RU2339344C1 - Nose external prosthesis and method of its manufacturing - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: external prosthesis consists of two parts. First part is exposed to prosthetic bed and has ledges incoming into nasal passages and retentional points of the defect edges. Second part modeling external form of the nose, nasal passages, whereat edges of the prosthesis are located in nasolabial folds, is made of hard acryl plastic and wire fixing device in the area of nasal bridge, which is fixed to the rim of the eye-glasses. First part is made of super elastic alloy on the bases of nickel titanium in the shape of a saddle according to the anatomical from of the nasal bridge, upper edge of the piriform opening, nasal septum, and according to anatomical form of the internal surface of the wings of nose with retentional loops exposed to the second part. Wire fixing device is a nickel titanium U-shaped wire element with 0.7-1.0 mm diameter and it is hard-set in the plastic of the second part. Ledges, incoming into the nasal passages and retentional points of the edges of the defect are 0.3 mm thick. Method of manufacturing of the external prosthesis presupposes insulation of eye brows, eyelashes, moustache with vaseline oil; taking cast of the face in accumbent position of the patient with elastic alginate and making plaster mask. Wax reproduction of the fist part of the prosthesis is modeled by pressing plaster face mask with one 0.3 mm layer of bugel wax, covering the nasal bridge as a saddle, upper edge of the piriform opening, nasal septum, forming also ledges incoming into the nasal passages, retentional points of the edges of the defect according to the anatomical from of the internal surface of the wings of the nose. Then retentional loops for connection of the parts of prosthesis are made from wax piece - parts on the side exposed to the second part of the prosthesis, pouring gate system is created, mold box is made and first part of prosthesis is molded of super elastic alloy on the bases of nickel titanium. Molding is fitted on the plaster mask and then on the face of the patient. Wax reproduction of the second part of prosthesis is modeled, by pressing of molding over the plastic mask with basic wax forming anatomical form and profile of nose identical or similar to the lost one. Form, size, direction and best location of the wire fixing device is determined by modeling its analog of clasp wire in a form of a U-shaped element. Form, size of the above said device is modeled in accordance with the analogue of nickel titanium wire with 0.7-1.0 mm diameter. The above said device is manufactured by high-temperature molding method. The above mentioned device is placed into the wax reproduction. Well-modeled prosthesis is plastered into the ditch consisting of two parts - bottom and lid. The ditch is kept under pressure until complete freezing of plaster. After wax was removed by vaporation method, the ditch is opened, surface of the upper plastic from is insulated by dividing lacquer, then upper part of the ditch is filled in with doughty acrylic resin mixed with addition of dry cosmetic powder of color corresponding to the hue of the color of patient's face; halves of the ditch are connected and pressured vertically. The ditch is cooled, and then prosthesis is taken out from the ditch, finished, processed, polished and fitted on the face of the patient and fixed to the rim of eye glasses.

EFFECT: ensures better medical-social rehabilitation of patients with subtotal and total nose defects.

28 dwg, 1 ex

Description

The invention relates to medicine, namely to maxillofacial orthopedics, surgery, traumatology, oncology, otorhinolaryngology, and can be used for temporary (until the flaw is removed by plastic surgery methods) or final prosthetics of patients with subtotal and total nose defects of various etiologies, as well as for the manufacture of an ectoprosthesis of the nose.

The closest to the technical essence of the prosthesis design and the achieved method of its manufacture are: a nose ectoprosthesis, consisting of two parts, the first of which is made of elastic plastic in the form of a lining in the places of the bone protrusions with the formation of retention sections introduced into the region of the edges of the nose defect and nasal the passages, the second - from solid acrylic plastic, simulating the external shape of the nose with the location of the edge of the prosthesis in the nasolabial folds, the inner surface of the wings of the nose, the lower nasal passages, with fixed a capping device, made in the form of a wire ligature, drawn through the edge of the prosthesis plastic in the nose region and monolithically fixed in the spectacle frame; a method of manufacturing an ectoprosthesis of the nose, including isolating Vaseline with eyebrows, eyelashes, mustache, obtaining a cast of the face in a reclining position of the patient with an elastic impression mass and making a gypsum mask, modeling a wax reproduction of an ectoprosthesis of a nose and fitting on a patient's face, installing a fixation device, plastering a wax reproduction of the prosthesis into a cuvette , wax removal by evaporation and opening the cuvette, insulating the surfaces of gypsum molds with dividing varnish, packaging of acrylic plastic with the addition of carriers and its polymerization, cooling the cuvette, removing the prosthesis from the cuvette, finishing, processing, grinding, fitting on the patient's face, making an elastic pad with retention areas and monolithic fastening to the spectacle frame (Kostur B.K., Minyaeva V.A. Chelyustno- facial prosthetics. - L .: Medicine, 1985. - P.71-84).

