RU2311147C2 - Appliance for treating osseous fractures in middle facial area - Google Patents

Abstract

FIELD: medicine, oral surgery.

SUBSTANCE: the suggested appliance has got the main carrying arch, fastening elements as Kirschner's needles, a mobile arch and a bridge for application between the mentioned arches. The above-mentioned bridge and arches are designed out of self-hardening plastic. One should introduce Kirschner's needles into zygomatic processes of temporal bones, into zygomatic arches, zygomatic processes of frontal bone, superciliary arches of frontal bone, nasal processes of frontal bone; as for free ends of these needles they should be curved along the skin to apply the main carrying arch above them. Kirschner's needles should be inserted into maxillary fragments. In oral cavity from palatine side the needles' ends are curved as a fishing hook. The ends of the needles withdrawn into the vestibule of oral cavity should be fixed towards the upper dental row. Free ends of the needles introduced into maxillary fragments should be curved along the skin and a mobile arch should be put onto these ends.

EFFECT: the innovation provides shortened period for therapy and decreases the number of complications at fractures of the middle facial area, higher efficiency.

1 dwg

Description

The invention relates to maxillofacial surgery and is intended for the treatment of middle fractures.

Known similar devices for the treatment of fractures of the facial skeleton. Operational fixation of bone fragments according to Federspil, which consists in securing the maxillary tooth splint with a stainless steel wire drawn through the thickness of the cheeks and fixed on a plaster head bandage, in which special wire frames are mounted. Fixation of fragments of the upper jaw using the set of Y.M. Zbarge (1957), consisting of a tooth tire with extraoral rods, a supporting head bandage with side metal strips and connecting rods and couplings. However, 62% of patients with fractures along the lines of Le Faure and treated with these methods did not achieve a sufficiently good final result, they needed correction of both the occlusion and the shape of the face (J. Ferrato et Bergren).

Regardless of the material used, all of the above and similar designs have two significant drawbacks: firstly, they cannot rigidly and motionlessly hold fragments of bones of the middle zone of the face in the required position, because they are all fixed with headbands. The scalp is mobile, it can move up to 1.5-2.5 cm and is constantly in motion, as a result of which the fixing elements of the structures do not provide reliable immobilization of bone fragments. The instability of bone fragments leads to an increase in the duration of treatment and deformations of the face shape, which, in turn, leads to repeated surgical interventions. In addition, these designs cannot be used for burns, abrasions and wounds of the soft tissues of the cranial vault.

Secondly, a significant drawback is their bulkiness and weight, causing significant physical and mental discomfort to patients, which also negatively affects the timing of their rehabilitation.

The closest prototype to our design is the device of G.I.Osipov, I.I. Ermolaev and S.M.Kvaskov for the treatment of skull fractures, consisting of supporting (main) arches made with longitudinal grooves, a series of alternating through holes and grooves the longitudinal axis, movably interconnected by locks in the form of shaped washers with holes for fixing screws and fasteners (AS No. 735247 of 04/07/78).

However, the known device has several disadvantages. Firstly, the method of fixing it is quite traumatic when skin incisions are made, holes are drilled into the bones with a milling cutter, where the screws are screwed. Secondly, the small area of the support of the fixative (screw) determines the rapid resorption (resorption) of bone tissue and loosening of the fixative. In this regard, reliable fixation of bone fragments of the middle zone of the face is not achieved. As a result, delayed consolidation occurs, leading to secondary displacements and improper fusion of bone fragments, which entails repeated surgical interventions.

The aim of the invention is to reduce the treatment time and reduce the number of complications of fractures of the middle zone of the face.

To achieve the goal, the following tasks were set: reliable, rigid fixation of the bones of the facial skull during fractures of the middle zone of the face along the lines of Le Fora for the entire period of treatment.

To perform the tasks, a device for treating fractures of bones of the middle zone of the face is proposed, containing the main supporting arch, fasteners in the form of Kirchner spokes, characterized in that it is equipped with a movable arc and a bridge for laying between the said arches, while the said bridge and arcs are made of self-hardening plastics, Kirchner spokes are inserted into the zygomatic processes of the temporal bones, into the zygomatic arches, the zygomatic processes of the frontal bone, the superciliary arches of the frontal bone, the nasal processes of the frontal bone, and the free ends of these spokes are made pivot along the skin and lay on them the main supporting arch, in addition, the Kirchner spokes are inserted into the fragments of the upper jaw, and in the oral cavity from the palatine side, the ends of the spokes bend in the form of a fishing hook, and the ends of the Kirschner spokes, brought out in front of the oral cavity, are fixed to the upper dentition, the free ends of the spokes inserted into the fragments of the upper jaw are bent along the skin and a movable arc is applied to these ends

