WO2023086035A1

WO2023086035A1 - Osteogenesis uni or bilateral form for the front of the mandibular and the chin with circular motion appliance

Info

Publication number: WO2023086035A1
Application number: PCT/SY2022/050002
Authority: WO
Inventors: Khaled ALOUF
Original assignee: Alouf Khaled
Priority date: 2021-11-15
Filing date: 2022-11-10
Publication date: 2023-05-19

Abstract

A prosthetic surgical device that builds the bone on a unilateral and bilateral basis, considering the anatomical and aesthetic aspects of the front of the lower jaw and the chin. It is used when there is bone loss in the front of the lower jaw and chin resulting from either a traumatic or pathological injury that led to the loss of part or entire the front of the lower jaw and the chin. These injuries often cause deformation, bone and soft tissues loss at the bottom of the face, as well as in the anterior of the tongue and the alveolar ridge of the front of the lower jaw and chin. This device maintains the shape of the jaw and face, and provides an advantage to military patients and traumatic injuries. It has three sizes that vary according to the area of loss, where the bone is completely and perfectly built, with the use of the described surgical technique.

Description

[Title established by the ISA under Rule 37.2] OSTEOGENESIS UNI OR BILATERAL FORM FOR THE FRONT OF THE MANDIBULAR AND THE CHIN WITH CIRCULAR MOTION APPLIANCE

Technical description of the invention:

A circular motion compensating expander surgical device that builds the front of the lower jaw and chin in a completely self-construction, so that it reshapes the front of the lower jaw and chin accurately and in harmony with the aesthetic and functional aspect without the need for bone grafts or other unilateral or bilateral construction, where the bone construction can be done on the one side (left or right), or both sides together as needed, by installing the device on the posterior part of the lower jaw body behind the front of the lower jaw and the chin on the right and left side by means of orthopedic fixing screws. The device is activated by moving the anterior part in the right and the left for osteogenesis. It builds new bone and tissues around it in the front of the lower jaw and chin, in a circular shape that matches the anatomical shape of the area. This device is used to build the front of the lower jaw and the chin by osteogenesis in patients with war injuries and severe traumatic injuries, as well as pathological injuries that led to the loss of the front of the lower jaw and chin

Previous technical condition:

By reviewing the medical literature, several methods for performing orthopedic replacement of the front of the lower jaw and chin were described using bone grafting. However, they depend on the autologous or heterogeneous bone grafts in addition to traction of the mucous slices to prepare the special bed for the bone grafts and the accompanying survival. These methods accompany with fistulas, insufficient mucosal tissues, and bone graft failure in the body area of the front of the lower jaw and the chin, and giving a distorted and unacceptable shape, especially in patients with war injuries or traumatic and pathological injuries who lost part of the front of the lower jaw and chin or the entire front of the lower jaw and chin. Modern methods were also used to construct the front of the lower jaw and the chin using unilateral bony expanders, but they did not give the desired results, neither from a functional nor an aesthetic point of view, as well as by using microsurgery and taking bone grafts from distant areas such as the iliac protuberance and the fibula bone with its surrounding copies. The transferred bone graft requires microvascular anastomoses to a recipient site artery and vein, which is a complex medical surgical procedure that requires a long surgical time in addition to taking a graft the body. This new invention provides an excellent service for these patients, as this device and its technique builds the bone of the front of the lower jaw and the chin by bilateral osteogenesis , which achieves excellent bone construction according to the requirements of the case in addition to the accompanying soft tissues, as this device allows freedom of movement towards the front and side to the centre area is semi-circular in accordance with the special anatomical shape of this sensitive area of the face in each end separately for the osteogenesis. For example, it is possible to expand and build autologous bone forward and, in the middle, up to 60 mm if the case requires it..

