RU2471436C2 - Method of surgical treatment of mandibular fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology of maxillo-facial area and is intended for treatment of patients with fractures of mandible with displacement of fragments. Two vertical cuts are made on external surface of alveolar process - medially and distally from tooth, extracted from fracture line, within alveolus. Cut is continued on transitional fold forward and backward. Operation wound is irrigated with ozonised physiological solution with concentration of ozone 500 mcg/l. Fragments are reposited and fixed with titanium mini-plates and intraosseous screws. Alveolus of tooth, extracted from fracture line, is filled with "Kolapol KP-3", impregnated with ozonised physiological solution. Muco-periosteal flap is mobilised, laid on wound with overlap of alveolus, and fixed with sutures. In post-operative period performed is parenteral intravenous introduction of ozonised physiological solution with concentration of ozone 200-220 mcg/l, with further irrigations of post-operative wound with ozonised physiological solution with concentration of ozone 500 mcg/l and applications of ozonised peach oil with concentration of ozone 200 mcg/l.

EFFECT: method makes it possible to create conditions for restorative regeneration of bone tissue in fracture zone, due to fixation of fragments and filling alveolus of tooth, extracted from fracture line with "Kolapol KP-3", impregnated with ozonised physiological solution.

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Description

The invention relates to medicine, namely to traumatology of the maxillofacial region, and can be used in patients with fractures of the lower jaw with displacement of fragments and localization of the tooth to be removed, in the area of the fracture line and preventing the reposition of fragments, or which is a source of odontogenic infection.

Known methods for treating fractures of the lower jaw.

1. The method of M. Champy. A feature of the method is a linear incision is performed along the vestibular surface of the alveolar process below the attached gum. Fragments are repaired, fixed by the 1st or 2 parallel miniplates and intraosseous screws (1).

The disadvantage of this method is a wide detachment of the periosteum, which violates the trophism of bone tissue and can contribute to the development of osteomyelitis.

2. The method of A. S. Artyushkevich. A feature of the method is that from the side of the vestibule of the oral cavity, a triangular or trapezoidal mucoperiosteal flap is cut out and exfoliated. On the toothless jaws in the fracture area, a horizontal incision is made along the crest of the alveolar process. In the presence of teeth - 3-5 mm below the attached gum (2). The disadvantage of this method is, if necessary, remove the tooth from the fracture line and replace the defect with osteoplastic material, there are no conditions for isolating the fracture line and osteoplastic material from the environment. Suturing the hole by bringing the edges closer does not provide a "tightness" of the wound, which creates the conditions for the identification of the graft and bone wound. This, ultimately, can lead to transplant rejection and the development of traumatic osteomyelitis of the lower jaw.

This method is taken as a prototype.

The aim of the invention is to improve the adaptation of the transplanted graft, optimize the regenerative regeneration of bone tissue in fractures of the lower jaw, increase the effectiveness of treatment, reduce the number of complications.

This goal is achieved by the fact that two vertical cuts are made along the outer surface of the alveolar process - medially and distally from the tooth removed from the fracture line, within the borders of the socket, the section is extended along the transitional fold anterior and posterior, the socket of the extracted tooth is filled with saturated ozonized physiological solution with ozone concentration 500 mcg / l “Kolapol KP-3”, the mucoperiosteal flap is mobilized, placed on the wound with the overlapping of the hole, fixed with sutures, in the postoperative period, parenteral intravenous the introduction of an ozonized physiological solution with an ozone concentration of 200 - 220 μg / l, followed by irrigation of the postoperative wound with an ozonized physiological solution with an ozone concentration of 500 μg / l and applications of ozonized peach oil with an ozone concentration of 200 μg / l.

Comparison of the proposed method with others known in the field of medicine, showed compliance with its criteria of the invention.

The method is as follows.

