RU2578161C2 - Method of treatment of jaw cysts - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to surgical methods of treatment in oral and maxillofacial surgery, and can be used for the treatment of cysts of the jaws. Straight-line incision some distance from the folds of transition towards mobile mucosa. Flap is separated from the cortical bone of the jaw. Cystectomy window is made by crown saw. Cyst membrane is separated from the bone and removed. Apex is resected with the formation of horizontal cut. Grid osteotomy is performed. Drilling bit is dipped into the bone until multipoint bleeding vessels appear. Bone cavity is filled with lyophilized osteoplastic materials "Lioplast." Spongy chips are mixed with the bone marrow punctate, which is obtained from the iliac crest. Flap is placed and fixed in place with a continuous suture.

EFFECT: method by optimizing the processes of bone reparative regeneration can reduce treatment time and reduce the number of postoperative complications.

1 cl, 4 dwg, 2 ex

Description

The invention relates to medicine, in particular to surgical methods of treatment in maxillofacial surgery, and can be used to treat jaw cysts.

There is a method of surgical treatment, consisting of a cystectomy with simultaneous resection of the apices of the roots protruding into the cavity of the cyst (Vernadsky Yu.I. Fundamentals of surgical dentistry. Os. - 2nd ed., Revised. And add. - Kiev: Vishcha school. Head ed -vo, 1984.- 392 p.).

Another treatment method is known - decompression-type cystotomy with the creation of a wide trepanation hole, removal of the outer part of the membrane and displacement of the mucoperiosteal flap into the cystic cavity. This technique allows you to gradually reduce the volume of the cyst until the complete restoration of the bone structure (Rabukhina N.A. Radiodiagnosis in dentistry / Rabukhina N.A., Arzhantsev A.P. - M .: Med. Information agency, 1999. - P.296) . Wide access to the cavity of the cyst excludes its suppuration. The main disadvantage of this method is the long postoperative treatment.

There is a method of surgical treatment of odontogenic jaw cysts by removing the cyst shell, and a trapezoidal mucosal-periosteal flap is preliminarily cut along the gingival margin and then along the alveolar process to the transition fold, after removal of the cyst shell, the antigenic layer of cement is removed from the tooth root and the formed hydroxyapatous cavity is filled with hydroxy the mucoperiosteal flap is placed in place and sutured. (RF patent No. 2116758, IPC АВВ 17/16).

There is a method of treating odontogenic cysts and cystogranulomas by performing a cystectomy followed by filling the bone cavity with a demineralized bone graft, and after the cystectomy, the bone cavity is filled with a mixture of demineralized bone graft with "Hydroxyapol" in a ratio of 1: 1. (Patent for invention No. 2223695, IPC 7 АВВ 17/00).

A disadvantage of the known methods is the duration of treatment, frequent complications, manifested in suppuration of a blood clot, osteoplastic material passing through the edges of the sutured wound.

The purpose of the invention is to reduce the treatment time for patients with extensive jaw cysts by optimizing the processes of reparative regeneration, reducing the number of postoperative complications.

The goal is achieved by the fact that after cystectomy with subsequent filling of the cavity with bone tissue substance, perforations are applied in a compact layer of the cyst bone wall in a checkerboard pattern with a step of 3 mm until multipoint bleeding vessels appear, and the bone cavity is filled with lyophilized osteoplastic material “Lioplast” mixed with autologous bone marrow , the flap is laid in place and fixed with a continuous seam.

Figure 1 presents the orthopantomogram of patient I. before cystectomy surgery according to Parch II.

Figure 2 presents the orthopantomogram of patient I. 6 months after cystectomy surgery according to Parch II.

Figure 3 presents the orthopantomogram of patient M. before cystectomy, removal of 4.7 tooth with intraocular ethmoid osteotomy and "Lioplast" with bone marrow puncture.

Figure 4 presents the orthopantomogram of patient M. 6 months after cystectomy, removal of 4.7 teeth with intraocular ethmoid osteotomy and Lioplast with bone marrow puncture.

The method is implemented as follows.

Under local anesthesia, a linear incision is made, departing from the transitional fold towards the movable mucous membrane by 2 mm over the causal and two adjacent teeth. The incision is performed by positioning the scalpel blade at right angles to the cortical plate. Dissect the mucous membrane, connective tissue and periosteum, while the incision does not cross the existing bone defect.

The flap is separated from the cortical plate of the jaw by moving the raspator in contact with the bone up to 5 mm apical to the proposed border of the cyst. With the fusion of the cyst membrane with a mucoperiosteal flap, it is cut with a scalpel.

A cystectomy window is made using a trepan. The expansion of the edges of the antrotomy window is performed using a pineal cutter. Its size corresponds to the vi diameter of the cyst.