Detailed explanation of the invention:

The goal of the innovative method and device is to fully or partially self-build the front of the lower jaw and chin, unilateral and bilateral, in a circular shape and in accordance with the anatomical shape of the region, by making the best bone resections without complications, as with traditional surgical methods, where many techniques were used. Using autologous or heterogeneous bone grafts to build the loss bone in the body of the front of the lower jaw and the chin, and the accompanying high failure rates for autologous bone grafts transferred from distant areas of the body and the accompanying difficulty in traction of soft tissues and securing an adequate amount of bone grafts and sufficient mucous membranes in case of extensive loss of the anterior-lateral area in order to cover the bone grafts, as well as the difficulty of creating a good bed for the bone graft. This technique is referred to as: Autologous reconstruction of the frontal bone and the unilateral and bilateral circular movement (the surgical technique is explained below) with the use of the mandibular and chin building device Single- and double-sided circular motion.

This device consists of four parts made of titanium, which are:

1. Fixed external skeletal part

2. Right movable part

3. Left movable part

4. Expansion tool

1.External fixed structural part:

It consists of three sections:

A. Fixed rear section right

B. Fixed rear section left

C. A circular middle section of a fixed whole polygon.

A&B. The two fixed posterior parts, right and left: They consist of a metal base to which a metal plate with a thickness of 1 mm. They contain 3 - 4 holes in the shape of an inverted T are attached to install the device on the area behind the missing part of the front of the lower jaw with bone fixing screws with a diameter of (2 mm). This part is fixed on the posterior region of the remaining bone from the posterior part of the body of the jaw, right and left, behind the front of the lower jaw and the missing chin, in a vertical straight line that is perpendicular to the occlusal plane and parallel to the surface of the bone vestibular. This section is fused with the device in a manner parallel to the inner surface at the posterior edge.

C. Intermediate part circular polygon fixed whole shape: It is a hollow polygon metal base with a curved semi-circle shape similar to the anatomical shape of the front of the lower jaw and the chin. It has three sizes that correspond to all ages. For the small shape is with a diameter of 6 cm, medium 7 cm, and large 8 cm, depending on the area. The larger the loss, the larger the size. The cross-section of this part is rectangular, the length is 8 mm and the is width of the cross-section is 6 mm. This metal base is curved polygonal tubular shape, which takes the form of a part of a circle that fuses on its inner lower surface The fixed at the posterior end of the right and left the two posterior fixed parts right and left sagittal downward parallel and parallel to the bony surface on which the two posterior fixed parts are fixed. Moreover, the metal base is rectangular, curved, tubular, and circular in shape that connects the two fixed rear sections, right and left, and is intended to accommodate the right and left moving parts and direct their movement towards the front and the side to the middle area and in a circular manner. Additionally, its outer vestibular surface contains two openings. Two sides dedicated to the installation of the side motor snail, right and left, and its lower surface contains a hole 2 mm in the middle that extends along the lower edge from the back to the mediastinum on both the right and left ends, as it moves away from the rear edge and the middle by 2 mm where this hole allows Moving the right and left movable section from the back to the middle and in a circular motion.

2. Right movable part: The part responsible for expanding and building the bone towards the front and side to the middle area and in a circular motion from the right through the movement of the lateral threaded spindle based on the curved movement axis located within the fixed tubular front curved metal base and linked to the moving building plate, which takes the shape of the inverted T and paralleled to the fixed plate. It contains four holes for orthopedic fixing screws. The right movable rear part moves towards the front and side to the middle on the curved axis through the helix in the centre of the moving part and in a circular motion. The external curved fixed from the right side, through which this movable axis is activated for bony expansion and construction. This spiral gimlet can be expanded up to 30 mm and thus obtaining an autologous bone for this area with a full thickness of 30 mm. Hence, the bone is self-built for the right loss area from the front of the lower jaw and chin, according to the anatomical and aesthetic shape of this area.

