Surgical method for treating congenital hard and soft cleft palate

FIELD: medicine.

SUBSTANCE: method involves cutting mucous membrane and periosteum in the area of lateral hard palate portions. Cuts are done in anterior and middle hard palate part. Mucoperiosteal flaps are produced. The flaps are separated from nasal mucosa and bone part of the hard palate. Mucous and submucous layer are cut in retromolar zones beginning from Langenbeck incision back edge and finishing in glossal surface projection of mandibular alveolar process with pterygoid processes hamulus of the main bone being exposed. Soft tissues are detached from the processes in interfacial space layer located between musculus levator veli palatini and the hamulus to the pharyngopalatine muscle insertion site. Upper pole of musculus levator veli palatini tendons is cut in the cases of lacking mobility. Reticular implant manufactured from 40-60 mm thick titanium nickelide thread and cell size of 3x3-4x4 mm is sutured to mucoperiosteal flaps surfaces turned towards nasal cavity or to each other after moving them. The implants are attached to each other. The mucoperiosteal flaps are fixed by means of removable protection plate.

EFFECT: enhanced effectiveness of treatment; prevented flap divergence; forming solid connective tissue regenerate.

 

The invention relates to medicine, namely to surgical dentistry and maxillofacial surgery, and is intended for the treatment of patients with cleft hard and soft palate.

The closest technical solution is a method of surgical treatment of congenital cleft hard and soft palate, including the dissection of the mucosa and periosteum in the region of the lateral parts of the hard palate, make additional cuts in the front and middle Department of the hard palate, the formation of additional mucoperiosteal flaps, Department of main flap from the nasal mucosa and bone of the hard palate and their mobilization, dissection of the mucosal and submucosal layers in retromolar zones, starting from the rear edge langenbecks section and ending in the projection of the posterior lingual surface of the alveolar process of the mandible with exposed hooks of the pterygoid processes of the main bone and soft tissue from which separate layer lifestealing space located between the m. levator veli palatini and hook up the insertion of Palatine-Palatine muscle dissection in cases of lack of mobility of the upper pole of the tendon of m. tensor veli palatini, sponging the edges of the cleft, the closure flaps of the soft palate between the three layers, the stitching of the lining of the nose, curved seams and ignim near the nodal joints of the main flaps of the hard palate, suturing wounds in the field kralovice temporomandibular spaces taking into account retransposes sky, closure of the defect in the anterior hard palate in any known manner and fixation of mucoperiosteal flaps removable protective plate [1].

The disadvantage of this method is the possibility of formation of postoperative defects due to failure of plastic material in many patients, dehiscence in the immediate postoperative period, due to the subsequent reduction of the sizes of patches and/or violations of reparative regeneration due to the presence of concomitant pathology of internal organs or immunological disorders of the body.

The task of the invention is to improve the efficiency of surgical treatment of patients with cleft hard and soft palate.

This object is achieved in that in the method of surgical treatment of congenital cleft hard and soft palate, including the dissection of the mucosa and periosteum in the region of the lateral parts of the hard palate, the holding sections in the front and middle Department of the hard palate, education mucoperiosteal flaps, Department of grafts from the nasal mucosa and bone of the hard palate and their mobilization, dissection of the mucosal and submucosal layers in retromolar the different zones, starting from the rear edge langenbecks section and ending in the projection of the posterior lingual surface of the alveolar process of the mandible with exposed hooks of the pterygoid processes of the underlying bone, separated from the last of the soft tissue layer lifestealing space located between the m. levator veil palatini and hook up the insertion of Palatine-Palatine muscle dissection in cases of lack of mobility of the upper pole of the tendon of m. tensor veli palatini, sponging the edges of the cleft, the closure flaps of the soft palate between the three layers, the stitching of the lining of the nose, curved seams, sewing scraps, hard palate near the anchor sutures, suturing wounds in the field kralovice temporomandibular spaces taking into account retransposes sky, closure of the defect in the anterior hard palate, the fixation of mucoperiosteal flaps removable protective plate, it is new that the surfaces of the mucoperiosteal flaps after they move facing the cavity of the nose or to each other, sew mesh implants from nickeled-titanium filaments with a thickness of 40-60 μm size cell 3×3-4×4 mm, fixed implants among themselves.

Mesh implants from nickeled-titanium filaments with a thickness of 40-60 μm and unit cell dimensions 3×3-4×4 mm prevents the reduction of the sizes of patches into the nearest water body is eating the postoperative period. Structural features and properties of the implants enable unimpeded germination tissue cells with the formation of the one with the implant material is a dense connective tissue regenerate.

