixation method.

 Example. Patient M-nick I.M., born in 1957, outpatient card N 4415, turned to the consultative office of the dental clinic of hospital N 1 in Donetsk on December 29, 1992 with gutters for pathological mobility and pain in the left corner of the lower jaw , numbness of the left half of the lower lip and a selection on the left.

 12/28/92, at about 19 hours, getting off the bus slipped and fell, hitting the left corner of the lower jaw on the curb. He did not lose consciousness, nausea, vomiting, dizziness was not.

 On examination, pronounced facial asymmetry is determined due to hematoma and edema in the left buccal region and the submandibular triangle. On palpation in front of the left corner of the lower jaw, pain, deformation, pathological mobility, bone crepitus are noted.

 When examining the oral cavity, there is a lack of contact between the front teeth due to the sensation of lower teeth.

Предъязычные валики выбухали, слизистая оболочка имбибирована кровью. Выраженная подслизистая гематома в области альвеолярного отростка на уровне отсутствующих

зубов. Гематома распространяется на ткани дна полости рта и щеки.

The pre-lingual ridges swelled, the mucous membrane was imbibed with blood. Pronounced submucous hematoma in the alveolar ridge at the level of absent

teeth. The hematoma spreads to the tissues of the bottom of the mouth and cheeks.

зуб, между остальными фронтальными зубами - щель до 5 мм.On the radiograph of the lower jaw dated December 29, 1992 in a direct projection, a violation of the continuity of the lower jaw in front of its left corner is determined. Diastasis of fragments is small. The fracture gap is narrow. Contact with tooth antagonist

a tooth, between the other frontal teeth - a gap of up to 5 mm.

зуба с небольшим смещением отломков.Diagnosis: fracture of the lower jaw in the region of the absent

tooth with a slight displacement of fragments.

 12/29/92, without anesthesia, a double splint was applied to the teeth of the lower jaw with hook loops and fixation of one part of the splint to the other through the interdental spaces using aluminum pins, on the teeth of the upper jaw - S. S. Tigerstedt splint with hook loops. Rubber traction restored bite.

 On the control x-ray after splinting from 12/29/92. it is determined that the large fragment is in the correct position; orthognathic bite. The small fragment is slightly outwardly shifted; it does not need correction.

 12/31/92, the upper tire was corrected: the ligatures fixing it were tightened. The lower tire is fixed firmly and does not need correction.

 8.01.93, during the control examination of the patient complaints are not presented. The face is symmetrical, the hematomas have resolved. In the area of the fracture, a muft-like, elastic consistency is palpated, bone callus is slightly painful upon palpation. Orthognathic bite. The fixation of the upper tire is made, the lower tire is fixed firmly.

 01/19/93, the patient appeared for a follow-up examination. There are no complaints. Orthognathic bite. Bone callus in the fracture area was thickened, painless on palpation. Intermaxillary elastic fixation was removed. The upper tire is movable. The lower one is firmly fixed.

 01/21/93 was for the inspection. There are no complaints. In local status unchanged. The bite is not broken. Tires removed. Recommendations are given.

 01/28/93 was for the inspection. No complaints. Orthognathic bite. It takes soft food.

 The advantages of the method lies in the fact that it is easy to use and can be performed by any health worker who does not have special training. This is especially valuable for mass defeats in cases of hostilities, major transport and mine accidents.

 However, the method provides a rigid fixation of fragments, allowing it to be used as a method of continuous therapeutic immobilization in the localization of fractures outside the dentition.

 Due to the fact that all the patient’s teeth are included in the fixation zone, the load on the periodontium is minimal, and this ensures the least trauma for the supporting teeth.

 The method is performed quickly and with minimal trauma for the patient, which is very important with concomitant traumatic brain injury.

 The method allows you to use a toothbrush for hygienic treatment of the oral cavity.

 To implement the method, a device was used for the temporary immobilization of fragments of the lower jaw, which provides a decrease in trauma and an increase in the reliability of fixation by a fragment of the lower jaw (see Figs. 1,2 and 3).

 The device shown in figure 1, consists of two tape tires 1 and 2, equipped with a discontinuous slot along their length 3, and metal pins 4. One of the tires is smooth, and the other is equipped with hook loops 5.

 The device is used as follows.

 A smooth splint is placed on the lingual side of the teeth of the lower jaw and bent along the dental arch. A splint with hook loops is placed on the vestibular side of the teeth of the lower jaw and is also bent along the dental arch.

 Both tires are interconnected through the interdental spaces using metal pins 4, placing the head of each pin 6 on the lingual side. Excess pins cut and bend them to the teeth.

 Hook loops are used for intermaxillary traction.

 The advantages of the device are ease of use, low trauma, and reliable fixation of fragments.

 The low invasiveness of the device allows its use for patients with traumatic brain injury. During the threat of vomiting, intermaxillary elastic fixation can be interrupted to prevent aspiration of vomit. When the fracture is localized outside the dentition, the device can be used for continuous therapeutic fixation of fragments.

 Moreover, due to the fact that each existing tooth is included in the fixation zone, the load on the teeth is minimal.

 The ease of use of the device allows you to use it not only to the dentist, but also to the dental technician and nurse, which is important for the mass flow of patients from the lesion, for example, during major transport or mine accidents.

Claims (2)

 1. A method for temporary immobilization of fractures of the lower jaw, including reposition and fixation of fragments, characterized in that rigid tape splints are applied to the vestibular and oral surfaces of the teeth of the lower jaw with an intermittent slot along their length and they are fixedly fixed to each other through the interdental spaces using metal pins.  2. A device for temporary immobilization of fractures of the lower jaw containing a tape vestibular splint with hook wrenches and elements of its fixation, characterized in that it is additionally equipped with an oral splint, both tires are made with intermittent slots along their length, and the fixation elements are made in the form of pins for installing them in the interdental spaces.

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