RU2709735C1 - Method for eliminating lower jaw atrophy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maxillofacial surgery, and can be used for eliminating atrophy of distal portion of mandibular alveolar portion. Mucous membrane of the oral cavity is incised along a crest of the alveolar portion of the lower jaw. Mucoperiosteal flap is reclined into the buccal side with subsequent plasty of the lower jaw with a bone autograft, perforation of the external cortical plate of the lower jaw, filling the space between the lower jaw and the bone autograft with a mixture of autogenous bone chips and chips of the osteoplastic material. Bone surface is closed with a collagen membrane with further mobilization of the mucoperiosteal flap. Closing the wound. Elimination of atrophy is carried out in distal portion of alveolar portion of lower jaw by making a hole with length of 25–32 mm, width of 1.5–2.5 mm, depth of 5–6 mm. Osteotomy is performed along its chewing surface. Bone autograft is represented by a bone autograft from a cranial vault prepared by a semilunar incision of skin, subcutaneous fat and periosteum in the parietooccipital region with subsequent peeling and folding of the skin-aponeurotic flap into the frontal region. Rectangular bone autograft of length 25–32 mm, width 15–20 mm and thickness 1.5–2.5 mm is sampled from one side of the cranial vault by retracting from sagittal suture 10–15 mm. Autograft is inserted into the formed hole, followed by filling the space between the lower jaw and the bone autograft with a mixture of autogenous bone chips and osteoplastic material chips Bio-Oss. Bone surface is closed with a collagen membrane. Mucous-periosteal flap is mobilized and wound is closed.

EFFECT: method provides higher functional and aesthetic effect for further dento-jaw rehabilitation of the patient by increasing the volume of bone tissue in the distal mandible.

1 cl, 4 dwg, 2 ex

Description

This invention relates to medicine, namely to maxillofacial surgery, and is intended to eliminate atrophy of the distal alveolar part of the lower jaw of various origins - congenital absence of teeth, atrophy, trauma of the jaw with the possibility of further dental implantation in this area.

There is a method of eliminating atrophy of the lower jaw by bone grafting of the alveolar part of the lower jaw with a bone autograft from the iliac crest. [Application No. 2009 112 996, A61B 17/24; Ivanov S.Yu. et al.].

The autologous bone autotransplant is taken either as a full-layer or in the form of a split fragment with subsequent fixation to the native bone in the area of atrophy along the crest of the alveolar ridge of the lower jaw after mobilization of the mucosal-periosteal flaps and perforation of the cortical plate of the receptive bed with subsequent covering of its collagenous membrane.

The disadvantage of this method is that there is no possibility of obtaining a simultaneous optimal height and width of the reconstructed area due to the structure, lack of volume and mobility of the bone fragment of the alveolar bone, which leads to insufficient volume of the alveolar bone due to lysis of the flap up to 80%.

Closest to the proposed method is a method of eliminating atrophy of the lower jaw by plasty of the alveolar part of the lower jaw using a bone autograft L-shaped, corresponding to the length of the recipient zone.

Its sampling is carried out in the retromolar region of the lower jaw by cutting the mucous membrane of the oral cavity along the crest of the alveolar part of the lower jaw, followed by folding the mucosal-periosteal flap to the buccal side.

The L-shaped bone autograft is adapted to the receiving bed by creating an additional L-shaped step in the apical part of the bone autograft.

The external cortical plate of the lower jaw is perforated in several places, a modified L-shaped bone autograft is attached and fixed in the zone of atrophy of the lower jaw using titanium microscrews.

The resulting space between the lower jaw and the bone autograft is filled with a mixture of autogenous bone chips and synthetic osteoplastic material. The bone surface is covered with a collagen membrane.

Mobilization of the mucoperiosteal flap is carried out. The wound is sutured.

The disadvantage of this method is that there is no possibility of collecting a large autologous bone graft and it is not possible to achieve the optimal height and width of the reconstructed lower jaw.

The technical result of this invention is to increase the functional and aesthetic result.

The technical result is achieved by the fact that in the method of eliminating atrophy of the lower jaw by cutting the mucous membrane of the oral cavity along the crest of the alveolar part of the lower jaw, folding the mucosal-periosteal flap to the buccal side, followed by plastic surgery of the lower jaw with a bone autograft, perforation of the external cortical plate of the lower jaw, filling the space between the lower jaw and the bone autograft with a mixture of autogenous bone chips and osteoplastic material chips, bone closure the surface with a collagen membrane with further mobilization of the mucoperiosteal flap and suturing the wound, a distinctive feature is that the elimination of atrophy is carried out in the distal alveolar part of the lower jaw by creating a hole 25-32 mm long, 1.5-2.5 mm wide, and depth 5-6 mm, an osteotomy along its chewing surface, and a bone autograft from the cranial vault obtained by a semilunar incision of the skin, subcutaneous fat and periosteum, is used as a bone autograft the parietal-occipital region with subsequent flaking and folding of the skin-aponeurotic flap in the frontal region, taking a bone autograft with a rectangular shape 25-32 mm long, 15-20 mm wide and 1.5-2.5 mm thick on one side of the cranial vault, departing from the sagittal suture 10-15 mm, which is installed in the formed hole, followed by filling the space between the lower jaw and the bone autograft with a mixture of autogenous bone chips and osteoplastic material chips, closing the bone surface of the lagenovoy membrane mobilization muco-periosteal flap and suturing wounds.

