RU2154427C1 - Method for fixing zygomatic bone fragments - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing wire through the zygomatic bone after reposition in the point belonging to vertical line drawn through frontal process width 2-2.5 mm below zygomatic bone body boundary in the direction downward inside to the opposite angle of the mandible through the maxillary sinus cavity until its bottom is reached at some transition point the bottom transforms into medial wall. EFFECT: enhanced effectiveness of treatment. 1 dwg

Description

 The invention relates to medicine and can be used in traumatology and maxillofacial surgery.

 Zygomatic bone fractures are a common traumatic pathology of the facial skeleton.

 In the treatment of isolated fractures of the zygomatic bone with a displacement, in contrast to its fractures combined with fractures of the upper jaw, it is not always necessary to resort to additional fixation of the fragments after their reposition. The need for additional fixation of fragments with isolated fractures of the zygomatic bone occurs with comminuted damage to the walls of the maxillary sinus. In addition, osteosynthesis is indicated for all fractures of the zygomatic bone, if treatment is performed later than 10 days from the moment of injury.

 A fracture of the zygomatic bone occurs, as a rule, in the region of the lower orbital margin and further along the zygomatic-maxillary suture, in the region of the frontal and temporal processes. Open osteosynthesis is performed in these places by wire sutures [1] or other fixatives. But exposure of fracture cracks is accompanied by significant skeletonization of the zygomatic bone fragments, which reduces the effectiveness of periosteal blood supply and increases the risk of inflammatory complications.

 Closest to the proposed is a method of fixing fragments of the zygomatic bone, in which the fixing elements (supports made of plastic or a formalized allogeneic bone graft) are placed in the cavity of the maxillary sinus [2]. For this, an incision is made along the arch of the vestibule of the oral cavity and the front wall of the maxillary sinus is skeletonized, at the same time, the fracture gap is revised. Form a hole in the sinus wall. Through the formed wide enough hole, the sinus is revised, the fragments are repositioned, and the fixing structure is installed in the sinus.

 Like the previous one, this method has a drawback - when fixing fragments with tamponade of the maxillary sinus cavity by one or another material used in the form of spacers, an additional trauma to the bone and mucous membrane of the maxillary sinus occurs. The operation takes a lot of time and is quite expensive. Even the revision of the sinus is not always justified, since recently in the literature the prevailing opinion is that revision of the sinus is necessary only for penetrating wounds. Removing the fixative structures from the sinus cavity requires repeated surgical intervention.

 The claimed invention solves the problem of creating a method of fixing fragments of the zygomatic bone less traumatic, not requiring large expenditures. The technical result when using the invention is to reduce the morbidity, simplification.

 This technical result is achieved in that when fixing fragments of the zygomatic bone at which reposition of the fragments is performed, it differs in that after reposition, the spoke is drawn through the zygomatic bone at a point located on a vertical line drawn through the middle of the width of the frontal process by 2-2.5 cm above the lower edge of the body of the zygomatic bone in the downward direction inward, to the opposite corner of the lower jaw through the cavity of the maxillary sinus until it stops at its bottom at the junction of the bottom into the medial wall.

The proposed method has several advantages:
1. the lack of bulky external fixation structures that make it difficult to care for seriously injured;
2. the method relates to closed methods of osteosynthesis, contributing to the preservation of periosteal blood supply to the fragments, which reduces the possibility of inflammatory complications and accelerates the process of fusion;
3. The minimum incisions-punctures performed during the proposed method are quite cosmetic and do not lead to additional scarring of the face;
4. the method is slightly traumatic and quickly feasible, can be performed under local anesthesia;
5. The removal of the retaining structure (spokes) after the consolidation of the fracture is performed through a small puncture-incision and can be performed on an outpatient basis.

 The method is illustrated in the drawing and is as follows. The fragments are repositioned, the zygomatic bone fragments are fixed after their reposition according to the generally accepted method of Limberg hook using a spacer-spacer (1) (diameter 2 mm), drawn through the cheekbone (2) at a point located on a vertical line drawn through the middle of the frontal process by 2 -2.5 cm above the lower edge of the body of the zygomatic bone in the downward and inward direction (towards the opposite corner of the lower jaw) through the cavity of the maxillary sinus (3) until it stops at its bottom at the transition to the medial wall. The needle bites off by 0.5 cm and sinks under the skin. In this case, it is advisable to carry out the knitting at low speeds so that there is no burn of the bone tissue, which in turn can lead to its rapid lysis along the channel produced by the knitting needle, and, accordingly, a decrease in the strength of the fixation of fragments. After biting off the needle with a light blow to the tip of the spoke, you can finish it into the bone to increase the reliability of fixation. To perform this operation, it is better to use a needle with feather sharpening or sharpening in the form of a spatula, which reduces the possibility of a burn of bone tissue, improves the possibility of jamming of the tip of the spoke in the bones of the sinus floor after finishing the knitting needle.

 The proposed method can only be used for isolated fractures of the zygomatic bone without fractures of the upper jaw.

 In extreme cases, with insufficient rigidity of fixing fragments after holding one spoke, you can hold the second spoke, slightly departing from the first and changing its direction by 5-10 degrees according to the described method.

 Clinical example: Patient K., born in 1964, went to the emergency hospital in the city of Cheboksary on the third day after an injury received in everyday life on January 28, 1999. After examination by a neurosurgeon and maxillofacial surgeon, the victim was diagnosed with a combined craniofacial injury. HFM. Brain concussion. Fracture of the right zygomatic bone with displacement. After the examination, on January 29, 1999, under intravenous anesthesia, the patient was repositioned of fragments of the right zygomatic bone with Limberg hook. Fragments in the correct position are not independently held. After repeated reposition of the fragments of the zygomatic bone, its osteosynthesis was performed with a spacer-spoke according to the proposed technique. Aseptic dressings were applied to the puncture wound from the Limberg hook and knitting needle. In the postoperative period, the victim received symptomatic, vitamin therapy, physiotherapeutic treatment. The wounds have healed. The patient was discharged for outpatient treatment on the tenth day. After the consolidation of the fracture on 02.26.1999 in the dental clinic, the needles were removed from the right zygomatic bone through a puncture incision made above the tip of the knitting needle. The wound healed independently after 3-4 days under a bandage.

 This method of osteosynthesis is used for two years. No significant complications in the early and long-term period were noticed.

Sources of information
1. Georgiev K., Ivanov Art. Traumatology in the maxillofacial region .- Sofia., Medicine and Physical Education, 1988. - P. 106. (Bulgarian).

 2. Bazhanov N.N., Ter-Asaturov G.P. Improving the treatment and rehabilitation tactics of victims with injuries of the zygomatic-orbital complex // Specialized care for victims of facial injuries with combined trauma: Sat. scientific tr -L., 1991.-S. 174-178.

Claims (1)

 A method of fixing fragments of the zygomatic bone, in which reposition of fragments is carried out, characterized in that after reposition, a spoke is drawn through the zygomatic bone at a point located on a vertical line drawn through the middle of the width of the frontal process 2 - 2.5 cm above the lower edge of the body of the zygomatic bone downward inward, to the opposite corner of the lower jaw through the cavity of the maxillary sinus until it stops at its bottom at the junction of the bottom into the medial wall.