The cyst membrane is separated from the bone with a smoothing tool and removed. The top of the tooth root is resected with the formation of a horizontal saw cut. A vestibular bevel at an angle of forty-five degrees is produced for quality control of the filling material in the canal on the root width Vi. Using a spherical boron with a diameter of 3 mm, a lattice osteotomy is performed - perforations are applied in a compact layer of the bone wall of the cyst in a checkerboard pattern with a pitch of 3 mm. Boron is immersed in the bone until multipoint bleeding vessels appear. In this case, the compact bone is removed by 50%. The bone cavity is filled with lyophilized osteoplastic material "Lioplast", which is an allogeneic spongy bone tissue subjected to mechanical and ultrasonic treatment. The spongy crumb is mixed with a bone marrow puncture, which is obtained using a bone trepan biopsy needle from the ilium scallop. The flap is laid in place and fixed with a continuous seam.

Subsequent examination is carried out every day after surgery for 7 days. During the examination, antiseptic treatment of the wound and radiography, dopplerography are performed. In the absence of complaints on the 7th day after the operation, sutures are removed.

The disadvantages of the known methods are that after removal of the near-root cysts, bone cavities remain, which reduce the strength of the jaw bones and can cause functional and aesthetic disorders. The main task after surgical removal of the shell of the radicular cysts of the jaw is to eliminate the defect by stimulating bone tissue neoplasm, as well as reducing the risk of relapse and possible complications in the postoperative period and maintaining the patient's working capacity.

Performing a cystectomy operation with the creation of a wide decompression “window” with simultaneous sampling of the material (bone tissue and cyst shell) for histological examination makes it possible to preserve the vitality of all structures adjacent to the cystic cavity (tooth roots, maxillary sinus, mandibular nerve canal) and reduce pressure inside the cystic cavity. Lattice osteotomy promotes the formation of platelet growth factor (Platelet-derived growth factor, PDGF) - a protein, one of the many growth factors. It plays an important role in angiogenesis. Contained in α-granules in platelets, synthesized in megakaryocytes. Each platelet contains about a thousand molecules of platelet growth factor. The factor is a strong stimulator of tissue repair, its receptors are located in the vascular wall on fibroblasts and smooth muscle tissue cells. PDGF stimulates the proliferation of these cells. In addition, PDGF increases the production of components of connective tissue (glycosaminoglycans, collagen, etc.). Filling the defect with Lioplast material mixed with an autopunctate of bone marrow containing stem cells also reduces the time required to form complete bone tissue and reduce the number of postoperative complications, in particular suppuration of the bone cavity.

The study of mixed blood flow in the projection of the cystic cavity and surrounding tissues by ultrasound Doppler flowmetry (Doppler ultrasound) on the instrument "Minimax-Doppler-K" (LLC "SP-Minimax", St. Petersburg, registration certificate No. ASN 2007 | 008 from 19.09 .2007) with a 25 MHz sensor. The sensor was fixed at a point located 3 mm below the top of the tooth included in the cavity of the cyst. The studies were carried out before the operation and 6 months after it. The following quantitative indicators were determined: linear blood flow velocities (cm / sec): Vas - maximum systolic blood flow velocity according to the average velocity curve; Qas - systolic volumetric velocity along the curve of the average velocity.

Under supervision were:

Patient I., 38 years old, turned to the clinic of maxillofacial surgery and dentistry of the Military Medical Academy on February 6, 2013 about a lower jaw cyst from 4.7 tooth (Fig. 1).

On admission, the patient complained of a bulging mucous membrane in the region of the lower jaw on the right. For the purpose of diagnosis, an orthopantomogram of the lower jaw was performed, on which a cyst was detected (size 3.5 * 2.7 cm). After that, the patient was referred to the CFM VMA. During examination revealed: the configuration of the face is not changed. On the coronal part of the 4.7 tooth, a large composite filling is determined. Percussion 4.7 tooth slightly painful. The change in the direction axis of the tooth 4.7 is determined (medial tilt). The mucous membrane of the oral cavity is pale pink, clean, moist. Symptoms of Dupuytren and Vincent are negative. Assessment of mixed blood flow.

Based on complaints, medical history, clinical, laboratory, x-ray studies, the final diagnosis was made: radicular cyst of the lower jaw in the area of 4.6 tooth.

After obtaining the results of laboratory, radiological (OPTG, Doppler ultrasound) research methods, as well as endodontic treatment of 4.7 tooth, the operation was performed on 02/11/2013: Cystectomy with resection of the apex of the roots of 4.7 tooth.

Doppler data: Vas 0.19 cm / sec; Qas 0.085 ml / min.

OPERATION: Under local anesthesia Sol.Ultracaini 1.7, a linear incision was made along the apex of the alveolar part of the lower jaw in the area of 4.5, 4.6 teeth and a periodontal section in the area of 4.7 tooth. The mucoperiosteal flap is exfoliated. The outer compact plate of the lower jaw in the area of 4.6 tooth was trepaned with a spherical bur in order to create an osteotomy window. The cyst membrane was removed and the tops of the roots of the 4.7 tooth were resected. The flap is laid in place and fixed with continuous sutures (Prolene 4.0). Hemostasis during the operation.