Known ectoprosthesis of the nose and a method of manufacturing an ectoprosthesis of the nose have the following disadvantages: the manufacture of the part of the prosthesis facing the prosthetic bed from elastic plastic in the form of a lining, the thickness of which is 2 mm or more (providing the minimum necessary strength characteristics) when forming retention sections introduced into the region of the edges defect of the nose and nasal passages, complicates nasal breathing, prevents the heating of air in the natural and artificial nasal cavities, as it is made of a material that does not conduct well lo, and heat insulating portions stored nasal mucosa in the airflow path; rapid deformation and insufficient strength of elastic plastic reduces the life of the prosthesis; the lack of biocompatibility with body tissues and the porosity of plastic under conditions of constant secretion of nasal secretions, chronic inflammation and tissue atrophy at the sites of contact with the prosthesis worsen the hygienic characteristics of the prosthesis; the monolithic connection of the ectoprosthesis of the nose with the spectacle frame leads to its immobility during the functioning of the facial muscles, which together reduces the results of medical and social rehabilitation of patients.

The objective of the invention is to increase the efficiency of medical and social rehabilitation of patients with subtotal and total defects of the nose by improving the quality and functional characteristics of the ectoprosthesis of the nose due to new design solutions using superelastic alloys based on titanium nickelide.

The problem is achieved in that in an ectoprosthesis of the nose, consisting of two parts, the first of which is facing the prosthetic bed and made with protrusions that are included in the nasal passages and retention points of the edges of the defect, the second part is made modeling the external shape of the nose, nasal passages, with the location the edges of the prosthesis in the nasolabial folds, made of hard acrylic plastic and a wire fixing device in the nose bridge fixed to the spectacle frame, is new that the first part is made of a superelastic alloy on again titanium nickelide in the form of a saddle according to the anatomical shape of the nose bridge, the upper edge of the pear-shaped opening, nasal septum, and also the anatomical shape of the inner surface of the wings of the nose, with retention loops from the side facing the second part, the wire fixing device is made in the form of a U-shaped wire element of titanium nickelide with a diameter of 0.7-1.0 mm and fixed motionless in the thickness of the plastic of the second part, and the protrusions included in the nasal passages and retention points of the edges of the defect have thicknesses inu 0.3 mm, and in the proposed method for the manufacture of an ectoprosthesis of the nose, which includes isolating Vaseline with eyebrows, eyelashes, mustaches, obtaining a facial impression in a reclining position of the patient with an elastic impression mass, making a gypsum mask, it is new that they model a wax reproduction of the first part of the prosthesis by compression of the gypsum face mask with one layer of clasp wax 0.3 mm thick, covering the nose in the form of a saddle, the upper edge of the pear-shaped opening, the nasal septum with the formation of protrusions entering the nasal passages, retention points of the edges of the defect, respectively, of the anatomical shape of the inner surface of the wings of the nose, then made from wax blanks from the side facing the second part of the prosthesis, retention loops to connect the parts of the prosthesis, create a gate system, make a mold and cast the first part of the prosthesis from superelastic an alloy based on titanium nickelide, the casting is fitted on a gypsum mask, then a wax reproduction of the second part of the prosthesis is modeled on the patient's face by compressing the casting on gypsum The face mask with basic wax with the formation of an anatomical shape and nose profile identical or similar to lost, determine the shape, size, direction and optimal location of the wire fixing device by modeling its analog from the clammer wire in the form of a U-shaped element, model the shape and size of the said device in accordance with the analogue of titanium nickelide wire with a diameter of 0.7-1.0 mm, make the specified device by high-temperature molding, set mentioned The device for wax reproduction, the simulated prosthesis is plaster in a cuvette, consisting of two parts - the bottom and the lid, the cuvette is kept until the gypsum has completely hardened under pressure, after removing the wax by evaporation, the cuvette is opened, the surface of the upper plaster mold is insulated with a separating varnish, the upper part of the cuvette is filled dough-like acrylic plastic mixed with powder of dry cosmetic powder of a color corresponding to the shade of the patient's face, half the cuvette is joined and pressed in a vertical direction, cool the cuvette, remove the prosthesis from the cuvette, finish, process and grind it, and then fit it on the patient's face and attach it to the spectacle frame.