3. Left movable part: This part is responsible for expanding and building the bone towards the front and side to the middle area and in a circular motion from the left through the movement of the lateral threaded spindle based on the curved movement axis located within the fixed tubular front curved metal base and attached to the moving building plate, which takes the shape of an inverted T paralleled to the fixed plate. It contains four holes for orthopedic anchor bolts. The left movable posterior part moves towards the front and side to the middle on the curved axis through the helix located in the centre of the moving part and in a circular motion. The external curved fixed from the left side, through which this movable axis is activated for bony expansion and construction. This lateral spiral gimlet can be expanded up to 30 mm thus obtaining an autologous bone for this area with a full thickness of 30 mm. Thus, the bone is self-built for the left loss area from the front of the lower jaw and chin, according to the anatomical and aesthetic shape of this area.

4. Expansion tool: The expansion tool has a hollow polygon head in proportion to the place designated for the right and left lateral expansion.

Surgical technique:

One of the modern methods of repairing defects in the front of the lower jaw and chin is building the bone by self-expansion in a circular motion, as the building of the bone by self-expanding This technique offers great advantages for oral and maxillofacial surgeon. Procedures are performed under general anaesthesia in combination with local anaesthetic and (adrenaline 1:100000) that is applied along the lateral orofacial vestibular groove of the mandible. Because of the bony cut will be on both sides of the front of the lower jaw and the missing chin, nasal intubation (NTI) is used for general anaesthesia. An incision is made on the vestibular groove of the lateral aspect of the mandible. The periosteum is then elevated. The flap design is similar to the flap for removal of impacted third molar. The anterior incision is extended to the area of the front of the lower jaw and the chain between the premolars. Afterwards, the soft tissues in the entire area are lifted from the ramus to the front of lower jaw and chin anteriorly. The bone is exposed in the posterior and the front areas. Then the location of the bony cuts is determined in the posterior and anterior aspect. The device is initially installed with bony fixing screws and the bone cuts are determined with small spherical burs. After that, the device is removed, and orthopedic dissemination of the right and left posterior regions is performed. The device is reinstalled and activated a full cycle in the right and the left regions. Consequently, circular expansion 1 mm is achieved anteriorly, middle and laterally in the right and the left side. According to protocol of osteogenesis, jaw expansion is accomplished by activating the device after latent period for one week. The jaw expansion is followed up until a complete construction of this complex anatomical region is achieved. The bilaterally device for bone construction in the front of the lower jaw and the chin remains additional period of 6 months to one year for retention. The result is a complete construction of the front of the lower jaw and the chin in an anatomically and aesthetically compatible way with all the surrounding tissues completely and perfectly.

Fig.1

illustrates all invention parts
1. Fixed external skeletal part

2. Right fixed part

3. Right movable part

4. Expansion tool

5. Expansion polygonal place

6. Left fixed part

7. Left movable part

Fig.2

illustrates the device fixed in place before the expansion

Fig.3

illustrates the device fixed in place after the expansion.

