RU2192201C2 - Removable maxillary resection prosthesis - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has flexible hemispheric obturator unit 1 and opening 2 in the lower part equal in size to defect inlet opening which base is rigidly connected to base 3 and artificial teeth. Base 3 has air valve 4 with bi-directional air passage. One end of valve 4 is connected to cavity of obturator 1 and the other one is connected to cap tooth 6 by means of threaded connection. Obturator 1 has wall thickness allowing one to stretch the obturator in horizontal plane A when supplying air under pressure via the valve into the obturator cavity. Rigidity ribs 7 are manufactured on the internal surface of obturator 1 along meridian B. EFFECT: avoided traumatic complications and mucosa decubitus. 5 cl,7 dwg

Description

 The invention relates to medicine, in particular to orthopedic dentistry, and is intended to fill the defect of the upper jaw of various origins with a complete resection of the upper jaw, as well as with partial resection of the toothless upper jaw, and in cases where the inlet of the defect is wider than the prosthetic part in the presence of teeth on the healthy side of the jaw.

 A known design of a resectable removable denture of the upper jaw, containing the basis of the prosthesis and a hollow obturator made of rigid plastic, which is inseparably connected with the basis (see AD Lubotsky. "Orthopedic care after resection of the upper jaw" in the collection "Questions of dentistry and maxillofacial surgery ". M. 1963, pp. 246-251) [1]. The prosthetic obturator is made before surgery, and the replacement part of the prosthesis is modeled arbitrarily. 3-4 weeks after the operation, the obturator is corrected by layering softened black gutta-percha in places where the prosthesis does not adhere to the edges of the defect. Then gutta-percha is replaced by plastic. Fixation of the prosthesis is carried out with the help of support-holding clasps, telescopic crowns and other known elements of fixing devices for plate or clasp prosthetics on the healthy side of the upper jaw, if it has teeth.

 The described prosthesis performs only a cosmetic function. Chewing with this prosthesis is impossible due to the fact that when chewing due to the occurring reciprocating movement, bedsores and scuffs appear, the teeth of the healthy side of the jaw are loosened and dislocated. In cases where the defect's inlet is wider than the prosthetic part or with total resection of the upper jaw, the prosthesis is not fixed at all, and therefore, the chewing function is not restored, there is no hermetic separation of the oral and nasal cavities, which leads to the preservation of nasal congestion and leakage of liquid food through the nose . In addition, in the case of postoperative contracture of the lower jaw, this prosthesis cannot be inserted into the cavity of the defect.

 The last problem is solved in the design of the resection removable prosthesis, consisting of two detachable parts - the base and the obturator, which are fixed to each other using magnets (see B.K. Kostur, V.A. Minyaeva "Maxillofacial prosthetics", L .: Medicine , 1985, pp. 33-34) [2]. Otherwise, this design has the same disadvantages listed.

 The resection removable denture of the upper jaw is also known (see S. N. Rodnaev. “Prosthetics with unilateral resection of the upper jaw and the absence of teeth” in the collection “Reconstructive surgery of the maxillofacial region”, Krasnoyarsk, 1989, pp. 99-102) [ 3], with which you can use the retention points in the event that the defect inlet is wider than the prosthetic part. The resectable denture of the upper jaw contains a base to which a monolithic obturator made of elastic plastic is rigidly attached.

 The disadvantage of the described design is the inability to fully restore the chewing function of the upper jaw and create a tight separation of the nasal and oral cavities. This is due to the possibility of using only certain, slightly expressed retention points of the defect to hold the prosthesis, which is not enough to fix the prosthesis.

 The closest constructive implementation to the claimed invention is a prosthesis for closing the palate after complete resection of the upper jaw (see SU ed. St. 1537239 A1, class 5 A 61 C 13/00, publ. 23.01.90, bulletin 3) [4 ] taken as a prototype.

 The prosthesis contains a base with artificial teeth, an obturator made in the form of a hemisphere of base plastic, the base of which is rigidly connected to the base of the prosthesis. The configuration of the obturator after complete resection of the upper jaw is fully consistent with the configuration of the defect. The prosthesis is fixed due to the tides located around the perimeter of the obturator and the L-shaped pelot mounted frontally on the obturator for insertion into one of the lower nasal passages.

