RU2382612C1 - Method of operative treating fracture of condylar process of mandible base with ingury of semilunar insisure and displacement of fragments - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: cut in retromaxillary region between anterior edge of nodding muscle and posterior edge of mandible ramus is made. Skin, subcutaneous fat, subcutaneous muscle and own neck fascia are dissected. Posterior back edge of mandible and base of condylar process of mandible are exposed. Periosteum is dissected on posterior edge of mandible rumus in place of fracture. Tissues are separated from bone fragments. Condylar process of mandible is taken on bone clip and brought onto external surface of mandible rumus. Controlled resection of its part adjacent to semilunar incisure of mandible is carried out by means of drill. Condylar process is reset into correct position. Osteosynthesis of bone fragments with further layer-by-layer wound closure and fixation of patient's bite are performed.

EFFECT: method ensures accurate and easy resetting and reliable fixation of condylar process of mandible in case of fractures in place of its base with injury of semilunar incisure and displacement of fragments, reduction of operative intervention duration.

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Description

The invention relates to medicine, namely to surgical dentistry and maxillofacial surgery, and can be used in the surgical treatment of a fracture of the base of the condylar process of the lower jaw with damage to the lunate notch and displacement of fragments.

Closest to the proposed one is the standard method of surgical treatment of fractures of the base of the sutured process of the lower jaw, which is as follows: under endotracheal anesthesia, an incision is made in the maxillary region, sharply and bluntly pass to the posterior surface of the lower jaw branch, a tendon of the chewing and medial pterygoid muscles is dissected, and they are skeletonized bone fragments, carry out their reposition in the correct position and osteosynthesis, followed by layer-by-layer suturing of the wound and fixation of the patient’s bite [1].

The disadvantage of this operation is the difficulty of correct reposition of the condylar process during fractures passing along the crescent cut of the lower jaw, as well as the high probability of its repeated displacement.

The objective of the invention: to ensure accurate reposition and reliable fixation of the condylar process of the lower jaw during fractures in the area of its base with damage to the lunate notch and the displacement of fragments.

The problem is solved due to the fact that the condylar process of the lower jaw is taken to the bone clamp and brought to the outer surface of the branches of the lower jaw, boron is controlled resection of its part adjacent to the lunate incision of the lower jaw, after which the condylar process is repaired to the correct position, osteosynthesis is performed bone fragments with subsequent layer-by-layer suturing of the wound and fixation of the patient’s bite.

The method is as follows.

Under intubation anesthesia, after a double treatment of the surgical field, an incision is made in the maxillary region between the anterior margin of the sternocleidomast and the posterior margin of the lower jaw branch. Cut the skin, subcutaneous fat, subcutaneous muscle and own fascia of the neck. The posterior lower part of the parotid salivary gland, together with the capsule, is cut off from the anterior edge of the sternocleidomastoid muscle and the parotid salivary gland is lifted crochet up and anteriorly. The posterior edge of the lower jaw branch and the base of the condylar process of the lower jaw are exposed. The periosteum is cut along the posterior edge of the lower jaw branch in the fracture region (Fig. 1). A raspator exfoliates tissue from bone fragments. The condylar process of the lower jaw is taken to the bone clamp and brought to the outer surface of the branches of the lower jaw, boron conducts a controlled resection of its part adjacent to the semilunar notch of the lower jaw, from 3 to 5 mm (Fig. 2), after which the condylar process is easily repaired into the correct position, osteosynthesis of bone fragments is performed (Fig. 3), followed by layered closure of the wound and fixation of the patient’s bite.

The results of the treatment in this way of 15 patients of the main group with a diagnosis of a base fracture of the condylar process of the lower jaw with displacement of fragments showed that during the operation due to the resection of the part of the condylar process adjacent to the lunate incision of the lower jaw, it became possible to quickly and easily direct it to the correct position , which allowed to reduce the time of surgical intervention.

In the postoperative period, there was not a single case of repeated displacement of the condylar process in these patients.