Claims

The unilaterally and bilaterally device for mandibular and chin construction is a device with circular movement. It composed of right posterior fixed part, left posterior fixed part, right movable part, left movable part, right and left helical hole, and expansion device.
Bone constructive device for the front of the lower jaw and the chin, in one or two sides is with circular motion, as mentioned in the first claim. The external fixed structure is in its circular, semi-cylindrical, polygonal shape, its lateral openings, its opening on the lower surface, and its movable part in the internal cavity directs movement anteriorly and laterally to the middle area and in a circular motion. In addition, its external buccal surface contains two lateral openings designated for the installation of the lateral spiral, right and left. Its lower surface contains a hole 2 mm in the middle that extends along the lower edge from the back to the middle in both the right and left ends, where it distances from the posterior and middle edges 2 mm This hole allows the movement of the right and left movable section from the back to the middle and in a circular motion. Depending on the bone loss, the device has three diameters that correspond to all ages (small 6 cm, medium 7 cm, and large 8 cm). The cross section of this part is rectangle with 8 mm length and 6 mm width.
Anterior mandibular and chin construction device with single and bilateral circular motion as mentioned in the first claim, the right posterior fixed part has an inverted T-form with thickness of 1 mm. It contains 3 - 4 holes for installing the device on the area behind the missing front of the lower jaw with bone fixed screws with a diameter of 2 mm. This part is fixed on the posterior region of the residual bone of the posterior part of the right body of the mandible behind the front of the lower jaw and the missing chin, in a vertical straight line that is perpendicular to the occlusal level and parallel to the surface of the bone buccally. This section is fused with the device and parallel to the inner surface at the right posterior edge.
Anterior mandibular and chin construction device with single and bilateral circular motion as mentioned in the first claim, the left posterior fixed part has an inverted T-form with thickness of 1 mm. It contains 3 - 4 holes for installing the device on the area behind the missing front of the lower jaw with bone fixed screws with a diameter of 2 mm. This part is fixed on the posterior region of the residual bone of the posterior part of the right body of the mandible behind the front of the lower jaw and the missing chin, in a vertical straight line that is perpendicular to the occlusal level and parallel to the surface of the bone buccally. This section is fused with the device and parallel to the inner surface at the left posterior edge.
The right movable part in anterior mandibular and chin construction device with single and bilateral circular motion is responsible for expansion and building the bone towards the front and side to the middle area with a circular motion from the right side. This motion is performed through movement of the lateral spiral gimlet based on the curved movement axis and locates within the anterior fixed tubular curved metal base and linked to the movable building plate. The lateral spiral puncture is in the form of inverted T and parallel to the fixed base. Furthermore, it contains four holes dedicated to orthopedic fixing screws. The right movable part moves anteriorly and laterally to the centre on the curved axis through the helix located in the centre of the movable part and in a circular motion. The spiral puncture connected to the curved movement axis has anteriorly a special base to insert expansion and activation tool. It is fixed on the right lateral side of the external and curved of the base. Activation of the curved movement axis with a full turn, it expands 1 mm. The activation is carried out through a hole located in the external stator. This gimlet can be expanded up to 30 mm. Thus, the bone is self-built in the front of the lower jaw and chin according to the anatomical and aesthetic shape of this area.
The right movable part in anterior mandibular and chin construction device with single and bilateral circular motion is responsible for expansion and building the bone towards the front and side to the middle area with a circular motion from the left side. This motion is performed through movement of the lateral spiral gimlet based on the curved movement axis and locates within the anterior fixed tubular curved metal base and linked to the movable building plate. The lateral spiral puncture is in the form of inverted T and parallel to the fixed base. Furthermore, it contains four holes dedicated to orthopedic fixing screws. The left movable part moves anteriorly and laterally to the centre on the curved axis through the helix located in the centre of the movable part and in a circular motion. The spiral puncture connected to the curved movement axis has anteriorly a special base to insert expansion and activation tool. It is fixed on the right lateral side of the external and curved of the base. Activation of the curved movement axis with a full turn, it expands 1 mm. The activation is carried out through a hole located in the external stator. This gimlet can be expanded up to 30 mm. Thus, the bone is self-built in the front of the lower jaw and chin according to the anatomical and aesthetic shape of this area.
A device for building for the front of the lower jaw and the chin, uni and bilateral, with a circular motion, as required in the first claim. The movement mechanism consists of the right lateral spiral puncture, which is fixed on the outer surface laterally of the external structure. It is in a slot designated for it, where it is in the front of the spiral gimlet on top of a polygon. This place is designated for inserting the expansion tool from the right side to expand and activate the device.
A device for building for the front of the lower jaw and the chin, uni and bilateral, with a circular motion, as required in the first claim. The movement mechanism consists of the right lateral spiral puncture, which is fixed on the outer surface laterally of the external structure. It is in a slot designated for it, where it is in the front of the spiral gimlet on top of a polygon. This place is designated for inserting the expansion tool from the right side to expand and activate the device.
9. A device for constructing the front of the lower jaw and the chin with a one-and two-sided circular motion as required in the first claim, where the expansion tool has a hollow polygon head in proportion to the place designated for the right and left lateral expansion.