 The disadvantages of the prototype are as follows.

 1. The implementation of the obturator of a rigid (base) plastic leads to injury to the mucous membrane of the defect.

 2. Running to fix the prosthesis tides around the perimeter of the obturator create pressure sores at the site of contact with the mucous membrane of the defect, due to the mismatch of the shape of the tides of the configuration of the defect.

 3. The presence of a pelota at one end of the prosthesis for fixation complicates nasal breathing, and also forms a first-type lever, fixing the prosthesis only in the frontal part, which is insufficient to restore chewing function, and only contributes to the formation of a food lump in the oral cavity.

 4. The lack of complete sealing of the oral cavity from the nasal cavity, due to the exact repetition of the defect configuration with compliance of the mucous membrane of the defect, leads to the communication of the oral and nasal cavities and the pouring of liquid food through the nose.

 The objective of the invention is the creation of a resection removable denture of the upper jaw, which does not have all of the above disadvantages.

 The technical result of the invention is the elimination of injury and the formation of pressure ulcers of the mucous membrane of the defect, the improvement of chewing function and the hermetic separation of the nasal and oral cavities with a complete resection of the upper jaw, with a partial resection of the toothless upper jaw and in the case when the inlet is wider than the prosthetics in the presence of teeth on healthy side.

 This is achieved by improving the adhesion of the surface of the obturator to the walls of the defect when using the prosthesis.

 The technical result is achieved by the fact that the resectable denture of the upper jaw contains a base with artificial teeth, an obturator, the base of which is rigidly connected to the base, made in the form of a hemisphere and corresponding to the configuration of the defect. According to the invention, the base is equipped with an air valve with bilateral conductivity, one end of which is connected to the obturator cavity, and the other by means of a threaded connection to the tooth cap. The obturator is made of elastic material and has a wall thickness that allows the obturator to stretch in the horizontal plane when air is supplied under pressure through a valve into the obturator cavity. At least two stiffeners are made on the inner surface of the obturator along the meridian relative to its dome.

 Another difference is the performance of the elastoplast obturator.

 Another difference is that the dome of the obturator has a wall thickness of 4.0 mm.

 Another difference is that the obturator, at its place of contact with the walls of the defect inlet, has a wall thickness of 2.0 mm.

 Another difference is that the obturator in the rest has a wall thickness of 1.0 mm.

 In FIG. 1 shows a resection removable denture of the upper jaw to connect the basis with the obturator.

 In FIG. 2 shows a resected removable denture of the upper jaw in assembled form.

 In FIG. 3 is a schematic drawing of a tooth cap in section with a double-sided conduction valve.

 In FIG. 4 shows a section in the horizontal plane of the obturator with eight stiffeners, where a) is the image of the obturator before inflation with compressed air; b) - image of the obturator in working condition after inflation with compressed air.

 In FIG. 5, 6 and 7 are illustrations illustrating the installation process of the prosthesis obturator in the defect cavity, where in FIG. 5 - the introduction of the obturator into the cavity of the defect; in FIG. 6 - the process of pumping air into the cavity of the obturator through the inlet of the valve; in FIG. 7 shows a finally installed obturator with a tooth cap.

 Resectional removable denture of the upper jaw (Fig.1,2) contains a hemisphere obturator 1 made of elastic material and has a hole 2 in the lower part equal to the defect inlet, the base of which is rigidly connected to the base 3 with artificial teeth. The basis 3 is equipped with an air valve 4 with bilateral conductivity (figure 3). One end of the valve 4 is connected to the cavity of the obturator 1, and the other by means of a threaded connection 5 to the tooth cap 6. The obturator 1 has a wall thickness that allows the obturator to stretch in the horizontal plane A (Fig. 1) when air is supplied under pressure through the valve obturator cavity.

 On the inner surface of the obturator 1 along the meridian B relative to its dome, stiffening ribs 7 are made.