The method is as follows (Fig. 1 to 3).

Before surgery, according to the MSCT data of the skull bones, the degree of atrophy of the alveolar part (1) of the lower jaw and the parameters of the donor area of the cranial vault are evaluated. Stereolithographic templates are made.

When a bone autograft (2) is taken from the cranial vault (3) along the previously outlined line (4) in the parieto-occipital region (5), a half-moon incision (6) of the skin, subcutaneous fat and periosteum is performed. By the method of blunt and acute dissection in the subperiosteal layer, they advance to the level of the coronal suture (7). Hemostatic clips are applied to the edges of the wound. The skin-aponeurotic flap (8) is peeled off, which is folded to the frontal side (9) and fixed with a nodal suture. In the parietal-occipital region (5), to the right or left of the sagittal suture (10), departing from it by 10-15 mm, using a Lindemann bur, reciprocal saws and a cutter, a bone autograft is taken 25-32 mm long, 15- wide 20 mm and a thickness of 1.5-2.0 mm. The defect in the donor area of the skull is closed with bone chips obtained during the sampling of a bone autograft.

An incision is made in the oral mucosa along the crest of the alveolar part (1) in the distal lower jaw, followed by the folding of the mucoperiosteal flap. Using the blunt and acute dissection method, they skeletonize the outer surface (11) of the lower jaw in the atrophy zone. Assess the size of atrophy. Using a pyezon tip, a longitudinal osteotomy is performed along the chewing surface of the lower jaw in the atrophy zone. Given the visualized zone of atrophy, the obtained bone autograft is adapted (2) according to the length and height of the defect. Perforation of the external cortical plate of the lower jaw is performed. A bone autograft (2) is inserted into the formed hole with a length of 25-32 mm, a width of 1.5-2.5 mm and a depth of 5-6 mm, immersing the bone autograft by 5-6 mm in order to increase the width of the alveolar part (1) in distal lower jaw.

The space between the lower jaw and the bone autograft is filled with a mixture of autogenous bone chips obtained during the sampling of a bone autograft and chips of osteoplastic material. A collagen membrane is placed on the bone surface.

The mucoperiosteal flap is mobilized and laid in place without tension. Suturing of surgical wounds is performed.

Example 1

Patient K.A., 25 years old. Diagnosis: Ectoderm dysplasia, primary partial adentia of the lower jaw, atrophy of the alveolar part in the distal lower jaw.

The patient underwent the elimination of atrophy of the lower jaw by the proposed method.

The bone autograft was taken from the cranial vault as follows.

In the operating room, under combined endotracheal anesthesia, after triple antiseptic treatment of the surgical field, soft tissues of the parieto-occipital region were infiltrated with physiological saline with adrenaline added in a 1: 4 ratio.

On the previously outlined line in the parietal-occipital region, a lunar incision was made in the skin, subcutaneous fat and periosteum. The skin aponeurotic flap was exfoliated. By the method of blunt and acute dissection in the subperiosteal layer, they passed to the level of the coronary suture. Hemostatic clips were placed on the edges of the wound. The aponeurotic skin flap was thrown back to the frontal side, fixed with a nodal suture with Lavsan 3-0 thread.

Further, to the left of the sagittal suture, 10 mm away from it, using a Lindemann bur, reciprocal saws and a milling cut, a bone autograft was taken 25 mm long, 20 mm wide and 1.5 mm thick. The defect in the donor area of the skull was closed with bone chips obtained during the sampling of a bone autograft.

A drainage with active aspiration was established through the performed contraperture.

The wound in the parietal region was sutured in layers with interrupted and interrupted sutures with Prolen 4-0 and Sterilin 4-0 threads, respectively.

The bone autograft was modeled as follows.

According to previously made stereolithographic models, the bone autograft was fitted, the obtained bone autograft was adapted according to the length and height of the defect.

A longitudinal osteotomy was performed along the chewing surface of the alveolar part of the lower jaw with the formation of an opening 25 mm long, 20 mm wide and 1.5 mm thick.

Perforation of the external cortical plate of the lower jaw was performed.

