Method for substituting vast mandibular defects

FIELD: medicine, oral surgery.

SUBSTANCE: one should cut the stump for several osseous fragments, replace the fragment with the help of compression-distraction apparatus till complete substitution of the defect, stabilize the fragment being the nearest one against the stump after development of the regenerate when submental area is reached, stabilize another fragment on reaching the area of mandibular angle, replace the last fragment before the contact with opposite stump is available, and in case of its absence - to cranial bottom. In peculiar case, one should cut fragments of 2 cm length. The innovation suggested enables to develop protuberance of submental area and accelerate defect's restoration.

EFFECT: higher efficiency for defects' substitution.

1 cl, 3 dwg, 1 ex

 

The invention relates to medicine, namely to maxillofacial surgery and Oncology.

There is a method of replacement of extensive defects of the lower jaw, which consists in sawing off and move the bone fragment with a length of 2 cm to a new place with a compression-distraction apparatus (KDA), accompanied by the formation of young bone tissue in an ever-increasing diastasis, up to full substitution of the defect of the mandible (M.b.shvyrkov, Geanuracos, Vremenko. Gunshot wounds of the face, oregano and neck. - M.: Medicine, 2001. - S-354).

The disadvantage of this method is the long period of osseous defect of the mandible - with a rate of 1 mm per day and the impossibility of recovering the missing branches of the jaw due to the fact that a large soft tissue pressure on young bone regenerate causes significant deformation, which cannot be eliminated by KDA; there is no possibility to create the necessary convexity of the chin region of the mandible.

The objective of the invention is to accelerate the process of osseous defect, providing the possibility of recovering the missing branches of the lower jaw and the creation of the convexity of the chin.

This is due to the fact that saw off a few bone fragments, depending on the length of the stump, and the movement is of Rahmanov produce so one of them is sure to leave you in the chin area, the other in the angle of the jaw, and the last fragment move before any contact with the opposite stump, and in case of its absence - to the base of the skull.

If the method prototype one bone fragment when moving through KDA increases young regenerate an average of 1 mm per day, the presence of multiple bone fragments increases this increase several times in accordance with their number. For example, if a bone defect of the mandible equal to 100 mm, the process of substitution using a single fragment will take 100 days, and in the presence of two fragments - time replacement will be 50 days.

To create a bulge in the chin moving the first fragment cease upon reaching this area. The formation of the missing branches of the jaw becomes possible due to the stabilization of the fragment left in the angle of the jaw, and then incrementally move the last fragment upward toward the base of the skull.

The method is as follows (Fig.1-3): after applying KDA on the lower jaw, depending on the length of the horizontal segment of the surviving stump (part of the body of the mandible) 1 produce multiple osteotomies and, thus, form paramesoamerica 2, 3, 4 length of 2 cm (figure 1). After a short compression (7-10 days) each fragment is moved in the direction of the bone defect with a rate of 1 mm per day, shaping young bone regenerate 9 (2-3). Total daily movement in millimeters is equal to the number of fragments. One fragment 2 (2-3) (closest to the cult, from which these sawed-off fragments) cease to move and leave it on the chin, another fragment 3 (2-3) stabilize in the angle of the jaw, and the last fragment 4 (2-3) move to prevent contact with the opposite stump 5 (figure 2)and in case of its absence - to the skull base 6 (Fig 3), and move it to produce at an angle of 7, corresponding to the angle 8 of the preserved part of the jaw.

Clinical example.

Patient M., aged 35. Case history No. KA-4195. Diagnosis: cancer of the parotid salivary gland on the right. After parotidectomy and combined radiotherapy. The defect of the body and the branches of the lower jaw to the right length 16 see

Operation: 05.05.2003, the lower jaw is superimposed compression-distraction apparatus of the four groups of spokes and with osteotomy of the surviving stump created three bone fragment length 2 see Produced by the compression ratio. 15.05.03, in the area of each osteotomy started distraction with a rate of 1 mm per day. 02.06.03, due to a violation of the patient tempo di the traction gap occurred distal regenerate. Distraction in this place terminated fragments of contiguous and created the compression ratio to 10 days. 12.06.03 was re-launched distraction with the same tempo. 03.07.03 distal fragment reached his chin and distraction regenerate in this place stopped. 14.07.03 average fragment has reached the position angle of the jaw and distraction terminated. 18.07.03, anterior fragment reached the base of the skull, distraction terminated. The distraction period, therefore was only 64 days. Started ripening period young bones. After 66 days in the field regenerates were pasupuleti dense bone tissue. Thus, to remedy the defect of the mandible length of 16 cm and it took only 130 days. If in the process of treatment used one movable bone fragment on the elimination of the defect length 16 cm would at least 320 days or more for the distraction of a fragment of 160 days and on the maturation of the young bone 160 days or more).

1. The way to replace the large defects of the lower jaw, including sawing off from the stump and moving fragment using the compression-distraction device up to full substitution of the defect, characterized in that the saw off from the stump a few bone fragments, after the formation of the regenerate closest to the cult of the fragment stabilize after reaching the chin, another slice stabilize after reaching the area of the mandibular angle, the last piece is moved before any contact with the opposite stump, and in case of its absence - to the base of the skull.

2. The method according to claim 1, characterized in that the saw off fragments of length 2, see



 

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