RU2478341C1 - Method of endoprosthetics of temporomandibular joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and is intended for application in surgical treatment of patients with diseases and injuries of temporomandibular joint. Ramus and angle of mandible are skeletised. After cutting off masseter, medial and lateral pterogoid mussles from ablated part of ramus of mandible, superelastic, hollow, mesh, woven, cylindrical titanium nickelide implants, with diameter 10-20 mm, 10-25 mm long, with cell diameter 1-3 mm, made from 50-60 mcm thick thread are fixed on formed stumps. Osteotomy is performed from incisure to posterior edge of ramus. Osteotomated fragment is removed. Endoprosthesis is fixed to ramus of mandible by means of two omega-shaped staples from titanium nickelide. Masseter muscles with implants are fixed to endoprosthesis of temporomandibular joint, preliminarily covered with fibrous titanium nickelide. Wound is sewn layer-by-layer and drained.

EFFECT: method makes it possible to normalise function of temporomandibular joint, preserve functions of messeter, medial and lateral pterogoid muscles due to fixation of messenter muscles to fibrous layer of endoprosthesis.

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Description

The invention relates to medicine and can be used for surgical treatment of patients with diseases and injuries of the temporomandibular joint.

The closest technical solution is a method for the surgical treatment of ankylosing lesions of the temporomandibular joint and underdevelopment of the lower jaw, including the scaling of the angle and branch of the lower jaw, vertical osteotomy from the middle of the notch to the posterior edge of the branch, the first horizontal osteotomy at the base of the condyle process, and the second horizontal osteotomy the posterior margin 2.5-3 cm below the cut of the lower jaw, removing the osteotomized fragment from the wound, releasing the temporal region from the anch ilotic bone formations, the introduction of an endoprosthesis of the temporomandibular joint from porous titanium nickelide with a capsule from the allogeneic dura mater into the temporal region of the articular fossa, fixation of the endoprosthesis to the lower jaw with titanium nickelide staples with shape memory, suturing the wound.

(RF patent No. 2411921, M. CL. AB61 17/24, 2009).

The disadvantages of this method are the difficulties of movement of the lower jaw due to dysfunction of the chewing and medial pterygoid muscles and the impossibility of lateral displacement of the lower jaw in the opposite direction due to the lack of lateral pterygoid muscle function, which negatively affects the functional state of the dentofacial apparatus as a whole.

The task of the invention is to restore the function of the temporomandibular joint with normalization of the functioning of the chewing, medial and lateral pterygoid muscles.

The problem is achieved in that in the proposed method of endoprosthesis replacement of the temporomandibular joint, including skeletonization of the angle and branch of the lower jaw, vertical osteotomy from the middle of the notch to the posterior edge of the branch, extraction of the osteotomized fragment, release of the temporal region from the bone formations, installation of the temporomandibular joint endoprosthesis of porous titanium nickelide with fixation to the branch with staples of titanium nickelide with shape memory and suturing of the wound, the new thing is that after cutting proper chewing, medial and lateral pterygoid muscles from the removed part of the lower jaw branch onto the formed stumps are fixed superelastic, hollow, mesh, braided, cylindrical nickel-titanium implants with a diameter of 10-20 mm, 10-25 mm long with a cell size of 1-3 mm, made of a thread with a thickness of 50-60 μm, after which chewing muscles with implants are fixed to the endoprosthesis of the temporomandibular joint from porous titanium nickelide, previously coated with fibrous, knitted titanium nickelide.

The installation on muscle stumps of superelastic, hollow, mesh, woven, cylindrical nickel-titanium implants with a diameter of 10-20 mm, a length of 10-25 mm and a mesh size of 1-3 mm, made from a thread with a thickness of 50-60 microns, provides the convenience of muscle fixation to the endoprosthesis of the temporomandibular joint and prevents the relaxation of muscle stumps during flashing. The superelastic properties of the implants do not interfere with the contraction and return to the initial state of these muscles during functioning. The biochemical and biomechanical compatibility of titanium nickelide with body tissues promotes the germination of muscle tissue through the mesh structure of the implant with the formation of a single organotypic regenerate with the implant material.

The method is as follows. Under endotracheal intubation anesthesia, maxillary access skeletonize the branch of the lower jaw. Outside, on the stump of the chewing, medial and lateral pterygoid muscle, superelastic, hollow, reticular, braided, cylindrical nickel-titanium implants with a diameter of 10-20 mm, a length of 10-25 mm with a mesh size of 1-3 mm, made from a thread of thickness 1, are fixed 50-60 microns. An osteotomy is performed from the notch to the posterior edge of the branch closer to the corner. The osteotomized fragment along with fragments (if any) is recovered. In patients with ankylosing lesions of the temporomandibular joint, the temporal region is freed from the latter. Using an omega-shaped staple made of titanium nickelide with a shape memory effect, an endoprosthesis of a branch of the lower jaw, including a superelastic perforated plate, to which permeable porous parts of a similar shape and size are fixed on both sides and have polished thickenings corresponding to configurations of the head of the lower jaw, continuing in the form of a neck and further in the shape of the posterior part of the branch, the porous part of which is coated with fibrous titanium nickelide. The chewing, medial and lateral pterygoid muscles are fixed to the fibrous layer of the endoprosthesis using a nickel-titanium filament 50-60 μm thick by applying loop-like sutures to the stump through the thickness of the mesh implants and the fibrous layer of the endoprosthesis to the place of their normal attachment. The wound is sutured in layers and drained.

