RU2201154C2 - Method for fixing fragments by means of metal wires in upper type cases of maxillary fracture - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves manually setting fractured bone fragments. Wire splints having fastening loops are mounted on both jaws. Skin is cut near the base of zygomatic process of the temporal bone. Metal wire is conducted from suprazygomatic area inwards from zygomatic process of the temporal bone downwards through subtemporal fossa to maxillary tuber with exit to the oral cavity. The wire is bent to match the maxillary arc shape. The outer wire end is bent like a hook around the zygomatic process of the temporal bone. The second wire not longer than 1.5 cm is introduced into proximal area of the zygomatic process of the temporal bone for avoiding wire slip from the zygomatic process of the temporal bone. The wire is fixed on the tooth splint. The same operations are done on the opposite side. EFFECT: stable fixation; reduced risk of traumatic complications. 2 dwg

Description

 The invention relates to medicine, namely to dentistry.

 The aim of the invention is to reduce the invasiveness of the intervention with achieving stiffer and more stable fixation of the fragments during fractures of the upper jaw and, as a result, reducing the incidence of postoperative complications and the timing of the coalescence of fragments during fractures. To achieve this goal, a new method of fixation of fragments in the upper jaw fractures of the upper jaw was developed.

 The essence of the method is as follows. Under local or general anesthesia after preliminary manual reposition of fragments under occlusion control, tooth wire splints with hook loops are placed on the upper and lower jaws. Then, a skin incision is made in the region of the base of the zygomatic process of the temporal bone and fragments are skeletonized. A metal knitting needle is carried out from the supra-zygomatic region inward from the zygomatic process of the temporal bone, downward through the infratemporal fossa to the tubercle of the upper jaw with access to the oral cavity and bend it in the shape of the upper dentition. The outer end of the knitting needle is crocheted around the zygomatic process of the temporal bone and, in order to prevent the hook from sliding off the process, the second spoke is inserted through the electric drill through the ends, the ends of which bite. The total length of the second knitting needle should not exceed 1.5 cm. Continuing the manual reposition of the fragments, the knitting needle, bent in the oral cavity in the form of the upper dentition, is fixed in the state of tension by the ligature wire to the tooth wire splint. Do the same from the opposite side. If necessary, bite correction is performed by intermaxillary rubber traction. There is a stable satisfactory fixation. The wound is sutured in the region of the base of the zygomatic process of the temporal bone.

 Example. Patient B, 50 years old, and.b. 8974, was admitted to the hospital for a bilateral upper jaw fracture of the upper type. Household injury received 2 days before admission. Locally determined swelling of the soft tissues of the middle zone of the face, pain on palpation of the zygomatic bones. The bite is broken by the type of open, the middle part of the face is elongated. "Symptom of points" is positive, hemorrhages in the sclera of the eyes are noted.

 Palpation is determined by the symptom of the "step" in the area of the infraorbital edges, zygomatic arches, the zygomatic alveolar ridge on the right and left. On radiographs of facial bones in axial and semi-axial projections, a violation of the integrity of bone tissue is determined in the form of a linear fracture going from the base of the nasal bridge through the medial and lower walls of the orbit along the cheekbone suture through the zygomatic arch to the pterygoid processes of the main bone on the right and left.

 After a general clinical examination and the application of tooth wire splints with hook loops on both jaws, an operation was performed: osteosynthesis of the upper jaw with metal knitting needles using a new technique. The essence of the operation. Under premedication, conduction (according to Weissblat with blockade of the II branch of the trigeminal nerve) and infiltration anesthesia with 2% novocaine solution, 20.0 ml of fragments were manually repaired and fixed with metal knitting needles to the right and left, drawn from the supraccullum region inward from the pre-skeletonized zygomatic process of the temporal bone downward and inward through the infratemporal fossa into the oral cavity, where after manual reposition of fragments and holding them in the correct position, the needle is pulled and bent in the shape of the upper dentition. Then the excess spokes are bitten off and the spokes are fixed with a ligature wire to the tooth wire splint. The outer end of the knitting needle is crocheted around the zygomatic process of the temporal bone, and in order to prevent the hook from sliding off the process, the second needle is inserted through the proximal section, the ends of which are bite. The length of this spoke is not more than 1.5 cm. Fragments of the upper jaw are firmly fixed. An intermaxillary rubber traction was applied. Then the wound in the area of the zygomatic arch is sutured, the suture line is stewed with a solution of brilliant green, an aseptic dressing is applied (Figs. 1, 2).

 The Faltin-Adams method for fixing fragments in upper jaw fractures was previously known, which consists in the following: after manual reposition of fragments and application of bent wire splints with hook loops on both jaws, the zygomatic process of the frontal bone is sharply and bluntly extracted more often by external access and after drilling holes, a wire loop is drawn through them, the ends of which are inserted into the mouth of the mouth with a thick injection needle and attached to the tooth splint. The same thing is done on the other hand. After 3-4 weeks after osteosynthesis, the ligatures are removed by pulling.

 However, this method is not without drawbacks. Firstly, the intervention is rather traumatic, which is associated with the danger of damage to blood vessels and nerves, circulatory disorders, and slowing down reparative processes. Secondly, it is impossible to achieve sufficiently rigid fixation of fragments, which slows down the coalescence of fractures.

The novelty of the proposed method lies in the fact that all these disadvantages are eliminated and it becomes possible to implement:
a) more stable fixation throughout the fragments;
b) less trauma during the manipulation, and therefore, a decrease in the likelihood of infection;
c) maintaining oral hygiene and the ability to open and close the mouth, which significantly improves trophic tissue and accelerates reparative processes, if there is no need for the application of intermaxillary rubber traction.

Sources of information
1. Bernadsky Yu. I. Traumatology and reconstructive surgery of the maxillofacial region. - 2nd edition. - Kiev, 1985

 2. Kabakov B.D., Malyshev V.A. Jaw fractures. - M., 1961

 3. Injuries of the maxillofacial region (Alexandrov N.M., Arzhantsev P.Z., Vikhreev B.C. and others) - M. 1986

 4. Halmos J. Traumatology of the maxillofacial skeleton. - Bratislava, 1975

Claims (1)

 The method of fixing fragments in upper jaw fractures of the upper type using metal knitting needles, including manual reposition of fragments, application of wire splints with hook loops on both jaws, characterized in that a skin incision is made in the region of the base of the zygomatic process of the temporal bone and the fragments are skeletonized, a metal is made the knitting needle from the supra-zygomatic region, inward from the zygomatic process of the temporal bone, downward, through the infratemporal fossa to the tubercle of the upper jaw with access to the oral cavity, bend it in the shape of the upper tooth of the arc of the jugular arch, the outer end of the knitting needle is crocheted around the zygomatic process of the temporal bone, in order to avoid slipping the hook from the process into the proximal part of the zygomatic process of the temporal bone, a second needle of no more than 1.5 cm in length is inserted through, the needle is fixed to the tooth splint, the same is done from the opposite side.

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