RU2546930C1 - Midface fracture apparatus and method for using it - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: midface fracture apparatus comprises upper and lower anchor splints provided with retention elements in the form of catch loops arranged along the full length of the anchor splints. A hook advancing 3-4 cm is provided in the middle of the lower anchor splint. The method implies as follows: first of all, a rubber elastic is mounted on the advanced hook of the anchor splint and the opposing catch loop of the upper anchor splint. After the fragment is reduced into its anatomic physiological position, the rubber elastics are mounted between the catch loops of the upper and lower anchor splints. At the same time, each side arch of the lower anchor splint is connected with separating wire to a fixed portion of facial bones; the separating wire is delivered through a cheek.

EFFECT: by ensuring reduction and stable fixation of the retrograde displaced fragments of the upper jaw in the position of the physiological bite for the full length of treatment, the method enables providing the higher clinical effectiveness, improving the patients' quality of life and reducing the duration of disability.

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Description

The present invention relates to medicine, in particular to maxillofacial surgery, can be used to provide assistance to victims with an isolated injury of the middle zone of the facial skeleton, and with combined injuries in the practice of disaster medicine, in the system of staged treatment of the wounded, as well as in trauma centers of various levels.

There are various methods and devices for treating bone fractures of the middle zone of the face.

So the known method, including the fixation of bone fragments of the upper jaw to the head gypsum cap. Fixation is carried out using the maxillary tooth splint and extraoral curved arches or stainless steel wire drawn through the thickness of the cheek (Timofeev A.A. Manual of Maxillofacial Surgery and Surgical Dentistry - Kiev, 2002 - P. 416-419).

Also known is a method of fixing bone fragments of the upper jaw to fixed areas of the facial skull, in which the tooth splint is a constituent element. Before the operation, the wire splint is tightly fixed to the teeth of the upper jaw. Ligatures made of metal wire fixed to the splint, the damaged upper jaw is attached (suspended) to the lower orbital edge of the maxillary bone and the base of the pear-shaped opening (Timofeev A.A. Manual of Maxillofacial Surgery and Surgical Dentistry - Kiev, 2002 - P. 416-418 )

However, the above methods and devices are quite effective only for fresh fractures and more or less mobile fragments of the upper jaw, and with wedged and stiff fragments, their use is problematic, because after achieving the necessary stability of the fragments, known methods and devices do not provide the possibility of their reposition, which requires further correction of both the bite and the shape of the face.

To do this, the patient is pulled by fragments using springs or rubber strips, which are attached to the tire with one end and to the gypsum cap with the other (Kabakov B.D., Malyshev V.A. Fractures of the jaws. M .: Medicine, 1981, S. 124).

The disadvantage of this device is the bulkiness and the presence of a significant number of extraoral constructions, significantly reducing the quality of life of the patient.

Closest to the claimed solution is a device made in the form of a tooth splint applied to both jaws. The fixation elements - hook loops are made along the entire length of each tooth splint. Using rubber rings superimposed on the hook loops of the upper and lower jaw splint, create maxillary traction (Timofeev A.A. Manual of Maxillofacial Surgery and Surgical Dentistry. - Kiev. 2002. - P. 450-451).

A disadvantage of the known device is that short with a sharp angle of inclination antagonizing hook loops does not allow stretching of a retrogradely displaced fragment of the upper jaw and, therefore, ensure a normal anatomical and physiological ratio of the jaws.

Also the disadvantages of the known method and device include the mobility of the lower jaw, which does not allow to achieve stability of the fragment of the upper jaw.

The objective of the proposed technical solution is to develop a device and method for the treatment of bone fractures of the middle zone of the facial skull with a retrogradely displaced fragment of the upper jaw.

The technical result of the proposed device and method is to increase the efficiency of treatment of fractures of bones of the middle zone of the facial skull, by ensuring the possibility of reposition and stable fixation of displaced fragments of the upper jaw to the physiological bite for the entire treatment period with a minimum of extraoral elements of the device.

The technical result of the device for the treatment of fractures of the middle zone of the face is achieved by the fact that it contains toothbrushes with fixation elements for rubber traction, made in the form of hook loops and located along the entire length of the tooth splints of the upper and lower jaw.

The main distinguishing feature of the claimed device is that in the Central section of the lower jaw splint, a hook is made that projects 3-4 cm forward.

The technical result of the proposed method for the treatment of fractures of the middle zone of the face is achieved by the fact that on the upper and lower jaw are applied tooth splints, the fixation of fragments of the upper jaw is carried out with rubber traction applied to the hook loops of the tooth splints.

