Method for removing underdevelopment and/or mandibular defect combining with maxillary underdevelopment

FIELD: medicine, oral surgery.

SUBSTANCE: one should cut mandibular branch through both cortical plates and spongy substance of the bone, carry out osteotomy of maxillary body at the level of pear-shaped foramens, vomer and pteromaxillary articulation at affected side, conduct additional osteotomy of pteromaxillary articulation at intact maxillary side, apply compression-distraction apparatus at affected maxillary side to fulfill compression and distraction of osseous fragments. The innovation in question enables to conduct operative interference since the age of 5-6 yr and provide individual schedule of distraction.

EFFECT: higher efficiency.

2 dwg, 1 ex

 

This invention relates to oral and maxillofacial surgery and can be used for the treatment of underdevelopment and/or defect of the mandible, combined with underdevelopment of the upper jaw congenital or acquired character.

Known way to eliminate underdevelopment of the lower and upper jaw (Molina F. Combined maxillary and mandibular distraction osteogenesis// Seminars in orthodontics, v.5, No. 1, 1999, R-45).

Patients with hemifacial microsomia make the cut at transition fold from 16 to 26 tooth. Skeletonize the upper jaw on both sides. Perform the osteotomy of the maxilla at the level of the pear-shaped holes, Coulter and chrysovalantou joint on the affected side. Chrysovalantou articulation on the healthy side remains intact. A second incision is made on nienasycenie furrow on the affected side. Skeletonize branch of the lower jaw and perform the corticotomy. Then impose rod distraction device. Wounds sutured in layers. The distraction begin on the 5th day after surgery at 1 mm per day. Before distraction produce premaxillary splinting. The distraction period is 3-4 weeks. The retention period of 8-10 weeks. All this time premaxillary splinting is stored.

The disadvantages of this method are

- age restrictions: a known manner can be the prpo is aerovane patients older than 12 years;

- premaxillary fixation leads to inflammatory and degenerative changes in the mucosa of the oral cavity, to the lack of adequate nutrition (liquid food) for a long time, the difficulty of caring for the oral cavity, the risk of aspiration during possible vomiting;

- lack of function of the upper and lower jaw negatively affects the formation of the regenerate;

- difficult to care for distraction rod apparatus;

- frequent inflammatory processes in the field rods are the indication for removal of the device before the end of the retention period, resulting in a disruption of the formation of complete bone regeneration, which negatively affects the results of the treatment;

unusual appearance of the patient worsens its psycho-emotional state;

- for more severe scarring on the skin from the terminals of the device.

The purpose of this invention is to reduce the morbidity method and postoperative complications, as well as lowering the voting age.

This objective is achieved in that in the solution of underdevelopment and/or defect of the mandible, combined with underdevelopment of the upper jaw by cutting the branches of the lower jaw, its a distraction osteotomy of the body of the maxilla at the level of the pear-shaped holes, Coulter and chrysovalantou sochinenie is on the affected side, a distinctive feature is that the cutting of the branches of the lower jaw carried out through both cortical plate and cancellous bone, bone fragments is subjected to compression, and then the distraction, additionally spend osteotomy chrysovalantou articulation on the intact side of the jaw with the subsequent imposition of compression-distraction device on the affected side of the upper jaw.

The proposed method is as follows: the operation was performed under endotracheal anesthesia. Cut to 6 cm in the mouth at transition fold on the affected side skeletonize branch of the lower jaw. Outline of the osteotomy line: boron or saw cut the outer cortical layer, and the front and rear edge of the branches of the lower jaw cut outer and inner cortical plate (inner cortical plate in the middle part remains). Set intraoral osseous compression-distraction apparatus, previously promoted by 2-3 mm, in order subsequently to produce compression. Drill diameter 1.6 mm form the screw holes. Holes are drilled through the two cortical layer. The depth gauge determines the length of the holes. Based on this, select the self-tapping screws of required length with a diameter of 2 mm, So the t is fixed to the bone fragments so, the screws pass through two of the cortical layer. The screws tighten until it stops. Osteotomes nadramia internal cortical plate. Carry out a compression of the bone fragments. Hemostasis during surgery. The wound is sutured in layers.

