RU2217083C1 - Method for making plastic repair of alveolar process in the cases of congenital hiatus - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves exfoliating mucoperiosteal flaps. Nasal bedding is built. Parietal bone is skeletted via coronal skin incision on the hairy head surface area. External cortical plate of the parietal bone is perforated to spongious layer on the boundary with temporal and frontal bones. The created recesses are connected with mill. Graft is taken. Bone sawdust and spongious substance are collected. Sutures are put in. The defect is filled with mixed bone sawdust and spongious substance. Cortical bone autograft is arranged on vestibular side and fixed attached with titanium screws to the alveolar process. Mucoperiosteal flaps are cut out on the greater and lesser alveolar process fragments and the wound is covered. EFFECT: enabled creating required volume of bone tissue.

Description

 The invention relates to medicine, namely to plastic reconstructive surgery of the maxillofacial region.

 All patients with congenital clefts of the upper lip, alveolar ridge and palate have congenital maldevelopment and secondary deformities of the upper jaw. To stabilize the results of orthodontic or surgical expansion of the upper jaw and restore the shape of the upper dentition, such patients are shown bone grafting of the alveolar process.

 A known method of treating congenital defects of the upper jaw by bone grafting of the lower edge of the pear-shaped opening with an allograft from cancellous bone (A.S. 719616, R.D.Novoselov, B.N. Davydov. Method of correction of the nasal septum with birth defects // Bull. Inventions, 1980, p. 22).

 However, this method has several disadvantages: the continuity of the upper jaw is restored only at the level of the apical basis, the bone volume is insufficient for subsequent teething or orthodontic movement of the teeth.

 The closest solution for the purpose and technical essence, taken as a prototype, is the method of bone grafting of the alveolar ridge (Jackson IT, Fasching MC Secondary deformities of cleft lip, nose, and cleft palate // Plastic surgery / Ed. JG McCarthy. Philadelphia: WB Saunders Co, 1990. P. 2828). The essence of the method is the detachment of the mucoperiosteal flaps along the edges of the defect, the formation of the nasal mucosa at the level of the piriform opening, the bone defect is filled with spongy ileal scallop and closed from above with the mucoperiosteal flap from the lateral fragment.

 The disadvantages of this method are significant resorption and friability of the bone tissue of the alveolar process in the transplantation area and the presence of noticeable scars in the donor area.

 The purpose of the invention is the restoration of the shape and function of the alveolar ridge and dentition.

 This goal is achieved in that the mucous membrane along the edges of the defect is used to form the nasal lining and the bed for the graft, the defect area is filled with spongy substance of the bones of the skull and bone filings. A compact plate of bones of the cranial vault is laid outside and fixed with titanium screws. The wound is covered with flaps of the mucous membrane of the gums and lips.

 Orthodontic expansion of the upper jaw is preliminarily performed. The operation is performed at the age of 8-10 years under endotracheal anesthesia as follows.

 1. Produce incisions bordering the edges of the defect in the alveolar process. Peel the mucoperiosteal flaps, tilt to the side of the defect and stitch together, forming a nasal lining at the level of the edge of the pear-shaped opening.

 2. Through the coronary incision of the skin of the scalp, the parietal bone is skeletonized. Neurosurgical trepan perforate the outer cortical plate of the parietal bone at the border with the temporal and frontal bones. Having done four recesses to the spongy layer, connect them with a mill, marking the boundaries of the future transplant. Bone sawdust is carefully harvested. Using an osteotome and a hammer, a transplant is taken. A sponge from a bone wound is collected with a curette spoon. Vicryl 4-0 sutures are applied to the subcutaneous tissue and 4-0 chrome-plated catgut on the scalp.

 3. The defect in the alveolar bone in the cleft is filled with a mixture of spongy substance and bone sawdust with blood. A cortical bone graft is placed from the vestibular surface and fixed with two titanium screws to the alveolar bone through pre-made holes.

 4. Cut out the mucoperiosteal flaps both on a small and on a large fragment of the alveolar process. The lateral flap is mobilized using the poker incision and vertical incisions on the periosteum. The wound is closed completely by suturing with non-absorbable materials.

The claimed method of plasty of the alveolar ridge with congenital clefts is characterized in that:
- restored the continuity of the alveolar process of the upper jaw along the entire height;
- rigid fixation of the cortical bone graft reduces its resorption;
- A sufficient volume of bone tissue is created for subsequent teething;
- the bone graft is taken through an incision in the scalp. After suturing, there is no noticeable scar on the skin, as with bone grafts of the rib or iliac scallop.

 Thus, the claimed method meets the criterion of "novelty." Comparison of the claimed method with the known in maxillofacial and plastic surgery did not reveal the signs that distinguish the claimed solution from the prototype, which allows us to conclude that the invention meets the criterion of "significant differences".

 Clinical example.

 Patient K. in A., 9 years old. I.B. 1245.

 Dz: bilateral cleft of the alveolar ridge, upper micrognathia, intermaxillary bone mobility.

 09/11/01 - Operation: bone grafting of the alveolar ridge by cranial autografts.

 Under ETN + infiltration anesthesia with 1% r-rd of lidocaine + r-r adrenaline 1: 100000, a parietal bone was skeletonized on the right through a coronal incision of the scalp and grafts were taken. A curette spoon collected spongy substance from a bone wound. Vicryl 4-0 sutures were placed on the subcutaneous tissue and 4-0 chrome-plated catgut on the scalp. Incisions were made bordering the edges of the defect in the alveolar process. Mucoperiosteal flaps are peeled off, overturned towards the defect and stitched together, forming a nasal lining at the level of the edge of the pear-shaped opening. Defects in the alveolar bone in the cleft region are partially filled with a mixture of spongy substance and bone sawdust with blood. Cortical bone autografts were placed from the vestibular surface and fixed with two titanium screws to the alveolar bone of the intermaxillary bone and the lateral fragment on the right with the maximum advancement of premaxilla forward. The autograft on the left is fixed with one screw in the premaxilla region and laid “overlaid” on the lateral segment. Mucoperiosteal flaps were cut and mobilized on lateral fragments of the alveolar process. Wounds are closed completely by suturing with Vicryl 4-0.

 Control examination after 8 months. Stabilization of the intermaxillary bone is noted. On the roentgenogram - bone regenerates in the region of defects in the alveolar process of the upper jaw, connecting the intermaxillary bone with lateral fragments.

The proposed method for plasty of the alveolar process for congenital clefts has the following advantages:
- allows you to rigidly fix the bone fragments of the upper jaw and create a sufficient volume of bone tissue for subsequent eruption or orthodontic movement of the incisor or canine;
- reduces the bone graft resorption in the postoperative period;
- avoids the formation of noticeable scars on the skin in the region of the donor zone.

Claims (1)

The method of plasty of the alveolar process for congenital clefts, including peeling of the mucoperiosteal flaps, formation of the nasal lining and closing of the bone defect, characterized in that the parietal bone is skeletonized through the coronal incision of the scalp, the external cortical plate of the parietal bone is perforated at the border with the temporal and frontal bones to the spongy layer, connect the formed recesses with a cutter, take the graft, collect bone filings and spongy substance, apply seams, filled with a mixture of cancellous bone defects and bone chips, stack cortical bone autograft from the vestibular side, fix it with titanium screws to the alveolar bone, cut out mucoperiosteal flaps on the small and large fragments of the alveolar process and close the wound.