Performing the first part of the nose ectoprosthesis facing the prosthetic bed with the protrusions entering the nasal passages and retention points of the defect edges in the form of a saddle according to the anatomical shape of the nose bridge, upper edge of the pear-shaped opening, nasal septum, and also the corresponding anatomical shape of the inner surface of the wings of the nose from a superelastic alloy based on titanium nickelide provides: high-precision matching of the prosthesis to the prosthetic bed due to its minimal shrinkage during casting; improved prosthesis fixation by increasing the effective retention area; reducing the thickness of the protrusions entering the nasal passages and retention points of the edges of the defect to 0.3 mm improves nasal breathing, helps to warm the air in the natural and artificial nasal cavities, since titanium nickelide has greater thermal conductivity compared to elastic plastic and performs the heat-retaining function of the stored sections of the mucous membrane of the nasal cavity in the air flow path, contributing to an increase in the body's resistance to the development of colds; increased strength and durability of the prosthesis due to the greater strength of titanium nickelide in comparison with elastic plastic, the reliability of the connection of the plastic and metal parts of the prosthesis through the presence of retention loops, and biocompatibility with body tissues and the absence of porosity under conditions of constant nasal secretion prevent inflammation and atrophy of the skin and the mucous membrane in places of contact with the prosthesis, increase the hygienic characteristics of the prosthesis. The implementation of the locking device in the form of a U-shaped wire element made of titanium nickelide, fixedly mounted in the thickness of the plastic of the second part of the nose ectoprosthesis and detachably connected to the eyeglass frame, in shape, direction and length, providing contact of the distal sections with the outer surface of the nose stops of the spectacle frame when located them on the bridge of the ectoprosthesis, promotes elastic retention interaction while maintaining the functional mobility of the prosthesis due to the superelastic behavior of the wire ikelid titanium element in the functioning of the patient's facial muscles, and increased resistance to fatigue during prolonged differently oriented deformation increases the reliability and durability of the design to be achieved while maintaining the retention stability.

In order to create the first part of the prosthesis from metal, a gypsum mask is additionally duplicated and a copy of it is made from the refractory mass. To create a structure that exactly corresponds to the prosthetic bed, having a minimum thickness, high strength and biocompatible characteristics with body tissues, a wax reproduction of the first part of the prosthesis from clasp wax 0.3 mm thick with a saddle-shaped covering on the anatomical shape of the nose bridge, the upper edge of the pear-shaped holes, nasal septum with the formation of protrusions included in the nasal passages and retention points of the edges of the defect, as well as the corresponding anatomical shape of the inner surface wings of the nose, then made retention hinge side, facing the second part of the prosthesis for connecting the plastic and metal parts of the prosthesis. The metal part of the base is casted after the gating system is created and the mold is made. To prevent atrophy and inflammatory reaction of prosthetic bed tissues, the metal part of the prosthesis facing the prosthetic bed is cast from a superelastic alloy based on titanium nickelide, which, due to minimal shrinkage and casting thickness, increases the effective retention area, the volume of supporting structures, and improves the fixation of the prosthesis. After casting, the metal frame is machined in a sandblasting machine to clean the refractory mass, polished, then fit on the patient's face. To exclude the translucency of the metal, it is primed on the side of the connection with the plastic. The clamping device is made of clammer wire and manufactured in accordance with the analogue by the method of high-temperature molding of nickel-titanium wire with a diameter of 0.7-1.0 mm by bending when it is locally heated to 450-500 ° C (the temperature that orders the crystal structure of the material in the deformable zone and sufficient for "remembering the form"), followed by chemical treatment and polishing in a mixture of nitric, hydrofluoric acid and water. The second part of the prosthesis is made of colorless acrylic plastic with the addition of powder of dry cosmetic powder of a color corresponding to the shade of the patient’s face skin, which is approved according to sanitary-hygienic and toxicological standards for contact with human skin, which is not a scarce material and is commercially available, with a wide selection palette individual color characteristics of the skin, which reduces the cost of prosthetics, makes it more affordable when satisfactory aesthetic p results.

The proposed device is illustrated by drawings, photographic materials and a clinical example, where:

Figure 1 - ectoprosthesis of the nose (frontal projection, diagram).