A device for treating fractures of bones of the middle zone of the face contains the main supporting arch 1 made of self-hardening plastic, to which fasteners are fixed in the form of Kirschner spokes 2 inserted into the zygomatic processes of the temporal bone, zygomatic arches, 3 zygomatic processes of the frontal bone, 4 superciliary arches of the frontal bone bones, 5 nasal processes of the frontal bone, the free ends of 6 spokes 2, 3, 4, 5 bend along the skin and impose on them the main supporting arch 1 of self-hardening plastic. The main carrier arc 1 is rigidly fixed to the movable arc 7 by a bridge 8, which are made of self-hardening plastic. Fastening elements in the form of Kirchner spokes 9 are fixed to the movable arc 7. Kirchner spokes 9 are inserted into the fragments of the upper jaw brought into the oral cavity from the palatine side, the ends 10 of the Kirchner spokes 9 are bent in the form of fishing hooks, the ends of the 11 Kirschner spokes 9, brought out on the threshold the oral cavity is fixed to the upper dentition. The free ends 12 of the spokes 9 inserted into the fragments of the upper jaw are bent along the skin and a movable arc 7 made of self-hardening plastic is applied to these ends 12.

The drawing shows a device for the treatment of bone fractures of the middle zone of the face, which is used as follows.

After processing the surgical field under local or general anesthesia, Kirschner spokes 2, 3, 4, 5 are inserted percutaneously into the zygomatic processes of the temporal bones, into the zygomatic arches, into the zygomatic processes of the frontal bone of the spoke 3, the superciliary arches of the frontal bone of the spoke 4, the nasal processes of the frontal bone of the knitting needle 5 at an angle to each other and to the bone plane. Knitting needles 2 pass the external cortical plate of the zygomatic process of the temporal bone, the spongy substance and the internal cortical plate. Knitting needle 3 is inserted into the zygomatic process of the frontal bone, passing the external cortical plate with access to the spongy substance to a depth of 1 cm, without going into orbit. The free ends of 6 spokes 2, 3, 4, 5 are bent along the skin at the level of 1 cm, on which the main supporting arch 1 of self-hardening plastic is superimposed.

Then, after preliminary reposition of bone fragments of the middle zone of the face, Kirschner spokes 8, 9, 10 are inserted percutaneously at an angle to each other and the bone plane, into the alveolar process of the upper jaw, into the walls of the maxillary sinuses, into the walls of the nasal cavity and the hard palate. Knitting needles 10, having passed a hard palate with access to the oral cavity, are bent in the form of a fishing hook, knitting needles 11, pulled out in front of the oral cavity, are bent along the upper dentition and fixed to it with wire ligatures. The free ends of the 12 knitting needles 9, 10, 11 are bent along the skin of the face at the level of 1 cm. A movable arc 7 of self-hardening plastic is applied to these ends of the 12 knitting needles 9, 10, 11. After the main reposition of bone fragments of the upper jaw during fracture of the bones of the middle zone of the face, a bridge 8 of self-hardening plastic is applied between the main supporting arch 1 and the movable arch 7.

The design of the needles 2, 3, 4, 5 and the main supporting arc 1, the needles 9, 10, 11 and the movable arc 7, the bridge 8 is on the patient until the optimal consolidation of fragments of the middle zone of the face.

During treatment of a fracture of the middle zone of the face with a device for treating bone fractures of the middle zone of the face, it is possible to carry out an additional reposition of fragments. To do this, destroy the bridge 8, connecting the main supporting arc 1 and the movable arc 7. Then carry out an additional reposition of fragments in case of a fracture of the middle zone of the face. Having finished reposition of the fragments, again bridge 8 is laid between the main supporting arc 1 and the movable arc 7 made of self-hardening plastic.

Claims (1)

A device for treating fractures of bones of the middle zone of the face, containing the main supporting arch, fasteners in the form of Kirchner spokes, characterized in that it is equipped with a movable arc and a bridge for laying between the said arcs, while the said bridge and arcs are made of self-hardening plastic, Kirschner spokes injected into the zygomatic processes of the temporal bones, into the zygomatic arches, the zygomatic processes of the frontal bone, the superciliary arches of the frontal bone, the nasal processes of the frontal bone, and the free ends of these spokes bend along the skin integument and lay on them the main supporting arch, in addition, Kirschner spokes are inserted into the fragments of the upper jaw, and in the mouth from the palatine side, the ends of the spokes bend in the form of a fishing hook, and the ends of the Kirschner spokes, brought out in front of the oral cavity, are fixed to the upper dentition, the free ends of the spokes inserted into the fragments of the upper jaw are bent along the skin and a movable arc is applied to these ends.