The method is as follows. The edges of the cleft refresh and in the region of the lateral parts of the hard palate dissected mucosa and periosteum on Langenbach and spending cuts in the front and middle Department of the hard palate for the formation of a mucoperiosteal flap, using one of the techniques developed Viewsim (1953), Mddubo (1960), Bednarikova (1964), Wiernicki (1964), Iavaroni and Gagetown (1998). Mucoperiosteal flaps prepare the chin from the palatal and alveolar processes of the maxilla and the horizontal plate of the Palatine bone. Take the neurovascular bundles of large palatal canals after resection of the rear wall of the latter and spend their dissection from the flaps. Next, separate the flap from the nasal mucosa in the border region of the hard and soft palate forward, cut through the mucosa and submucosa in retromolar areas to the lingual surface of the alveolar process of the mandible and expose the hooks of the pterygoid processes of the underlying bone. Soft tissue is separated from the last layer lifestealing space from the inner surface of the inner construction of the second plate main bone to attach m. pharingo-palatini, without changing the place of attachment m. tensor veli palatini, and the lack of mobility of the tissues of the upper pole of the tendons of these muscles cross. The flaps of the soft palate are sutured together in three layers. Nasal mucosa impose negative seams. To mucoperiosteal the flaps after they are moved from the side surfaces, which are facing the nasal cavity or to each other (in the latter case, their decapitalizing), hem mesh implants with unit cell dimensions 3×3-4×4 mm made in accordance with their configuration from nickeled-titanium filaments with a thickness of 40-60 μm. The thus prepared mucoperiosteal flaps sewn together in two layers of nickeled-titanium thread. Wounds in the area kralovice temporomandibular spaces taking into account retransposes sky is sutured interrupted sutures tightly. Additional fixation mucoperiosteal flaps provide iodoform stripes and removable protective plate.

Example. Patient M., 3 years, turned to the clinic for congenital complete left-sided cleft hard and soft palate with the aim of surgical treatment. Under endotracheal anesthesia refreshed the edge of the cleft, held sections of Langenbach, Ernst, educated and mobilized mucoperiosteal flaps (in the front section according to methods Vijayaba), mobile is implemented mucosa of the lower section of the nasal cavity, superimposed seams on the flaps of the soft palate in three layers, the mucous of the nose - reversible stitches, wounds in the area kralovice temporomandibular spaces taking into account retransposes sky sutured tightly from the side surfaces of the flaps of the hard palate installed mesh implants, the appropriate form with unit cell dimensions 3×3 mm from nickeled-titanium filament thickness of 50 μm, similar to the implant installed on decapitalizing surface of the flap, mobilized by Whithouse, implants together nickeled-titanium filament thickness of 90 μm, the mucosa and periosteum stitched near the nodal joints, the flap in front of the crevices fixed through the entire thickness to the surrounding tissues, nickeled-titanium welds, additional fixation mucoperiosteal flaps carried out iodoform stripes and removable protective plate. Postoperative for smooth, sutures were removed after 10 days. Wound healing is primary. Monitoring was recommended by the orthodontist and treatment by a speech therapist. When viewed through 6 months have seen a good anatomical and functional results.

Clinical trials of the proposed method performed on 16 patients who underwent uranoplasty using the proposed implants. In the observation of patients within 3 years of any anatomical and functional is lnyh abuses by the hard and soft palate not found.

The advantages of the proposed method lies in the fact that as a result of use as a reinforcing fabric mesh implants from nickeled-titanium filaments, in the immediate postoperative period differences flap that prevents postoperative defects. Thanks biochemical and biomechanical compatibility of titanium nickelide with biological tissues implants made of this material long-term function in the body, not attalas and emerging regenerate gradually grows in their column.

Literature

1. Kharkiv L.V. Surgical treatment of congenital nasredine sky. Kiev: "Health", 1992.

The method of surgical treatment of congenital cleft hard and soft palate, including the dissection of the mucosa and periosteum in the region of the lateral parts of the hard palate, the holding sections in the front and middle Department of the hard palate, education mucoperiosteal flaps, Department of grafts from the nasal mucosa and bone of the hard palate and their mobilization, dissection of the mucosal and submucosal layers in retromolar zones, starting from the rear edge langenbecks section and ending in the projection of the posterior lingual surface of the alveolar process of the mandible with exposed hooks of the pterygoid processes of the main coast is, separated from the last of the soft tissue layer lifestealing space located between the m. levator veli palatini and hook up the insertion of Palatine-Palatine muscle dissection in case of lack of mobility of the upper pole of the tendon of m. tensor veli palatini, sponging the edges of the cleft, the closure flaps of the soft palate between the three layers, the stitching of the lining of the nose, curved seams, sewing scraps, hard palate near the anchor sutures, suturing wounds in the field kralovice temporomandibular spaces taking into account retransposes sky, closure of the defect in the anterior hard palate, the fixation of mucoperiosteal flaps removable protective plate, wherein the surfaces of the mucoperiosteal flaps after they move facing the cavity of the nose or to each other, sew mesh implants from nickeled-titanium filaments with a thickness of 40-60 μm cell size 3×3÷4×4 mm, fixed implants among themselves.



 

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