SU1286180A1 - Method of treatment of diseases and injures of temporo-mandibular articulation - Google Patents

Abstract

This invention relates to the field of medicine, namely to reconstructive reconstructive surgery. The purpose of the invention is to prevent the development of stenosis of the external auditory canal by preserving the integrity of its cartilage. The distance from the edge of the trestle is made by intracutaneous incision. Fabricated to the bone of the external auditory canal. The posterior lower margin of the parotid gland parenchyma is prepared and shifted to the sides. The capsule of the temporomandibular joint is exposed. Kra wounds divorced by a retractor. Then cut through the capsule of the temporomandibular joint. If necessary, additional operative insertion is made on the components of this joint. w O)

Description

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The invention relates to medicine, namely to reconstructive reconstructive surgery and can be used in surgical dentistry.

The purpose of the invention is to prevent the development of stenosis of the external auditory canal by preserving the integrity of its cartilage.

The method is carried out as follows.

- Intra ear skin incision is made along the front wall of the external auditory canal, 2-3 mm indent from the edge of the trestle, starting from the curl stem to the lower border of the cartilage of the auricle and ending with partial dissection of the earlobe. Then, the skin from the incision line is removed by an acute method. As a result, the isolated dermal section of the trestle is turned to the side. The skin wall of the external auditory canal is not separated. Next, the tissues of the previous region are decompressed at a depth along the front surface of the cartilage to the bone part of the external auditory canal. The repaired cartilage of the trestle, together with the cartilage, is displaced and fixed to the posterior wall of the external auditory canal, closing the entrance to the auditory canal to prevent blood from entering the latter in the course of the operation. It is prepared in the posterior low margin of the narenchyma of the parotid salivary gland and shifted to the side, exposing the capsule of the temporomandibular joint. Cranes are diluted with a retractor, creating a fairly good overview of the joint capsule. An additional incision is made in the skin and subcutaneous tissue of the ear lobe to improve the visibility. After that, a longitudinal incision is made along the border of the bone and chr - shchev.ogo departments of the external auditory canal (parallel and below the ear and temporal nerve) and cut through the capsule of the temporomandibular joint. After that, depending on the available pathology, the necessary operative accommodation on the components of the temporomandibular joint is carried out.

Example. Patient K., born in 1952, was admitted with complaints of pain in the area of the temporomandibular joint on the right, eating disorder. From the anamnesis, it was established that a mandibular injury was received 14 days ago. During external examination there were no special changes in the face configuration. Opening the mouth is limited due to pain in the temporomandibular joint on the right. Palpation of this area is mildly painful, and during the movements of the lower jaw, the movements of the condylar process were not identified. The loading symptom is positive to the right. The bite is broken due to the displacement of the lower jaw in pain.

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open bite in the frontal area 4 mm in size. The mucous membrane in the area of the upper arch of the oral cavity of normal color. Based on the results of clinical and objective research methods (electromyography, X-ray), a diagnosis was made: a closed high fracture of the condylar process of the lower jaw to the right with displacement of fragments. Osteo-synthesis of the mandibular condylar process was performed on the right using the proposed intra-aural operative access to the temporomandibular joint in combination with the submandibular access.

Under endotracheal anesthesia, an external skin incision is made, the margin of the mandible is on the right, 4 cm long. The tissues are separated by layers, and the external and posterior surfaces of the mandible branch are skeletal. Next, a boron undergoes an osteotomy of the mandible branch by a vertical incision from the base of the condylar process to the angle of the mandible. The bone fragment of the posterior margin of the branch is removed. The knucks from the remnants of the lower jaw branch reveal a sedentary fragment of condylar process, which is tightly fixed by cicatricial commissures in the temporal lobe. An attempt to reposition this fragment into the correct anatomical position and to carry out osteosynthesis was unsuccessful. After that, an intra ear skin incision is performed along the front wall of the external auditory canal, and, 2-3 mm indent from the edge of the trestle, starting from the curl stem to the lower border of the xycorpus of the auricle. Intra ear incision was continued partially on the ear lobe with dissection of the skin and subcutaneous tissue. Then, the skin of the previous area was separated from the incision line by an acute method. As a result, the dedicated skin section of the curl was turned aside. Then, the tissues of the pre-apex region were deeper in depth along the anterior surface of the cartilage to the bone part of the external auditory canal. To improve the visibility, an additional incision was made in the skin and subcutaneous tissue of the earlobe. After that, a longitudinal section was made along the posterior border of the bone and cartilage sections of the external auditory canal (parallel and below the ear-temporal nerve) and the capsule of the temporomandibular joint was cut through. The edges of the dissected capsule were taken on handles and taken to the sides. Then, the capsule was detached from the condyle of the condylar process and exposed to a fracture line. Under the control of vision, the head of the condylar process was transferred to the articular medulla, the combined access (intra-and submaxillary) made an osteosynthesis of a bone fragment with a resected mandibular branch. Immobilized bone fragments are attached to the mandible branch. Thus restored the integrity of all components of the lower jaw. The wounds are sutured in layers with catgut and polyamide thread. Aseptic dressing. On the 2nd day after the operation, the maxillary fixation was imposed, which was removed on the 28th day. The postoperative course is smooth and the functional results of the operation are good.

Claims (1)

DETAILED DESCRIPTION A method for treating diseases and injuries of the temporomandibular joint by intra-aural access to the temporomandibular joint, characterized in that, in order to prevent the development of stenosis of the external auditory canal, is internal, without complications. Healing of the primary 10 auricular incision is made, indenting from the tension. At the control inspection through the Nursery, the tissues are prepared to the bone 1 year after surgery, a full con-department of the external auditory canal was noted, and the solidification of bone fragments without deformata cut through the capsule of the temporomandibular mandibular contours. Anatomical joint. The functional and functional results of the operation are good. Claims of the invention A method for treating diseases and injuries of the temporomandibular joint by intra-aural access to the temporomandibular joint, characterized in that, in order to prevent the development of steno