Distinctive techniques of the proposed method are that pre-impose rubber traction on the protruding hook of the lower jaw splint and antagonizing to it the hook loop of the upper jaw splint. After reposition of the fragment in the anatomical and physiological position, rubber traction is applied between the hook loops of the upper and lower jaw splints. At the same time, a wire ligature connects each lateral arch of the lower jaw splint with the fixed part of the facial skull, while the wire ligature is passed through the cheek.

A comparative analysis of the claimed technical solutions with the prototype showed that the claimed device and method for its use differ from the known solutions with the indicated elements and techniques. These differences allow us to conclude that the claimed technical solution meets the criteria of the invention of "novelty."

The analysis of patent and medical literature has shown that the proposed device and method of its use contain features that distinguish them not only from the prototype, but also from other options for the surgical treatment of bone fractures of the middle zone of the facial skull. It:

- in the central section of the lower jaw splint, a hook is made that projects 3-4 cm forward;

- traction of the displaced fragments of the upper jaw is achieved by an intermaxillary traction, one end imposed on the hook protruding 3-4 cm forward located in the central section of the lower jaw splint, and the other end on the antagonizing loop of the upper jaw splint;

- stable fixation of repaired fragments of the upper jaw in the bite for the entire treatment period is achieved by fixing the lower jaw to the upper jaw by applying rubber rings to the hook loops of the upper and lower jaw tires and two-sided fixation of the lower jaw by wire ligatures attached at one end to the lateral arches of the tooth the lower jaw and the other end drawn through the thickness of the cheeks to the fixed parts of the facial skull, such as the zygomatic bone.

Distinctive techniques of the claimed device and method for its application provide the possibility of obtaining the specified technical result, namely, to increase the effectiveness of the treatment of bone fractures of the middle zone of the facial skull by ensuring the possibility of reposition and stable fixation of displaced fragments of the upper jaw in the anatomical and physiological position for the entire treatment period. A rational combination of the capabilities of the device and method allows you to minimize extraoral structural elements. The above allows us to conclude that the proposed technical solutions meet the criterion of "inventive step".

The device and method of its application that make up the claimed invention are intended for use in medicine. This method and device can be used in maxillofacial surgery. The possibility of implementing the proposed method using the proposed device is confirmed by the methods and means described in the application, therefore, the proposed solution meets the criteria of the invention "industrial applicability".

The essence of the claimed invention is illustrated by figures 1 and 2. In FIG. 1 schematically shows a view of the proposed device, superimposed on the jaw, during the reposition stage - stretching the displaced fragments of the upper jaw (see Appendix to the description of the application, page 1). In FIG. 2 shows a schematic view of a device superimposed on the jaw during the implementation of the stage of stabilization of repaired fragments of the upper jaw in the physiological bite (see Appendix to the description of the application, page 2). Where: 1 - a tooth splint on the upper jaw; 2 - a tooth splint in the lower jaw; 3 - hook loops; 4 - protruding forward hook; 5 - rubber rings; 6 - wire ligature; 7 - zygomatic bone.

The inventive method using the inventive device is as follows. Toothed tires 1 and 2 with hook loops 3 are placed on the upper and lower jaw 3. The protruding hook 4 on the lower tire 2 is connected to the upper jaw tooth link tire antagonizing it 1 by a rubber ring 5 and the displaced fragment of the upper jaw 1 is extended and repositioned (Fig. . one).

After reposition of the upper jaw fragments in the anatomical and physiological position, rubber rings 5 are placed on the hook loops 3 of the tooth tires 1 and 2. At the same time, the wire ligature 6 through the hook loop 3 grabs the lateral arch of the tire 2 on the lower jaw, then ligature 6 is passed through the thickness of the cheek and fixed to one of the intact processes of the zygomatic bone 7 (Fig. 2). With this technique, stabilization of the repaired fragments of the upper jaw in the physiological bite is achieved.

The essence of the proposed method of reposition and fixation of displaced fragments of the upper jaw and a device for its use is illustrated by a clinical example.

Victim B. born in 1980 on 08/20/11 at 16 ^{55 by the} ambulance brigade delivered to the department of maxillofacial surgery. About 4 hours ago, he suffered an industrial injury - during the disassembling of the wheel of a heavy truck, a circlip broke and hit it in the face at high speed. First aid was provided at the Central Hospital, a gauze sling bandage was applied. On the basis of clinical and radiological data, the diagnosis was established: a fracture of the upper jaw according to the type of For-2 with a retrograde position of the upper jaw and an open bite. 08/20/10 at 18 ⁰⁰ after antishock measures under general anesthesia with endonasal intubation of the trachea, an operation was performed to reposition and stabilize the upper jaw.