The day after surgery: the face configuration is changed due to postoperative edema in the buccal region on the right. The skin is clean, physiological in color. Regional lymph nodes are not palpable. The mouth opens in full, painlessly. The mucous membrane in the area of 4.7 tooth is slightly swollen, hyperemic. Palpation is slightly painful. Seams are wealthy. Hemostasis is stable. There is no detachable.

Postoperative course without complications. The patient received a course of antibacterial, desensitizing therapy and was discharged with recommendations: adherence to oral hygiene, removal of sutures for 7-10 days after surgery.

6 months after surgery inspection.

The face configuration is not changed. The skin is clean, physiological in color. Regional lymph nodes (submandibular) are not enlarged, painless on palpation. The mouth opens in full, painlessly. The mucous membrane of the oral cavity is pale pink, clean, moist. In the area of the postoperative wound, a formed scar of pale pink color, soft in consistency, is determined by the incision line.

In FIG. 2 shows an orthopantomogram of a patient after 6 months.

Doppler data: Vas 0.41 cm / sec; Qas 0.175 ml / min.

Patient M, 30 years old, came to the clinic of maxillofacial surgery and dentistry of the Military Medical Academy on July 29, 2013 with a preliminary diagnosis of a lower jaw cyst from 4.7 tooth (figure 3).

On admission, the patient complained of slight discomfort in the lower jaw on the right. For the purpose of diagnosis, an orthopantomogram of the lower jaw was performed, on which a cyst was detected (size 1.4 * 1.9 cm). After that, the patient was referred to the CFM VMA. During examination revealed: the configuration of the face is not changed. The skin is clean, physiological in color. Regional lymph nodes (submandibular) are not enlarged, painless on palpation. The mouth opens in full, without pain. The mucous membrane of the oral cavity is pale pink, clean, moist. On the coronal part of the 4.7 tooth, a composite filling is determined. Percussion 4.7 tooth is painless. The change in the direction axis of the tooth 4.7 is determined (medial tilt). Symptoms of Dupuytren and Vincent are negative.

Based on complaints, medical history, clinical, laboratory, radiological research methods, the final diagnosis was made: radicular cyst of the lower jaw from 4.7 tooth.

Doppler data: Vas 0.16 cm / sec; Qas 0.090 ml / min.

After obtaining the results of laboratory, radiological (OPTG, Doppler ultrasound) research methods, as well as endodontic treatment of 4.8 teeth, an operation was performed on August 1: Cystectomy, extraction of 4.7 teeth with intraocular ethmoid osteotomy and Lioplast with bone marrow puncture.

OPERATION: Under local anesthesia of Sol.Lidocaini 2% -2.0, a puncture was made in the area of the apex of the iliac scallop using bone trepone and 5 ml of bone marrow puncture was obtained.

Under local anesthesia Sol.ULtracaini 1,7№3, a periodontal incision was made in the area of 4.7 4.8 teeth. The mucoperiosteal flap is exfoliated. 4.7 tooth removed. Made osteotomy window. Removed a cyst with a capsule. Lattice osteotomy was performed. The bone cavity is filled with osteoplastic material "Lioplast" and bone marrow punctate. The flap is laid in place and fixed with interrupted sutures (Prolene 4.0). Hemostasis during the operation.

The day after surgery: the face configuration is changed due to postoperative edema in the buccal region on the right. The skin is clean, physiological in color. Regional lymph nodes are not palpable. The mouth opens in full, painlessly. The mucous membrane in the area of 4.7 tooth is slightly edematous, hyperemic. Palpation is slightly painful. Seams are wealthy. Hemostasis is stable. There is no detachable.

Postoperative course without complications. After receiving a course of antibacterial, desensitizing therapy, the patient was discharged with recommendations: adherence to oral hygiene, removal of sutures for 7-10 days after surgery.

6 months after surgery inspection.

The face configuration is not changed. The skin is clean, physiological in color. Regional lymph nodes (submandibular) are not enlarged, painless on palpation. The mouth opens in full, painlessly. The mucous membrane of the oral cavity is pale pink, clean, moist. In the area of the postoperative wound, a formed scar of pale pink color, soft in consistency, is determined by the incision line.

In FIG. 4 shows an orthopantomogram of a patient after 6 months.

Doppler data: Vas 0.85 cm / sec; Qas 0.2 ml / min.

Claims (1)

A method of treating jaw cysts by cystectomy, followed by filling the cavity with bone tissue material, characterized in that the perforations in the compact layer of the bone wall of the cyst are staggered in increments of 3 mm before the appearance of multipoint bleeding vessels, the bone cavity is filled with lyophilized osteoplastic material “Lioplast”, mixed with bone marrow autopuncture, the flap is placed in place and fixed with a continuous suture.

Images