SU1242134A1 - Method of treatment of fracture of lower jaw - Google Patents

Description

The invention relates to medicine, namely to surgical dentistry.

The aim of the invention is to prevent complications.

The method is carried out as follows.

After reposition and fixation of fragments, mainly in the lateral parts of the body of the mandible, pre-prepared and sterilized 1-2 mm thick plate of allocution are placed on the outer surface of the fragments, it is pre-fitted to the conditions of the defect so that it overlaps the bone defect jaws, and its ends were on fragments at a distance of not less than 14 mm from the edge of the defect. In this position, the bone plate is temporarily held on the fragments and, using a drill with a diameter of 2-3 mm, is formed in it at opposite ends, located above the bone fragments, to open in an amount depending on the indications of the operation.

The holes in the plate form no closer than 10 mm to the edge of the defect, while on the outer surface of the fragments they leave a slight trace from the drill with a diameter of 2-3 mm. Then, the bone plate is removed and the intra bone cavities are drilled in the fragments 4–5 mm in the fragments perpendicular to the outer surface of the fragments, in the places previously indicated by the drill with a diameter of 2-3 mm, since the axes of the intra bone cavities and holes in the bone plate should coincide . In order to provide sufficient fixing force to the shchurup, the depth of the channel must be at least 2/3 of the thickness of each of the fragments. The depth of the channels varies depending on the height of the periosteal part of the schurup, which is caused by the thickness of the outcrop plate and the relief of the outer surface of the fragments.

In some cases, bone channels drill through the entire thickness of fragments, an inner cortical bone B is constructed. The formed intraosseous canals are inserted into previously prepared cylindrical liners of bioinert material with elastic properties that correspond to the depth of the channel. The diameter of the liner depends on its elastic-elastic properties, but it should always be larger than the diameter of the intraosseous canal. At the same time, a channel with a diameter of 1-1.5 mm, which serves as a guide for shchurup, is made inside the insert in the center by 2/3 of its height. Next, the outboard plate is placed on the outer surface of the fragments in the initial position and screwed down the screw. Rotating along the channel of the insert, the schruup cuts the thread, thereby deepening and spreading the elastic

the liner, which provides more complete contact with the cancellous bone layer, creates an effort for firm fixation of the screw and a reserve of elastic forces to compensate for the weakening of fixation of the screw during bone resorption along the intraosseous canal walls.

The bone plate is covered with an adhesive composition, for example, MK-9, to model a graft in the form of an existing bone defect in the body of the mandible.

Example. Patient B., 43, as a result of a household injury, received a fracture of the lower jaw between 6 and 7 teeth. Aluminum tires were superimposed on the upper and lower jaws with maxillary traction. The patient was on outpatient treatment. An abscess began, a tooth was removed from the fracture gap, an incision was made, at the site of which a fistula with purulent discharges was formed.

The patient was admitted for treatment with a diagnosis of chronic posttraumatic mandibular osteomyelitis on the right.

There is an asymmetry of the face due to the presence of swelling in the right submandibular region, where a little painful infiltrate 4 × 6 cm in size is palpated. In the center of the infiltrate there is a fistula with a discharge of a small amount of pus. The skin around the fistula is hyperemic. Bite teeth broken. Fragments are stiff.

Under anesthesia, an operation is performed, an incision is made in the right submandibular region up to 10.0 cm long. The fistulous course is excised. Expose fragments of the jaw, the ends of which were resorbed and softened. The granulations and softened parts of the ends of the scapulae are removed, after which a defect of 1.5 cm was formed. The fragments of the lower jaw could hardly be put in the correct position, thereby restoring the bite. In the fragments with the help of a drill, they form channels (in a small fragment - two, in a large one), impose a plate plate of 0.2X1.0X5.0 cm in size with a pre-prepared graft in the form of a defect from a collagen-based composite material. A plate of allocution is fixed to the fragments by screwing screws from the alumina into the bone canals into which cylindrical inserts of allohrasha are previously inserted with a diameter greater than the diameter of the bone canals.

Layered overlay catgut schvy. On the skin - the hair grooves. In the postoperative period, antibiotic therapy was carried out, general strengthening treatment, and physiotherapy. In the first 16 days after surgery, the fragments were retained with an additional maxillary traction. On the 8th day after the operation, the joints are removed Wound healing by primary tension. 28 days later

1242134

nazubnye wire tires. OpeningPosleoperative period is 19

mouth was initially limited to 2.0 cm, nodn m. The patient was examined one year after

gradually reached normal size. No complaints

The patient was discharged for outpatient treatment of the lower jaw saved in full,

in a satisfactory condition. the taste is correct.

Claims (1)

METHOD FOR TREATING A LOWER JAW FRACTURE by means of osseous fixation of fragments using an allograft, characterized in that, in order to prevent complications, a bony plate is first placed on the outer surface of the fragments, and then intraosseous channels are drilled into which inserts from bionnerty material are inserted, then onto the outer surface re-lay the plate, cover it with glue and simulate the grafts in the form of a defect. Yu With