RU2253391C1 - Method for substituting vast mandibular defects - Google Patents

Abstract

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

Description

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

There is a method of replacing extensive defects of the lower jaw, consisting in sawing and moving a bone fragment 2 cm long to a new place using a compression-distraction apparatus (CDA), accompanied by the formation of young bone tissue in an ever-increasing diastasis, until the defect of the lower jaw is completely replaced (M. B. Shvyrkov, G. I. Burenkov, V. R. Demenkov. Gunshot wounds to the face, lororgan and neck. - M .: Medicine, 2001. - S.345-354).

The disadvantage of this method is the long period of replacement of a bone defect in the lower jaw - at a rate of 1 mm per day and the inability to restore the missing jaw branch due to the fact that the high pressure of the soft tissues on the young bone regenerate causes its significant deformation, which cannot be eliminated with the help of CDA; there is no possibility of creating the necessary bulge of the chin region of the lower jaw.

The objective of the invention is to accelerate the process of replacing a bone defect, providing the ability to restore the missing branch of the lower jaw and creating a bulge of the chin.

This is achieved due to the fact that several bone fragments are cut off, depending on the length of the stump, and the fragments are moved in such a way that one of them is left in the chin area, the other in the jaw angle region, and the last fragment is moved until contact with opposite stump, and in the absence of it - to the base of the skull.

If, according to the prototype method, one bone fragment when moving through KDA gives an increase in young regenerate on average 1 mm per day, then the presence of several bone fragments increases this increase several times in accordance with their number. For example, if there is a bone defect of the lower jaw equal to 100 mm, the process of its replacement using one fragment will take 100 days, and if there are even two fragments, the replacement time will be 50 days.

To create a bulge in the chin area, the movement of the first fragment is stopped upon reaching this area. The formation of the missing branch of the jaw becomes possible due to the stabilization of the fragment left in the region of the angle of the jaw, and the subsequent gradual movement of the last fragment upward, towards the base of the skull.

The method is as follows (Fig.1-3): after applying the CDA to the lower jaw, depending on the length of the horizontal segment of the preserved stump (part of the body of the lower jaw) 1, several osteotomies are produced and, thus, movable fragments 2, 3, 4 are formed in length 2 cm (figure 1). After short-term compression (7-10 days), each fragment is moved in the direction of the bone defect at a rate of 1 mm per day, forming a young bone regenerate 9 (Fig.2-3). The total daily movement in millimeters will be equal to the number of fragments. One fragment 2 (Fig. 2-3) (closest to the stump from which these fragments are sawn off) is stopped moving and left in the chin region, another fragment 3 (Figs. 2-3) is stabilized in the region of the jaw angle, and the last fragment 4 (Fig.2-3) is moved to contact with the opposite stump 5 (Fig.2), and in the absence of it - to the base of the skull 6 (Fig.3), and its movement is made at an angle 7, corresponding to the angle 8 of the preserved part the jaw.

Clinical example.

Patient M., 35 years old. The medical history No. KA-4195. Diagnosis: cancer of the parotid salivary gland on the right. Condition after parotidectomy and combined radiation treatment. Defect of the body and branches of the lower jaw on the right 16 cm long.

Operation: 05/05/2003, a compression-distraction apparatus of four groups of spokes was placed on the lower jaw and three bone fragments 2 cm long were created using an osteotomy of the preserved stump. Compression was performed. 05/15/03, in the area of each osteotomy, distraction began at a rate of 1 mm per day. 06/02/03, as a result of a violation of the patient's rate of distraction, a distal regenerate ruptured. The distraction in this place is stopped, the fragments are brought together and compression is created for 10 days. On June 12, 2003, distraction began again at the same rate. 07/03/03 the distal fragment reached the chin and the distraction of the regenerate in this place was stopped. 07/14/03 the middle fragment reached the position of the angle of the jaw and distraction is stopped. 07/18/03, the anterior fragment reached the base of the skull, distraction stopped. The distraction period, thus, amounted to only 64 days. The period of maturation of the young bone has begun. After 66 days, dense bone was felt in the regenerate area. Thus, to eliminate the defect of the lower jaw with a length of 16 cm, it took only 130 days. If only one movable bone fragment was used in the treatment process, it would take at least 320 days or more to eliminate the defect 16 cm long (for the fragment to be distracted for 160 days and for the young bone tissue to mature for 160 days or more).

Claims (2)

1. A method for replacing extensive defects of the lower jaw, including sawing from the stump and moving the fragment using a compression-distraction apparatus until the defect is completely replaced, characterized in that several bone fragments are sawed from the stump, after the regenerate is formed, the fragment closest to the stump is stabilized upon reaching the area the chin, another fragment is stabilized upon reaching the region of the angle of the lower jaw, the last fragment is moved until contact with the opposite stump occurs, and in the case of and its absence - to the base of the skull. 2. The method according to claim 1, characterized in that the fragments are cut off 2 cm long.

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