Figure 2 - ectoprosthesis of the nose (lateral projection, diagram).

Figure 3 - ectoprosthesis of the nose (projection from the prosthetic bed, diagram).

Figure 4 - the appearance of patient B. before treatment (frontal projection).

In Fig.5 - the appearance of patient B. before treatment (left semi-lateral projection).

Figure 6 - appearance of patient B. before treatment (left lateral projection).

In Fig.7 - the appearance of patient B. before treatment (semi-axial projection).

On Fig - gypsum mask patient B.

Figure 9 is a duplicated, refractory mask of patient B. with a simulated wax reproduction of the metal part of the nose ectoprosthesis.

Figure 10 - superelastic part of the nose prosthesis of titanium nickelide (projection from the side facing the plastic part of the prosthesis).

11 is a superelastic part of the nose ectoprosthesis of titanium nickelide (projection from the side facing the prosthetic bed).

On Fig - superelastic part of the nose ectoprosthesis of titanium nickelide after applying a primer coating on a gypsum mask.

On Fig - wax reproduction of the anatomical shape of the nose of the patient B. on a gypsum mask.

On Fig - fitting wax reproduction of an ectoprosthesis of the nose on the face of patient B. (frontal projection).

On Fig - fitting wax reproduction of an ectoprosthesis of the nose on the face of patient B. (left hemisphere projection).

On Fig - fitting wax reproduction of an ectoprosthesis of the nose on the face of a patient B. (left lateral projection).

On Fig - ectoprosthesis of the nose (frontal projection).

On Fig - ectoprosthesis of the nose (projection from the prosthetic bed).

On Fig - ectoprosthesis of the nose (projection from the side of the external nasal passages).

In Fig.20 - an ectoprosthesis of the nose on the face of patient B. (frontal projection).

In Fig.21 - an ectoprosthesis of the nose on the face of patient B. (left hemisphere projection).

In Fig.22 - an ectoprosthesis of the nose on the face of patient B. (left lateral projection).

In Fig.23 - ectoprosthesis of the nose on the face of patient B. (semi-axial projection).

On Fig - ectoprosthesis of the nose on the face of a patient B. at the time of a smile.

On Fig - ectoprosthesis of the nose on the face of a patient B. at the time of contraction of the facial muscles of the left half of the face.

On Fig - ectoprosthesis of the nose on the face of patient B. at the time of contraction of the facial muscles of the right half of the face.

On Fig - ectoprosthesis of the nose on the face of a patient B. at the time of contraction of the facial muscles of the forehead.

On Fig - ectoprosthesis of the nose on the face of patient B. at the time of tilting the head down.

An ectoprosthesis of the nose consists of two parts: the first 1 of which, facing the prosthetic bed, is made in the form of a saddle according to the anatomical shape of the nose bridge 2, the upper edge of the pear-shaped opening 3, the nasal septum 4, with protrusions entering the nasal passages and retention points of the edges of the defect 5 and, accordingly, the anatomical shape of the inner surface of the wings of the nose 6, with retention loops 7 from the side facing the second part, is made of a superelastic alloy based on titanium nickelide; the second - simulates the external shape of the nose 8, nasal passages 9, with the location of the edge of the prosthesis 10 in the nasolabial folds, made of solid acrylic plastic. The locking device 11 is made in the form of a U-shaped wire element made of titanium nickelide, fixed motionless in the thickness of the plastic of the second part in the region of the nose bridge 12, detachably fixed to the spectacle frame.

