Method for removing underdevelopment of mandibular mental department

FIELD: medicine, oral surgery.

SUBSTANCE: one should apply compression-distraction apparatuses in area of mandibular angles, perform mental osteotomy, go on osteotomic line along mandibular body up to angles, compress osseous fragments followed by distraction of osteotomized mandibular fragment. The innovation enables to conduct therapy at the age of 5-6 yr.

EFFECT: higher cosmetic result.

2 dwg, 1 ex

 

This invention relates to oral and maxillofacial surgery and can be used to eliminate underdevelopment of the chin of the lower jaw congenital and acquired character.

There are a large number of ways of genioplasty using autotransplants, allografts, plastic endoprostheses from various synthetic materials (IGMASS-12, the silicone composition of polymethylmethacrylate with hydroxyapatite - "Polycap").

A known solution to the underdevelopment of the chin of the lower jaw by contouring using plastic endoprosthesis consists in the fact that the chin Department of the mandible fixed with an insert made of IGMASS-12, and facial contours become an acceptable form (Balin, VN, Alexandrov NM Contour // Clinical operative oral and maxillofacial surgery. - St.-Petersburg, 1998, s-130).

The disadvantages of this method are:

- the presence of foreign material (IGMASS-12);

- age limit - 16 years;

- rejection of the endoprosthesis.

The closest to the invention is a method of eliminating underdevelopment of the chin of the lower jaw, which consists in the fact that after osteotomy of the chin and simultaneous extension of the last forward formed in the bone defect UKL is devout ALLO - or autograft (Nikitin A.A. How genioplasty at the bottom of the symmetric micrognathia// A.S. No. 17334703, publ. 1992).

The disadvantages of the method described above are:

- age limit - 16 years;

- graft rejection;

- osteomyelitis displaced bone fragment;

partial resorption of autologous or allograft;

- the lack of a predictable treatment outcome.

The purpose of this invention is to reduce the number of complications, lowering the voting age and effectiveness of treatment.

This objective is achieved in that the solution to the underdevelopment of the chin of the lower jaw by osteotomy of the chin and advance it forward a distinctive feature is that pre-impose Ilizarov apparatus in the field angles of the lower jaw, and after osteotomy of the chin continue the line of the osteotomy on the body of the lower jaw to the corner, the bone fragments are subjected to compression and subsequent distraction osteotomies fragment of the lower jaw.

The method is as follows.

The operation was performed under endotracheal anesthesia. The incision in the mouth at transition fold from retromolar the area of one side to retromolar region other hand skeletonize the body of the mandible the two sides. Gently mobilize the neurovascular bundle from both sides. In the angle of the lower jaw set compression-distraction apparatus parallel to the bottom edge of the body, pre-promoted by 1-2 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, the Device is fixed to the bone fragments 6 screws so that the latter pass through two of the cortical layer. The screws tighten until it stops. Screw machine output through a separate incision (0.3 mm) on the skin in the ear region. In a similar way fix the second compression-distraction apparatus in the angle of the lower jaw with the other hand. Using an oscillating saw perform extended osteotomy of the chin after chin the osteotomy line goes through the body to the angle of the mandible on both sides. The osteotomy line passes below the roots and rudiments of teeth. Perform compression of bone fragments (figure 1). Hemostasis during surgery. The wound is sutured. Put the seam at the wound in a screw device on the skin.

The distraction begin on the 5th day after surgery is about 0.5 mm per day in 2 doses of 0.25 mm. The retention period lasts at least 12 weeks (figure 2).

Example.

Patient B., 6 years old, was admitted with a diagnosis of bilateral newartriot TMJ, hypoplasia of the chin of the lower jaw. From the anamnesis it is known that 2 years ago the operation was performed osteotomy of the mandible with 2 sides with one-stage arthroplasty with prosthetic implants from Paligap" with the aim of eliminating bilateral arthrosis of the temporomandibular joint. To eliminate underdevelopment of the chin of the lower jaw was applied the proposed method.

The operation is performed under endotracheal anesthesia. The incision in the mouth at transition fold from retromolar the area of one side to retromolar region other hand skeletonema the body of the mandible on both sides. Mobilized the neurovascular bundle from both sides. In the angle of the mandible with 2 sides installed and fixed Ilizarov apparatus parallel to the bottom edge of the body, pre-promoted by 1-2 mm Screws vehicles brought out through a separate incision (0.3 mm) on the skin in the ear region. Using an oscillating saw made extended osteotomy of the chin after chin the osteotomy line goes through the body to the angle of the mandible on both sides. The osteotomy line was the cognate roots and rudiments of teeth. Implemented compression of the bone fragments. Hemostasis during surgery. The wound is sutured knotted sutures.

In the postoperative period, the patient is conducted anti-inflammatory therapy. Sutures were removed on day 10 after surgery. Distraction was started on the 5th day after surgery to 0.5 mm per day in 2 doses of 0.25 mm to Nominate the chin region of the mandible managed 20 mm After 12 weeks Ilizarov apparatus was removed. In operation, the size of the regenerate on each side was 20 mm and there was a full bone. As a result of the treatment received good cosmetic result. The follow-up period of 6 months, without negative dynamics.

According to this method operated 3 children aged 6 to 13 years with a good cosmetic result.

The advantages of the proposed method:

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

- the absence of possible negative aspects inherent in the methods using various types of transplants;

- absence of foreign material;

- a predictable result,

- genioplasty is exclusively local fabrics,

- ability to change the position of the chin of a fragment of the lower jaw, depending on the wishes of the patient and parents in the process of distraction.

SPO is about eliminating underdevelopment of the chin of the lower jaw by osteotomy of the chin and advance it forward, wherein the pre-impose Ilizarov apparatus in the field angles of the lower jaw, and after osteotomy of the chin continue the line of the osteotomy on the body of the lower jaw to the corner, the bone fragments are subjected to compression and subsequent distraction osteotomies fragment of the lower jaw.



 

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