RU2618891C1 - Nose epiprothesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: optical image of the patient's head is obtained. Nose is modeled on the optical image. A digital nose model is milled using wax. Implants are mounted into the cheel bone, with simultaneous locking of healing abutments facing the nasal cavity. Abutments are retained by screws. A reinforcing member is fixed to the implant abutments, the member has a ring located in the middle of the pear-shaped openings, where a magnetic member is fixed, having a magnetic pole charge opposite to the magnet fixed in the first prosthesis element. A custom tray is made from a polymer to cover the nose defect boundaries by 3 mm along the perimeter. A functional impression is made. A plaster model is made based on the functional impression. The mating multipolar magnetic element is fixed in a projection mounted on the reinforcing element fixed to cheek bone implants. The wax nose prototype with a magnetic element is copied using silicone material. Wax is replaced by silicone rubber of pre-chosen colour and transparency. The external nose prosthesis is fixed on the patient's face.

EFFECT: manufacturing method allows epiprothesis stabilization and prevention of voltage fields around the implant with minimal impact on the postoperative facial tissue, and provides nose epiprothesis with high aesthetic and functional properties.

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Description

The invention relates to medicine, and in particular to maxillofacial prosthetics, and is intended for prosthetics of the nose in its absence. A nose implant is known from the prior art, comprising silicone segments for the back and tip of the nose, characterized in that an isthmus is provided between the back and the tip of the implant, the back is thickened with respect to the isthmus and tip, and a stiffener along the axis is provided in the area of the isthmus on the inner surface of the implant (Application for invention No.2000121900 / 14, 08/18/2000). Nasal ectoprosthesis and method of making a nasal ectoprosthesis, including isolating Vaseline with eyebrows, eyelashes, mustaches, obtaining a facial impression in a reclining position of the patient with an elastic impression mass, making a gypsum mask, characterized in that the wax reproduction of the first part of the prosthesis is modeled by compressing the gypsum mask with one layer of clasp wax 0.3 mm thick, covering the nose in the form of a saddle, the upper edge of the pear-shaped opening, the nasal septum with the formation of protrusions entering the nasal passages, the retention point the edges of the defect according to the anatomical shape of the inner surface of the wings of the nose, then they are made from wax blanks from the side facing the second part of the prosthesis, retention loops to connect the parts of the prosthesis, create a gating system, make a mold and cast the first part of the prosthesis from a nickelide-based super-elastic alloy titanium, the casting is fitted on a gypsum mask, then on the patient's face a wax reproduction of the second part of the prosthesis is simulated by crimping the casting on a gypsum mask base wax with the formation of an anatomical shape and profile of the nose identical or similar to lost, determine the shape, size, direction and optimal location of the wire fixing device by modeling its analogue from a clammer wire in the form of a U-shaped element, model the shape and size of the said device in accordance with an analog of titanium nickelide wire with a diameter of 0.7-1.0 mm, make the specified device by high-temperature molding, install the mentioned device about the wax reproduction, the simulated prosthesis is gypsum in a cuvette, consisting of two parts - the bottom and the lid, the cuvette is maintained until the gypsum has completely hardened under pressure, after removing the wax by evaporation, the cuvette is opened, the surface of the upper gypsum mold is insulated with a dividing varnish, the upper part of the cuvette is filled with a pasty acrylic plastic mixed with powder of dry cosmetic powder, the color corresponding to the shade of the patient's face, connect the half of the cuvette and extrude in a vertical direction and cooled cuvette, the cuvette is removed from the prosthesis, it furnish performed, processing and polishing, and then the accuracy of fit to the patient's face and mounted to the eyeglass frame (RF Patent 2339344).

There is a known method of nasal prosthetics, in which 3 extraoral implants are installed along the edge of the postoperative defect, the main bed of the implant for the nasal prosthesis is a pear-shaped ridge at the base of the nose (2 implants - left and right), another bed was an incision. After that, a one-stage prosthetics technology is used, in which a nasal prosthesis with separately located abutments and magnetic fixation was chosen. It was investigated in which direction the protruding parts of the abutments are directed. According to the plaster model of the prosthetic element, a nose model was formed from basic wax. A wax model was prepared, evaluated on the patient and brought to its final form. The wax is heated, and the surface of the gypsum model and the mold are covered with release agent and autopolymerizable acrylic plastic. Acrylic plastic is pressure treated in a polymerizer. The shape of the prosthesis, its color and texture are finally made out using special plastic. The finished prosthesis is sanded and polished. A magnet is attached to the top of the support. An impression is made from the contact surface between the abutment and the attachment using single-phase silicone. Magnets connect to abutments (http://www.hearingimplant.ru/litsevoe-protezirovanie/articles/litsevye-protezy/).

An exoprosthesis and a method of its manufacture are known from the prior art, including obtaining a model of a face mask, modeling a part of the face from wax, installing fixing devices, characterized in that digital processing and three-dimensional computer modeling of a lost nose are performed on the basis of a volume scan of a patient’s facial defect and face of a close relative , milling on a machine with numerical control of a plastic prototype of a nose exoprosthesis, its duplication and casting of a nose exoprosthesis from silicone with giving we have the individual characteristics of the skin of the patient (RF Patent 2514120). Known prosthesis for the nose, which is modeled and manufactured by computer simulation and computer milling of dental wax. In this method, the nose prosthesis is attached to special magnetic locks that make it easy to install. Magnets are installed in the prosthesis and on the fixing elements of the prosthesis in the bones of the facial section of the skull. To ensure the most tight fit of the edges of the wax to the skin of the patient's face, a strip of molten wax about 5 mm wide is applied with a brush along the edges of the prosthesis. After that, the wax model is poured with modeling rubber to obtain a rubber mold. The prosthesis is molded in manufactured rubber form from a pre-selected color and transparency of siloxane rubber. When casting a silicone prosthesis in rubber form, the counterparts of the fasteners on the implants are precisely positioned. After casting, the prosthesis is painted - capillaries, pores and small skin defects are drawn on it to give a more natural appearance (http://www.directorinfo.ru/article.aspx?id=23638&iid=1088).