Operation progress: individual tooth tires with hook loops are made of aluminum wire with a cross section of 1.8 mm. At the same time, a hook is made in the central section of the tooth splint for the lower jaw that protrudes 3-4 cm forward. Using wire ligatures from bronze-aluminum wire with a cross section of 0.3-0.4 mm, the tires were fastened to the teeth of the upper and lower jaw. An elongated hook of the lower jaw tire and an antagonizing hook loop of the upper jaw tire have an elastic traction in the form of a rubber ring. Using a Dufo needle, a wire ligature (0.4 mm steel wire) was drawn from the oral cavity through the thickness of the cheek from the inner and outer sides of the zygomatic arch, forming a loop on its upper edge. Similarly, the same wire ligature was performed on the other zygomatic bone. The ends of the wire ligatures protruding into the oral cavity are fixed without tension by twisting on the hook loops of the lateral arches of the lower jaw tire.

The next morning, after repositioning the upper jaw to the state of a physiological bite, the final stabilization of the repaired upper jaw was carried out. To do this, the wire ligatures were tensioned on the zygomatic arches by twisting the ends of the ligatures protruding into the oral cavity, attached to the hook loops of the lateral arches of the lower jaw tire. Also, rubber rings were superimposed on the hook loops of the upper and lower jaw tires.

Rehabilitation of the victim took place without complications. The wire ligatures stabilizing the upper jaw were removed on the 22nd day after the operation, the intermaxillary rubber rings on the 28th. The patient was discharged on the 30th essence. The position of the upper jaw at discharge is stable, the bite is orthognathic. Disability restored completely.

This method and device for its use is used in clinical practice.

From 2009 to 2013, in the Department of Oral and Maxillofacial Surgery, OGAUZ “AGB No. 1” in Angarsk, 103 patients with mid-face bone fractures were treated. Among them, with various types of maxillary fractures, 45 patients aged 20 to 59 years. Of these, 24 patients were operated using the traditional methods of Fiederspiel and Adems; using the proposed device and method, 21 victims.

In the first group, the ratio of victims depending on the type of fracture was distributed as follows: with For-1 fractures - 66.6% (16 people), with For-2 fractures - 25% (6 people) and with For-3 fractures - 8.4% (2 people).

In the group of patients operated using the proposed device and method for its use: fracture of the upper jaw according to For-1 was observed in 10 patients, according to For-2 in 7, and For-3 in 4. Of these, 17 were men and 4 were women. In 7 patients, surgery was performed under general anesthesia, in 14 under conduction anesthesia.

Reposition of the upper jaw in the group of patients operated using the proposed device and method occurred from 2 hours to 1 day. The timing of fracture healing depended on the severity of the injury and the type of fracture. So, in case of fractures of the upper jaw according to For-1, clinical consolidation of fragments was observed on average on the 24th day; for fractures in For-2 on the 28th day, for For-3 on the 35th.

Patients, depending on the severity of the injury, were transferred from a round-the-clock inpatient treatment to a day hospital or outpatient treatment on days 14-20.

In all cases, the physiological bite was restored, and a functional and aesthetic result was achieved.

A comparative analysis of the effectiveness of treatment showed that in the group of patients treated in the traditional way, the recovery time was on average 4 ± 1.3 days longer than in the group of patients treated using the proposed device and the method for its use.

Due to the presence of extraoral structural elements, all patients of the first group had to be treated in a round-the-clock hospital, which reduced their quality of life. Due to inadequate repositioning of the upper jaw, 4 patients (16.6%) required a reoperation.

Thus, the proposed device for the treatment of fractures of the middle zone of the face and the method of its application provide the possibility of more efficient reduction and stable fixation of retrogradely displaced fragments of the upper jaw, improve the quality of life of the victims at the stages of rehabilitation, and reduce the period of disability.

Claims (2)

1. A device for treating fractures of the middle zone of the face, containing dentition tires of the upper and lower jaw, on which fixation elements are made in the form of hook loops located along the entire length of the tooth splints, characterized in that a hook protruding in the central section of the mandible splint is protruded 3-4 cm forward. 2. A method of treating fractures of the middle zone of the face, including applying a splint to the upper and lower jaw, fixing a fragment of the upper jaw with a rubber rod superimposed on the hook loops of the splint, characterized in that the rubber rod is previously applied to the protruding hook of the lower jaw splint and the hooking loop of the upper jaw splint antagonizing it; after the fragment is repositioned into the anatomical and physiological position, rubber rods are applied between the hook loops of the upper and lower jaw splint and, simultaneously, the wire ligature connects each side arch of the lower jaw splint with the fixed part of the facial skull, while the wire ligature is passed through the cheek.

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