 In the particular case of performing the prosthesis, the obturator is made of elastoplast and the wall thickness of its dome is 4.0 mm, the wall thickness of the obturator in place of its contact with the walls of the defect inlet is 2.0 mm. The rest of the obturator has a wall thickness of 1.0 mm.

 To make a prosthesis, a cast of a postoperative defect is preliminarily taken, the model is cast and the model is made of an elastic material, in particular from Elastoplast, an obturator with a given wall thickness. In a specific example, the thickness of the dome of the obturator is 4 mm, the thickness of the walls of the obturator is 1 mm, and at the place where the obturator is adjacent to the walls of the inlet of the defect is 2 mm. At the same time, in the manufacture of a thin-walled elastic obturator, stiffeners 7 made of rigid plastic, for example, Ftoraks, are placed on the inner surface of the walls of the obturator by plastic polymerisation.

 To insert the prosthesis into the defect cavity, the elastic obturator 1 with stiffening ribs 7 is folded like a fan and inserted into the defect cavity (Fig. 4, a, Fig. 5). Compressed air is introduced into the cavity of the obturator 1 by means of a syringe through a double-conduction valve 4 (Fig. 6) with the removed cap-cap 6 (Fig. 6). In this case, the walls of the obturator 1 are stretched in the horizontal plane, since the wall thickness is small (1 mm). But since the wall thickness of the obturator 1 in the upper part is greater than in the horizontal plane, it does not stretch in the vertical plane. This leads to the retraction of the obturator 1 in the cavity of the defect and the retention of the basis of the prosthesis in the oral cavity (Fig.7).

 Under air pressure in the obturator, valve 4 closes and a tooth cap 6 is screwed onto it. Since the prosthesis has thin elastic walls, stiffeners create a framework supporting soft tissues of the face. In the region of stiffeners 7, the walls of the obturator 1 are not stretched (Fig. 4, b), and between the stiffeners the walls of the obturator 1 are stretched, while the rib is pulled inward, and the walls protrude and touch the defect of the postoperative cavity. Since the stiffener at the point of retraction into the obturator does not touch the obturator wall, an air cushion 8 is formed there, which eliminates the pain of bursting while using the prosthesis and prevents pressure sores from occurring. The volume of the obturator, depending on the pain and for good fixation of the prosthesis, can be regulated by the patient himself by supplying or lowering air through valve 5.

 It is necessary to remove the obturator from the postoperative cavity as follows: using a blunt-ended needle with a removed cap, press the valve 4 and excess air is removed, then the obturator is carefully removed from the cavity.

 Clinical examples of the use of a resectable denture of the upper jaw.

 Example 1. Patient A., born in 1947, operated on in 1998 for cancer of the upper jaw, applied for orthopedic treatment to the clinic 5 of Rostov-on-Don. The patient made a complete resection of the upper jaw. Prosthetics according to the generally accepted methodology, which he had carried out earlier, could not be achieved with the restoration of chewing function, since the prosthesis was not fixed in the oral cavity. On the basis of the clinic, this patient had a resection removable denture of the upper jaw with an elastic thin-walled obturator, with 10 stiffeners and a valve with bilateral conductivity. The obturator is made of elastic plastic "Elastoplast", and the basis of the prosthesis and stiffeners - on the obturator made of plastic "Ftoraks". After fitting the prosthesis, one correction was made. The chewing function of the upper jaw is restored at the level of removable prosthetics. The patient himself adjusts the degree of stretching of the obturator depending on his sensations as necessary. No bedsores. The phonation and cosmetic effect are fully restored.

. Твердое небо и альвеолярный отросток, за исключением вышеназванной части альвеолярного отростка, отсутствует. Больному изготовлен резекционный съемный протез верхней челюсти с полым эластичным тонкостенным обтуратором с 6-ю ребрами жесткости, с клапаном двусторонней проводимости и кламмерной фиксацией. Обтуратор выполнен из эластичной пластмассы "Эластопласт", а базис протеза и ребра жесткости - из пластмассы "Фторакс". Жевательная функция, косметический эффект, фонация восстановлены полностью, достигнута полная герметичность ротовой и носовой полости, пролежней нет.Example 2. Patient J., born in 1970, operated on in 1991 for a benign tumor of the upper jaw, applied for orthopedic treatment. On examination, an extensive postoperative defect of the upper jaw was found, the inlet was wider than the prosthetic part. Part of the alveolar bone on the healthy side with four teeth on it has been preserved