Then make a section on transition the crease from the tuberosity of the maxilla one side to the tuberosity of the opposite side. Skeletonize the upper jaw on both sides. To the upper jaw on the affected side is fixed intraoral osseous compression-distraction apparatus (alveolar distractor company Martin) not less than 12 screws with a diameter of 2 mm and a length of no more than 5-7 mm Device was set at an angle to the midline, at the time of distraction will provide the divergence of the bone fragments in the form of a wedge, the apex of which is located in the area skolealderen crest healthy side. Perform the osteotomy of the vomer and maxilla at the level of the pear-shaped holes on two sides with conducting osteotomy in the field chrysovalantou joint in healthy and affected side (figure 1). Produce compression. Hemostasis during surgery. The wound is sutured in layers.

The distraction of the mandible begin on the 5th day after surgery at 1 mm per day for 4 admission to 0.25 mm; the distraction of the maxilla - 10 day 0.5 mm per day in 2 doses of 0.25 mm, the retention Period lasts at least 12 weeks figure 2).

Example

Patient M., 9 years was in the clinic with a diagnosis of hemifacial microsomia left. At admission were determined asymmetry of the face. Chin was shifted to the left by 2 see the size of the branches of the lower jaw on the left side equal to 3 cm, and the right 5 see the Bite is offset from the midline of 0.7 mm to the left. Occlusal plane was inclined position. Also defined the underdevelopment of the upper jaw. The patient was held osteotomy of the upper jaw on both sides and lower jaw on the left with the imposition of a compression-distraction apparatus.

The operation is performed under endotracheal anesthesia. Cut to 6 cm in the mouth at transition fold on the affected side skeletron branch of the lower jaw. The planned osteotomy line. Installed and fixed intraoral osseous compression-distraction apparatus 6 screws, pre-promoted by 2-3 mm Osteotome produced a complete osteotomy of the branches of the lower jaw. Produced by compression of the bone fragments. Hemostasis during surgery. The wound is sutured in layers.

Then the incision is made on the transition fold from the tuberosity of the maxilla one side to the tuberosity of the opposite side. Skeletron upper jaw on both sides. To the upper jaw on the affected side is fixed intraoral osseous compression-distraction apparatus (alveolar shall istructor company Martin) 12 screws. The device is fixed at an angle to the midline. Performed osteotomy of the maxilla at the level of the pear-shaped holes on two sides, with the osteotomy in the field chrysovalantou joints on both sides. Also produced osteotomy Coulter. Performed the compression ratio. Hemostasis during surgery. The wound is sutured in layers.

In the postoperative period conducted anti-inflammatory therapy, and physiotherapy. Sutures were removed 10 days after surgery. Distraction of the mandible started on 5 day field operations 1 mm per day for 4 admission 0.25 mm Distraction of the maxilla started at 10 day 0.5 mm per day in 2 doses of 0.25 mm, the Length of the distraction was 20 days. The retention period lasted 12 weeks, after which the devices were removed. Alignment is presented full bone size 20 mm on the lower jaw and 10 mm on the upper jaw. As a result of the treatment received good cosmetic and functional result: the face was symmetrical, occlusal plane was in a horizontal position. The follow-up period of 6 months without negative dynamics.

In this method operated on 10 patients aged 6 to 15 years.

Thus, the proposed method is suitable for simultaneous elimination of underdevelopment and/or defect of the mandible, combined with underdevelopment ver is her jaw congenital or acquired character, allows to achieve stable good cosmetic and functional results.

The advantages of the proposed method:

- significantly reduced the age limit, the method may be used with 5-6 years;

no premaxillary fixation;

- saved function of the upper and lower jaw, which positively affects the formation of the regenerate;

- the possibility of adequate nutrition and adequate care for the oral cavity;

acceptable appearance of the patient;

- there are no scars on the skin;

- unlimited retention period;

- significantly reduced the risk of inflammatory processes;

- ability to conduct independent from each other distraction upper and lower jaw with your individual schedule distraction for each of the jaws.

Solution underdevelopment and/or defect of the mandible, combined with underdevelopment of the upper jaw by cutting the branches of the lower jaw, its a distraction osteotomy of the body of the maxilla at the level of the pear-shaped holes, Coulter and chrysovalantou joint on the affected side, characterized in that the cutting of the branches of the lower jaw carried out through both cortical plate and cancellous bone, bone fragments is subjected to compression and then the distraction, additionally spend osteotomy chrysovalantou socl the tion on the intact side of the upper jaw with the subsequent imposition of compression-distraction device on the affected side of the upper jaw.



 

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