Under general anesthesia, after twice treating the operative field in the oral cavity with ozonized physiological saline with an ozone concentration of 500 μg / l, two vertical incisions are made in the oral cavity - one medially, the second distally from the tooth to be removed located in the fracture line. Incisions begin from the top of the interdental papilla and end at the level of the transitional fold of the lower jaw. Further, the incisions extend anterior and posterior along the transitional fold at the level of two adjacent teeth. A mucoperiosteal flap is peeled off with a raspator, exposing the fracture line. The surgical wound is constantly irrigated with ozonized saline with an ozone concentration of 500 μg / L. The tooth is removed from the fracture line, the well is treated, washing it out of the syringe with ozonized saline solution with an ozone concentration of 500 μg / L. An audit of the fracture line is carried out, freely lying small bone fragments are removed, large ones are put in place. Under the control of vision and bite, the fragments are repaired to the correct position and fixed with bone titanium mini-plates and intraosseous screws. The hole of the tooth removed from the fracture line is rinsed abundantly with ozonized physiological saline with a known concentration of ozone, filled with soaked ozonized saline, in the same concentration, “Kolapol KP-3”. The mucosal-periosteal flap is mobilized by dissecting the periosteum at the place where the vertical parts of the incisions become horizontal. The flap is moved so that it overlaps the hole of the extracted tooth filled with the Kolapol KP-3 osteoplastic material, without tension. The flap is fixed with interrupted sutures from the polypropylene polyamide thread. The wound in the oral cavity is sutured with nodal sutures tightly, without leaving drains.

In the postoperative period, traditional drug therapy is replaced by intravenous administration of ozonized physiological solution with an ozone concentration of 200-220 μg / L. The first dressing is carried out the next day - the oral cavity, the postoperative wound is treated with jet or plentifully moistened with ozonized physiological solution with an ozone concentration of 500 μg / l, gauze swab, then ozonated peach oil is applied to the suture line. The course of treatment is 6 to 10 procedures daily. Physiotherapy starts on the next day after surgery: cryotherapy 2-5 sessions, from the third day prescribed physical therapy in combination with electrical procedures. Functional load is carried out from the first day with a gradual increase in volume and duration.

Clinical examples.

1. Patient A., 18 years old, medical history No. 1325/118, was admitted to the clinic of the Samara State Medical University on March 18, 2008 with an emergency diagnosis: An open fracture of the lower jaw in the left corner with a displacement of fragments. A clinical and radiological examination and subsequent surgical treatment were performed: 37 and 38 teeth were removed from the fracture line, the holes were filled with osteoplastic material, the fragments were repaired and fixed according to the proposed technique. In the postoperative period, ozone therapy was performed. A control x-ray study was performed the day after the operation. The postoperative period without features. The sutures were removed on the 7th day after the operation, 8 beds were performed in the clinic.

2. Patient B., 22 years old, medical history 6126/338, was admitted to the Maxillofacial Surgery Clinic of SamSMU on March 29, 2009 with a diagnosis of Open fracture of the lower jaw on the left with displacement of fragments. After a clinical and radiological examination, the patient underwent surgery to remove a tooth from the fracture line, bloody reposition and osteosynthesis of fragments of the lower jaw, according to the proposed method. In the postoperative period, ozone therapy was performed. The postoperative period without features. Control examination after 6 months. The patient does not show complaints, the face is symmetrical, opening the mouth in full, painlessly.

Using the proposed method for the treatment of fractures creates optimal conditions for the regenerative regeneration of bone tissue in the fracture zone, provides sufficient morphological and functional reconstruction of the bone regenerate, provides restoration of the bone tissue of the lower jaw, reduces the time of postoperative rehabilitation.

INFORMATION SOURCES

1. Champy M., Lodde Z. P., Muster D. et al. Les osteosyntheses par plawues vissees ministurisees en chirurgie faciale et cranienne. Indications. Resultats a propos de 400 cas. - Ann. Chir. plast. - 1977. - Vol.22. - No. 4. - P.261-264.

2. Artyushkevich A.S. Comparative evaluation of surgical methods for treating fractures of the lower jaw from the position of blood circulation, function, biomechanics: author. dis. ... Dr. honey. sciences. - Smolensk, 1995 .-- 88 p.

Claims (1)

A method for treating mandibular fractures by reposition of fragments, fixing them with bone titanium mini-plates for osteosynthesis and intraosseous screws with intraoral access, removing a tooth from the fracture line, characterized in that two vertical incisions are made along the outer surface of the alveolar bone - medially and distally from the fracture removed tooth, within the borders of the hole, the incision is extended along the transitional fold anterior and posterior, the hole of the extracted tooth is filled with saturated ozonized saline solution with ozone concentration of 500 μg / L “Kolapol KP-3”, the mucoperiosteal flap is mobilized, placed on a wound with overlapping holes, fixed with sutures, in the postoperative period, parenteral intravenous administration of ozonized physiological solution with an ozone concentration of 200-220 μg / l, s subsequent irrigation of the postoperative wound with ozonized saline solution with an ozone concentration of 500 μg / l and applications of ozonized peach oil with an ozone concentration of 200 μg / l.