. The hard palate and the alveolar process, with the exception of the above part of the alveolar process, are absent. A resected removable denture of the upper jaw with a hollow elastic thin-walled obturator with 6 stiffening ribs, a bilateral conduction valve and clamper fixation was made to the patient. The obturator is made of elastic plastic "Elastoplast", and the basis of the prosthesis and stiffeners are made of plastic "Ftoraks". Chewing function, cosmetic effect, phonation are fully restored, complete tightness of the mouth and nasal cavity is achieved, there is no pressure sore.

входное отверстие в дефект уже протезируемой части, но на здоровой стороне отсутствуют все зубы. Больной изготовлен резекционный съемный протез с полым тонкостенным обтуратором по вышеописанной конструкции с тремя ребрами жесткости и клапаном с двусторонней проводимостью. Обтуратор выполнен из "Эластопласта", а базис протеза и ребра жесткости - из "Фторакса". В данном случае фиксация протеза осуществляется только за счет обтуратора. Восстановлены жевательная функция, фонация, достигнуты хороший косметический эффект и полное разобщение гайморовой и ротовой полостей. Протез хорошо фиксируется, не вызывает пролежней и натертостей.Example 3. Patient U., born in 1924, was operated on in 1999 for cancer of the upper jaw. As a result of the operation, there is a postoperative defect of the upper jaw on the right, there is no part of the hard palate measuring 1x2 cm and part of the alveolar process at the level of four teeth

the inlet to the defect is already the prosthetic part, but on the healthy side all the teeth are missing. The patient made a resection removable prosthesis with a hollow thin-walled obturator according to the above construction with three stiffeners and a valve with bilateral conductivity. The obturator is made of "Elastoplast", and the basis of the prosthesis and stiffening ribs are made of "Ftoraksa". In this case, the prosthesis is fixed only at the expense of the obturator. The chewing function, phonation were restored, a good cosmetic effect and complete dissociation of the maxillary and oral cavities were achieved. The prosthesis is well fixed, does not cause pressure sores and scuffs.

Sources of information
1. A.D. Lubotsky "Orthopedic care after resection of the upper jaw." On Sat "Questions of dentistry and maxillofacial surgery." M. 1963, pp. 246-251.

 2. B.K. Kostur, V.A. Minyaeva "Maxillofacial prosthetics". The medicine. 1985, pp. 33-34.

 3. S.N. Rodnaev "Prosthetics with unilateral resection of the upper jaw and the absence of teeth." On Sat "Reconstructive surgery of the maxillofacial region." Krasnoyarsk 1989, pp. 99-102.

 4. SU Auth. St. 1537239 A1, cl. 5 A 61 C 13/00, publ. 01/23/90, Bulletin 3 - prototype.

Claims (5)

 1. Resectional removable denture of the upper jaw containing a base with artificial teeth, an obturator, the base of which is rigidly connected to the base, made in the form of a hemisphere and corresponding to the defect configuration, characterized in that the base is equipped with an air valve with bilateral conductivity, one end of which is connected to the cavity the obturator, and the other through a threaded connection with the tooth cap, the obturator is made of elastic material and has a wall thickness that allows the obturator to stretch into at a horizontal plane when air is supplied under pressure through a valve into the obturator cavity, at least two stiffeners are made on the inner surface of the obturator along the meridian relative to its dome.  2. Resection prosthesis of the upper jaw according to claim 1, characterized in that the obturator is made of elastoplast.  3. Resection removable denture of the upper jaw according to paragraphs. 1 and 2, characterized in that the dome of the obturator has a wall thickness of 4.0 mm  4. Resection removable denture of the upper jaw according to paragraphs. 1 and 2, characterized in that the obturator in place of its contact with the walls of the inlet of the defect has a wall thickness of 2.0 mm  5. Resection removable denture of the upper jaw according to paragraphs. 2 to 4, characterized in that the obturator in the rest of the wall has a wall thickness of 1.0 mm

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