An ectoprosthesis of the nose is made as follows. After the external tamponade of the nasal passages with wet gauze wipes, leaving the retention points of the defect edges open, isolating the eyebrows, eyelashes, mustaches in the patient’s recumbent position with a petroleum jelly, they receive an impression of the face with an elastic impression mass and make a plaster face mask. Mark the boundaries of the first part of the prosthesis, duplicate a gypsum face mask and make a copy of it from the refractory mass. A wax reproduction of the first part of the prosthesis is simulated by compressing a gypsum face mask with one layer of clasp wax 0.3 mm thick, covering the nose bridge, the upper edge of the pear-shaped opening, the nasal septum with the formation of protrusions entering the nasal passages, retention points of the edges of the defect and, accordingly, anatomical shape of the inner surface of the wings of the nose. Retention points are made in the form of loops on the side facing the second part of the prosthesis for connecting the plastic and metal parts of the prosthesis from wax blanks 0.3 mm thick, 3-5 mm wide, 2-2.5 mm high, at a distance of 5-10 mm apart. Create a gate system and make a mold. The flask on the vibrating table is filled with a refractory mass and maintained until completely solidified. Wax is melted at a temperature of 300 ° C for 30 minutes, the mold is calcined to a temperature of 950 ° C for 30-40 minutes, after which the temperature is increased to 1230-1250 ° C for 20-30 seconds, titanium nickelide is melted (Pat. RF №2162667, IPC A61C 13/20, A61K 6/04, 1999) and rotate the entire crucible system with the flask. Under the action of centrifugal force, the molten metal fills the flask, contributing to a uniform casting structure due to its uniform compaction throughout the volume. After casting is completed, the flask is cooled to room temperature, the casting is removed from the flask, cleaned in a sandblasting apparatus, and the sprues are cut. The metal frame is subjected to chemical treatment and polishing in a mixture of nitric, hydrofluoric acid and water (in a ratio of 4: 1: 4), fit on a gypsum mask, then on the patient's face. The metal frame on the connection side with the plastic part of the prosthesis is coated with a special composition that excludes the transmission of metal through plastic, corresponding in color and shade of the skin to the patient’s face, for example, “Conalor”. A wax reproduction of the second part of the prosthesis is simulated by compressing the metal frame on a gypsum face mask with basic wax to form an anatomical shape and nose profile identical or similar to that lost corresponding to the patient's face in a given age period, with the edge of the prosthesis located in the nasolabial folds and nasal passages providing breathing as close to natural. An ectoprosthesis of the nose modeled in this way is tried on the patient's face. Clarify the anatomical features, the shape and size of the outer surface of the prosthesis, taking into account the wishes of the patient. The shape, size, direction and optimal location in the nose bridge of the prosthesis of the fixing device are determined by modeling its analogue from the clasp wire in the form of a U-shaped element and fitting until the distal sections come into contact with the outer surface of the nose stops of the spectacle frame when the ectoprosthesis is placed on the nose bridge. The shape and size of the fixing device are modeled in accordance with the analogue using crown-shaped forceps made of nickelide titanium wire with a diameter of 0.7-1.0 mm by bending when it is heated to 450-500 ° C (temperature sufficient to "remember the shape") followed by chemical treatment and polishing in a mixture of nitric, hydrofluoric acid and water (in a ratio of 4: 1: 4). A fixation device of titanium nickelide is installed in the wax reproduction of the ectoprosthesis of the nose. The simulated prosthesis is gypsum-plated in a cuvette consisting of two parts, a bottom and a cover. The cuvette is equipped with grooves and protrusions for fixing its detachable parts. In the lower part of the cuvette, a face mask with an ectoprosthesis of the nose is plastered in an upright position, the upper part of the cuvette is installed and filled with liquid gypsum on a vibrating table. The cuvette is maintained until the gypsum has completely hardened under pressure. After removing the wax by evaporation, the cuvette is opened, the surface of the upper gypsum mold is isolated with a separating varnish. The upper part of the cuvette is filled with a pasty colorless acrylic plastic mixed with dry powder powder of a color corresponding to the skin tone of the patient’s face, half of the cuvette is joined and pressed in a vertical direction. Plastic is polymerized. Cool the cuvette. The prosthesis is removed from the cuvette, it is trimmed, processed and polished, and then fitted on the patient's face.

Example. Patient V., 12 years old, turned in connection with an aesthetic defect in the face, lack of an external nose.

From the anamnesis: at the age of 7 months he received a thermal burn of the face, for which he was repeatedly hospitalized, four plastic surgeries were performed to replace flaws in the skin of the face. Surgical repair of a nose defect was temporarily denied until the growth of the facial skeleton.

Objectively: violation of the face configuration due to deformation of the tissues of the upper lip, cheeks, eyelids, forehead, lack of an external nose. The skin covering the flaw is pigmented, scarred.

DS: Total nasal defect, post-burn cicatricial deformity of the face, condition after surgical treatment.

An ectoprosthesis of the nose was made to the patient according to the developed technology. Dynamic observation for 1 year showed the absence of signs of inflammation of the tissues of the prosthetic bed, satisfactory functional results of prosthetics and social rehabilitation of the patient, a decrease in the number of respiratory diseases. The patient constantly uses the prosthesis, attends secondary school, satisfactory performance.