All 15 patients received positive treatment results, and the hospital stay ranged from 9 to 12 days. Subsequently, the patients were discharged for outpatient aftercare at the dentist-surgeon at the place of residence.

In 20 patients of the control group with a fracture of the base of the condylar process of the lower jaw with damage to the lunar notch and displacement of fragments, surgical treatment was performed using the standard method. It was noted that during the operation more time is required in order to reposition the condylar process in the correct position, which generally increased the duration of surgical treatment. In addition, in the postoperative period, three patients of the control group experienced a repeated displacement of bone fragments, which required additional surgical treatment. The terms of hospitalization of patients in the control group ranged from 10 to 14 days.

Clinical example 1. Patient K., 36 years old, independently applied to the maxillofacial surgery department of the Regional Clinical Hospital on May 12, 2008. The patient complained of swelling of the soft tissues of the face on the left, pain in the lower jaw on the left, limited opening of the mouth, and the inability to eat and chew food.

From the anamnesis it was established that the patient was hit in the face by an unknown person on May 11, 2008, he did not lose consciousness, and there was no nausea of vomiting. 05/12/2008, the patient contacted the KKB, was hospitalized in the Department of Maxillofacial Surgery.

During an external examination of the patient, a violation of the face configuration due to edema, soft tissue hematoma in the left parotid chewing region was determined. The mouth opened to a limited extent of 2.5 cm. On radiography, a fracture of the left condylar process of the lower jaw was determined with damage to the lunar notch and displacement of the fragments.

Dental formula:

ABOUT ABOUT P P eighteen 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 ABOUT ABOUT P P ABOUT ABOUT where O - missing tooth, P - seal, K - root.

The patient was diagnosed with a fracture of the left condylar process of the lower jaw with displacement.

Upon admission, the patient was splintered jaws according to Tigerstedt.

Surgical treatment of this patient was carried out according to the proposed method: under intubation anesthesia, after a double treatment of the surgical field, an incision was made in the left maxillary region between the front edge of the left sternocleidomast and the posterior edge of the lower jaw branch on the left. Dissected skin, subcutaneous fat, subcutaneous muscle and own fascia of the neck. The posterior lower part of the left parotid salivary gland, together with the capsule, was cut off from the front edge of the left sternocleidomastoid muscle and the left parotid salivary gland was raised crochet up and anteriorly. The posterior edge of the lower jaw branch on the left and the base of the left condylar process of the lower jaw were exposed. The periosteum was dissected along the posterior edge of the lower jaw branch to the left in the fracture area. Raspator exfoliated tissue from bone fragments (figure 4). The left condylar process of the lower jaw was taken on a bone clamp and brought to the outer surface of the left branch of the lower jaw. Boron performed a controlled resection on 4 mm of its part adjacent to the lunate incision of the lower jaw on the left (Figs. 5, 6, 7, 8), after which the left condylar process was easily repaired to the correct position (Fig. 9) and fixed with a bone suture (figure 10). The wound was sutured in layers and the patient’s bite was fixed with rubber traction.

Immediately after surgery, the patient was transferred to the Department of Oral and Maxillofacial Surgery.

The next day after surgical treatment, the patient underwent a panoramic radiography of the lower jaw in the direct and lateral projections.

When evaluating X-ray images on a negatoscope, the correct position of the left condylar process of the lower jaw was determined.

Thus, this patient did not need additional surgical treatment.

Surgical sutures were removed 8 days after surgical treatment. The hospital stay was 12 days. Subsequently, the patient was discharged for outpatient follow-up treatment at the dentist-surgeon at the place of residence.

Clinical example 2. Patient V., 42 years old, was taken by an emergency team to the maxillofacial surgery department of the Regional Clinical Hospital on July 7, 2008. The patient complained of swelling of the soft tissues of the face on the right and left, pain in the lower jaw on the right and left, bleeding from the mouth, malocclusion, inability to eat and chew food.