The disadvantages of existing methods of nose prosthetics based on extraoral implants include the difficulty of bone formation around the thread of the implants (osseointegration) associated with complex treatment of patients, namely, the upcoming or performed radiation and chemotherapy.

The objective of the invention is prosthetics of the nose with its defects of various etiologies.

The technical result of the invention is the manufacture of a nose prosthesis based on artificial elements, with minimal impact on postoperative facial tissues with high aesthetic and functional properties for nose prosthetics.

The technical result is achieved due to the fact that the epiprosthesis of the nose consists of two elements connected to each other by physical attraction of different-pole magnets, where the first element is a nose made of medical silicone, individualized in color and shape to the skin of the patient, characterized by the presence of the inner surface in the center of a rigidly fixed magnetic element in the form of a truncated cylinder with a height of 2.6 mm and a diameter of 9.4 mm and a reinforcing element made of titanium with by the method of computer milling, which provides further fixation of the prosthesis of the nose, presented in the form of a ring with an inner diameter of 9.7 mm and a magnet installed, having a pole charge opposite to the magnet fixed in the first element of the prosthesis, in the form of a truncated cylinder 2.6 mm high and 9 diameter , 4 mm and outwardly extending from the ring, radial processes having a bend and holes in the end sections through which screw fixation of the structure to implant abutments installed in the zygomatic bone.

The length and diameter of the zygomatic implants provide a sufficient area of contact with bone tissue, which provides primary stabilization and the possibility of using them as artificial supports for fixing the prosthesis of the nose, even in patients who have or will undergo radiation and chemotherapy. In addition to the retention function, the magnet provides redistribution of the load of the severity of the prosthesis of the nose from the soft tissues to the cheekbone implants, and the bending of the reinforcing element also reduces the indicated load, which prevents the occurrence of stress fields around the implants.

The epiprosthesis of the nose is illustrated by drawings, where in FIG. one:

1. implants fixed to the zygomatic bone

2. implant abutments

3. reinforcing element

4. reinforcing element ring

5. The magnet of the reinforcing element in FIG. 2:

1. implants fixed to the zygomatic bone

2. implant abutments

5. magnet of the reinforcing element

6. magnet prosthesis

7. epiprosthesis of the nose.

The method of prosthetics of the nose using the proposed epiprosthesis of the nose is as follows:

1. Obtain an optical image of the patient’s head by comparing graphic files of facial scanning and computed tomography in a digital module of the dental CAD / CAM system.

2. Modeling on the obtained optical image of the head of the nose according to the parameters.

3. Alignment of the digital model of the nose with the patient.

4. Milling a digital model of the nose of wax.

5. Fitting and fitting the wax model of the nose in the clinic, matching the wax model of the nose with the patient.

6. The operation to install implants (1) in the zygomatic bone, passing symmetrically on both sides, at the base of the pear-shaped hole in the thickness of the alveolar process of the upper jaw through the maxillary sinuses with the final fixation in the body of the zygomatic bone, with simultaneous fixation of the formers of the gums facing the nasal cavity.

7. Screw fixation of abutments (2).

8. Fixing the implant abutments, seven days after the operation, the reinforcing element (3), which provides further fixation of the nose prosthesis connecting the implant abutments (2), having a ring (4), located in the middle of the pear-shaped hole on which the magnetic element is fixed ( 5) having a pole charge opposite to the magnet fixed in the first element of the prosthesis.

9. Production of an individual polymer spoon by computer milling of a digital prototype modeled on an optical image of the head, with the condition of covering the borders of the nose defect by 3 mm around the perimeter.

10. Obtaining a functional impression.

11. Production of a gypsum model obtained by the specified functional print.

12. Fixation of the response opposite-pole magnetic element (6), in the projection mounted on the reinforcing element (3), fixed on the cheekbone implants (1).

13. Duplication of the wax prototype of the nose with a magnetic element (6) silicone mass.

14. Replacement of wax with siloxane rubber, pre-selected for color and transparency using a hardware color analyzer.

15. Color individualization of the ectoprosthesis of the nose (7) with dyes.

16. Fixation of the finished ectoprosthesis of the nose (7) on the patient's face.

Claims (1)

The epiprosthesis of the nose consists of two elements connected to each other by physical attraction of bipolar magnets, where the first element is a nose made of medical silicone, individualized in color and shape to the skin of the patient, characterized by the presence of a rigidly fixed magnetic element on the inner surface of the center in the form of a truncated cylinder with a height of 2.6 mm and a diameter of 9.4 mm and a reinforcing element made of titanium alloy by computer milling, ensure which further fixes the prosthesis of the nose, presented in the form of a ring with an inner diameter of 9.7 mm and a mounted magnet, having a pole charge opposite to the magnet fixed in the first element of the prosthesis, in the form of a truncated cylinder with a height of 2.6 mm and a diameter of 9.4 mm and outwardly extending from the ring, radial processes having a bend and holes in the end sections through which screw fixation of the structure to implant abutments installed in the zygomatic bone is carried out.

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