The proposed method is illustrated by photographs, where

figure 1 is a partial endoprosthesis of a branch of the lower jaw;

figure 2 is a partial endoprosthesis of a branch of the lower jaw coated with fibrous titanium nickelide;

figure 3 superelastic, mesh, braided, hollow, cylindrical nickel-titanium implant;

figure 4 x-ray of patient C. with a fracture of the head of the lower jaw before surgical treatment;

figure 5 x-ray of patient C. with a fracture of the head of the lower jaw after endoprosthetics of the branches of the lower jaw;

in Fig.6, patient C. 3 years after surgical treatment (direct projection);

Fig. 7, patient C. 3 years after surgical treatment (left lateral projection).

An example implementation.

Patient S., 19 years old, was admitted to the hospital with a diagnosis of a left-sided fracture of the head of the lower jaw with a displacement of a small fragment inside. Performed condilectomy with removal of a small fragment and endoprosthetics of the posterior part of the lower jaw branch, which was performed as follows. A branch of the lower jaw is skeletonized under endotracheal intubation anesthesia with a maxillary left-side access, superelastic, hollow, braided, mesh, cylindrical nickel-titanium implants with a diameter of 20 mm, 25 mm long with a mesh size of 2 mm, are fixed outside the stump of the chewing and medial pterygoid muscles from a thread 60 μm thick, by self-fixation, a similar implant with a diameter and length of 10 mm is fixed onto the stump of the lateral pterygoid muscle by analogy. An osteotomy was performed from the notch to the posterior edge of the branch closer to the corner, the osteotomized fragment and small fragment were removed, and a partial endoprosthesis of the lower jaw branch including a superelastic perforated plate was fixed to the lower jaw branch from the osteotomy using two omega-shaped staples made of titanium nickelide with shape memory effect to which, on both sides, permeable porous parts of a similar shape and size are fixed, having a polished thickening corresponding to the configuration of the head of the lower jaw, zhayuschiesya a neck and further on the shape of the back of the branches of which is covered with a porous fibrous TiNi. The chewing, medial and lateral pterygoid muscles are fixed to the fibrous layer of the endoprosthesis using a nickel-titanium filament with a thickness of 60 μm by applying loop-shaped sutures to the stump through the thickness of the muscles, mesh implants and the fibrous layer of the endoprosthesis to the places of their normal attachment. The wound is sutured in layers, drained. Primary wound healing. On examination, after 3 years, the mouth was opened in full, the lateral movements of the lower jaw were preserved, functional disorders of the dentition were not detected.

Using the proposed method for endoprosthetics of the temporomandibular joint (from 2005 to 2008), 21 patients were treated, 5 of them for a fracture of the head of the mandible, in 3 cases of deforming temporomandibular arthrosis, and in 13, ankylosing lesions of the temporomandibular joint. When viewed after 3 years in all cases of violations of the lower jaw, no satisfactory anatomical and functional result was achieved

The technical result of the proposed method is to normalize the function of the temporomandibular joint while maintaining the function of the proper chewing, medial and lateral pterygoid muscles. Superelastic thin-profile mesh implants fixed on the stump of the masticatory muscles contribute to the strength of the fixation of the latter to the fibrous layer of the endoprosthesis, preventing razvolenie, do not interfere with the contractility of the muscles and their return to their original position during the functioning of the masticatory apparatus. The fibrous layer covering the porous part of the lower jaw branch endoprosthesis creates a superelastic elastic system, preventing the endoprosthesis from penetrating through the surrounding soft tissues. Due to the biocompatibility of titanium nickelide with body tissues, biological tissues from recipient areas grow through the porous, fibrous and mesh structures of the implantation material, forming a single organotypic regenerate.

Claims (1)

A method of endoprosthetics of the temporomandibular joint, including skeletonization of the angle and branch of the mandible, vertical osteotomy from the middle of the notch to the posterior edge of the branch, extraction of the osteotomized fragment, release of the temporal region from bone formations, installation of the temporomandibular joint endoprosthesis from porous nickelide to titanium fix staples made of titanium nickelide with shape memory and suturing of the wound, characterized in that after cutting off the chewing, medial and lateral wings superelastic, hollow, mesh, braided, cylindrical nickelide-titanium implants with a diameter of 10-20 mm, a length of 10-25 mm with a mesh size of 1-3 mm, made of thread 50 -60 μm, after which the chewing muscles with implants are fixed to the temporomandibular joint endoprosthesis, previously coated with titanium fibrous nickelide.

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