The technical result of the invention is: to increase the strength and durability of the prosthesis due to the high strength properties of titanium nickelide in comparison with elastic plastic, the reliability of the connection of the plastic and metal parts of the prosthesis through the presence of retention loops, superelastic behavior and increased fatigue resistance of the wire fixing device made of titanium nickelide when long multi-vector deformations while maintaining the necessary achieved retention st Ability high accuracy of the prosthesis correspondence to the prosthetic bed due to minimal shrinkage of titanium nickelide during casting; prevention of inflammation and atrophy of the skin and mucous membrane at the sites of contact with the prosthesis due to the biocompatibility of titanium nickelide with body tissues; improving the functional characteristics of the prosthesis: fixing due to the superelasticity of titanium nickelide and increasing the effective retention area of the prosthesis part facing the prosthetic bed, as well as the elastic retention interaction of the fixing wire device, which allows preserving the functional mobility of the prosthesis due to its superelastic behavior during the functioning of the patient’s facial muscles ; nasal breathing by reducing the thickness of the protrusions entering the nasal passages and retention points of the edges of the defect to 0.3 mm, warming the air in the natural and artificial nasal cavities due to the heat-resonating properties of titanium nickelide from stored sections of the nasal mucosa in the air flow, which contributes to increase the body's resistance to the development of colds. These design features of the device in the aggregate, the wide variation possibilities of achieving the desired aesthetic result due to the use of cosmetic powder, make it possible to increase the efficiency of medical and social rehabilitation of patients with subtotal and total nose defects using the methods of maxillofacial orthopedics.

Claims (2)

1. Nose ectoprosthesis, consisting of two parts, the first of which is facing the prosthetic bed and made with protrusions entering the nasal passages and retention points of the edges of the defect, the second part is made modeling the external shape of the nose, nasal passages, with the location of the edge of the prosthesis in the nasolabial folds , made of hard acrylic plastic and a wire fixing device in the nose bridge fixed to the spectacle frame, characterized in that the first part is made of a superelastic alloy based on titanium nickelide, in the form of a saddle according to an the tomic shape of the nose bridge, the upper edge of the pear-shaped opening, nasal septum, and also the anatomical shape of the inner surface of the wings of the nose, with retention loops on the side facing the second part, the wire fixing device is made in the form of a U-shaped wire element made of titanium nickelide with a diameter of 0, 7-1.0 mm and fixed motionless in the thickness of the plastic of the second part, and the protrusions included in the nasal passages and retention points of the edges of the defect have a thickness of 0.3 mm 2. A method of manufacturing an ectoprosthesis of the nose, including isolating a petrolatum with eyebrows, eyelashes, mustaches, obtaining a facial impression in a reclining position of the patient with an elastic impression mass, making a gypsum mask, characterized in that they simulate the wax reproduction of the first part of the prosthesis by compressing the gypsum mask with one layer of clasp wax 0.3 mm thick, covering the nose in the form of a saddle, the upper edge of the pear-shaped opening, the nasal septum with the formation of protrusions entering the nasal passages, the retention points of the edges of the defect with According to the anatomical shape of the inner surface of the wings of the nose, then they are made from wax blanks from the side facing the second part of the prosthesis, retention loops for connecting the parts of the prosthesis, create a gate system, make a mold and cast the first part of the prosthesis from a superelastic alloy based on titanium nickelide, the casting is fitted on a gypsum mask, then a wax reproduction of the second part of the prosthesis is modeled on the patient’s face by compressing the casting on the gypsum mask of the face with the base restoration com with the formation of an anatomical shape and profile of the nose identical or similar to the lost one, determine the shape, size, direction and optimal location of the wire fixing device by modeling its analog from a clammer wire in the form of a U-shaped element, model the shape and size of the said device in accordance with the analogue of nickelide titanium wire with a diameter of 0.7-1.0 mm, make the specified device by high-temperature molding, install the aforementioned device in a wax rep The products, the simulated prosthesis, are plastered in a cuvette consisting of two parts - the bottom and the lid, the cuvette is kept until the gypsum has completely hardened under pressure, after removing the wax by evaporation of the cuvette, the surface of the upper plaster mold is insulated with a separating varnish, the upper part of the cuvette is filled with pasty acrylic plastic, mixed with the addition of powder of dry cosmetic powder, the color corresponding to the shade of the patient's face, connect the half of the cuvette and press in the vertical direction, cool the cuve etu, they remove the prosthesis from the cuvette, finish it, process it and grind it, and then fit it on the patient's face and attach it to the spectacle frame.

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