The obtained modified bone autograft 25 mm long, 20 mm wide and 1.5 mm thick was placed in the formed hole in the atrophy zone.

The space between the lower jaw and the installed bone autograft was filled with a mixture of autogenous bone chips obtained during the sampling of a bone autograft and chips of Bio-Oss osteoplastic material.

A Bio-Gate collagen membrane was placed on the bone surface.

The mucosal-periosteal flap was mobilized and laid in place without tension. They performed suturing of surgical wounds with interrupted and U-shaped sutures. An aseptic moderately compressive dressing was applied.

Example 2

Patient B.M., 18 years old. Diagnosis: Ectoderm dysplasia, primary partial adentia of the lower jaw, atrophy of the alveolar part in the distal lower jaw.

The patient underwent the elimination of atrophy of the lower jaw by the proposed method.

The bone autograft from the cranial vault was taken as follows.

In the operating room, under combined endotracheal anesthesia, after triple antiseptic treatment of the surgical field, soft tissues of the parieto-occipital region were infiltrated with physiological saline with adrenaline added in a 1: 4 ratio.

On the previously outlined line in the parietal-occipital region, a lunar incision was made in the skin, subcutaneous fat and periosteum. The skin aponeurotic flap was exfoliated. By the method of blunt and acute dissection in the subperiosteal layer, they passed to the level of the coronary suture. Hemostatic clips were placed on the edges of the wound. The aponeurotic skin flap was thrown back to the frontal side, fixed with a nodal suture with Lavsan 3-0 thread.

Further, to the right of the sagittal suture, 10 mm away from it, using a Lindemann bur, reciprocating saws and a cutter, a bone autograft was taken with a length of 32 mm, a width of 15 mm and a thickness of 2.5 mm. The defect in the donor area of the skull was closed with bone chips obtained during the sampling of a bone autograft.

A drainage with active aspiration was established through the performed contraperture.

The wound in the parietal region was sutured in layers with interrupted and interrupted sutures with Prolen 4-0 and Sterilin 4-0 threads, respectively.

The bone autograft was modeled as follows.

According to previously made stereolithographic models, the bone autograft was fitted, the obtained bone autograft was adapted according to the length and height of the defect. A longitudinal osteotomy was performed along the chewing surface of the alveolar part of the lower jaw with the formation of an opening 32 mm long, 15 mm wide and 2.5 mm thick.

Perforation of the external cortical plate of the lower jaw was performed.

The obtained modified bone autograft, 32 mm long, 15 mm wide and 2.5 mm thick, was placed in the formed hole in the atrophy zone. The final adaptation of the bone autograft in the defect area was performed. The space between the lower jaw and the installed bone autograft was filled with a mixture of autogenous bone chips obtained during the sampling of a bone autograft and chips of Bio-Oss osteoplastic material. A Bio-Gate collagen membrane was placed on the bone surface.

The mucosal-periosteal flap was mobilized and laid in place without tension. They performed suturing of surgical wounds with interrupted and U-shaped sutures. An aseptic moderately compressive dressing was applied.

Thus, the proposed method has the advantage of increasing the volume of bone tissue in the distal lower jaw in the atrophy zone due to the high density of the bone autograft, similar biological properties to the bone tissue of the lower jaw, which creates optimal conditions for dento-jaw rehabilitation of the patient.

Claims (1)

A method for eliminating atrophy of the lower jaw by cutting the mucous membrane of the oral cavity along the crest of the alveolar part of the lower jaw, folding the mucoperiosteal flap to the buccal side, followed by plastic surgery of the lower jaw with a bone autograft, perforation of the external cortical plate of the lower jaw, filling the space between the lower jaw and bone marrow chips of autogenous bone and chips of osteoplastic material, closing the bone surface with a collagen membrane with further mobilization of the mucosal-periosteal flap and suturing of the wound, characterized in that the elimination of atrophy is carried out in the distal alveolar part of the lower jaw by creating an opening 25-32 mm long, 1.5-2.5 mm wide, 5-6 mm deep, osteotomy on its chewing surface, and as a bone autograft, a bone autograft from the cranial vault is used, obtained by a semilunar incision of the skin, subcutaneous fat and periosteum in the parieto-occipital region, followed by exfoliation and folding we take a skin aponeurotic flap in the frontal region, with a fence of a bone autograft of rectangular shape 25-32 mm long, 15-20 mm wide and 1.5-2.5 mm thick on one side of the cranial vault, departing from the sagittal suture 10-15 mm which is installed in the formed hole, followed by filling the space between the lower jaw and the bone autograft with a mixture of autogenous bone chips and Bio-Oss chips of the osteoplastic material, closing the bone surface with a collagen membrane, mobilization of the mucosal-periosteal gloss uta and suturing wounds.

Images