From the anamnesis it was established that the patient was beaten by the unknown on July 7, 2008, he did not lose consciousness, there was no nausea, vomiting, he called an ambulance at home, after which he was taken to the maxillofacial surgery department.

During the external examination of the patient, a violation of the face configuration due to edema, soft tissue hematoma in the right parotid chewing region and in the region of the lower jaw angle to the left was determined. Bite broken. The mouth opened to a limited extent of 2.5 cm. A two-sided fracture of the lower jaw with displacement of fragments: the right condylar process of the lower jaw with damage to the lunar notch and angular on the left was determined on x-ray. 38 tooth was in the fracture gap (11).

Dental formula:

ABOUT eighteen 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 ABOUT ABOUT ABOUT where O - missing tooth, P - seal, K - root.

The patient was diagnosed with a bilateral fracture of the lower jaw with displacement of fragments: the right condylar process and angular on the left.

When the patient was admitted to the ward, Tigerstedt splinted the jaw and removed 38 teeth from the fracture gap.

Surgical treatment of displacement of the right condylar process in this patient was carried out according to the method we proposed: under intubation anesthesia, after a double treatment of the surgical field, an incision was made in the right maxillary region between the front edge of the right sternocleidomast and the posterior edge of the lower jaw branch on the right. Dissected skin, subcutaneous fat, subcutaneous muscle and own fascia of the neck. The posterior lower part of the right parotid salivary gland together with the capsule was cut off from the front edge of the right sternocleidomastoid muscle and the right parotid gland was raised crochet up and anteriorly. The posterior edge of the lower jaw branch on the right and the base of the right condyle process of the lower jaw were exposed. The periosteum was cut along the posterior edge of the lower jaw branch to the right in the fracture area. Raspator exfoliated tissue from bone fragments. The right condylar process of the lower jaw was taken on a bone clamp and brought to the outer surface of the right branch of the lower jaw. Boron performed a controlled resection of 3 mm of its part adjacent to the lunar incision of the lower jaw on the right, after which the right condylar process was easily repaired to the correct position and fixed with a bone suture. Osteosynthesis of the angle of the lower jaw on the left was performed according to the generally accepted method. The wounds were sutured in layers and the patient’s bite was fixed with rubber traction.

Immediately after surgery, the patient was transferred to the Department of Oral and Maxillofacial Surgery.

The next day after surgical treatment, the patient underwent a panoramic radiography of the lower jaw in the direct and lateral projections.

When evaluating X-ray images on a negatoscope, the correct position of the right condyle and the angle of the lower jaw on the left were determined (Fig. 12, 13).

Thus, this patient did not need additional surgical treatment.

Surgical sutures were removed 9 days after surgical treatment. The hospital stay was 12 days. Subsequently, the patient was discharged for outpatient follow-up treatment at the dentist-surgeon at the place of residence.

The advantages of the proposed method are the ability to quickly and easily reposition the condylar process in the correct position, which generally reduces the duration of surgery. Thanks to its reliable fixation to the branches of the lower jaw, the risk of its repeated displacement is significantly reduced.

Literature

1. Robustova T.G. Surgical Dentistry. M., 2003 .-- 504 p.

Claims (1)

A method for surgical treatment of a fracture of the base of the condylar process of the lower jaw with damage to the lunate notch and the displacement of fragments, including an incision in the maxillary region between the anterior edge of the sternocleidomast and the posterior edge of the lower jaw branch, dissection of the skin, subcutaneous fat, subcutaneous muscle and neck fascia, exposure of the posterior edge of the branch of the lower jaw and base of the condylar process of the lower jaw, dissection of the periosteum along the posterior edge of the branch of the lower jaw in the fracture area, peeling I tissue from bone fragments, characterized in that the condylar process of the lower jaw is taken to the bone clamp and brought to the outer surface of the branches of the lower jaw, boron conducts a controlled resection of its part adjacent to the lunate incision of the lower jaw, after which the condylar process is repaired to the correct position, osteosynthesis of bone fragments is carried out, followed by layer-by-layer suturing of the wound and fixation of the patient’s bite.

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