RU2285503C2 - Mandibular condyle endoprosthesis - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has porous titanium nickelide head member, fastening members and two titanium nickelide wire branches crossing and twining around each other. The wires are continuation of unclosed wire ring manufactured from titanium nickelide. The head member has ellipsoid shape and smooth articulation surface and ring-shaped notch arranged on lesser circle perimeter for placing the unclosed wire ring therein. Gauze fabric manufactured from titanium nickelide monofiber is brought through hole in eyelet formed by crossing wire branches. It allows the fabric to be bandaged around condylar head member surface and twining portion of the wire branches and enable distal fragment of the lateral pterygoid muscle, articulation bursa fragments and articulation ligaments to be attached by suturing.

EFFECT: enhanced effectiveness of treatment; enabled attachment of articulation bursa tissues and ligament fragments to the endoprosthesis.

2 cl, 10 dwg

Description

The invention relates to medicine, namely to maxillofacial surgery, and can be used in traumatology and oncology.

Known design of the prosthesis of the temporomandibular joint (patent RU No. 2118519, M.cl. A 61 F 2/30), containing the maxillary and temporal fastening elements made in the form of segments of cylindrical tubes made of porous titanium nickelide, and a connecting element in the form of a nickel-titanium segment wires with bends in the middle part.

The design flaws are poor integration with periarticular tissues and incomplete restoration of joint function.

An endoprosthesis of the condyle of the lower jaw is also known (patent SU No. 1805933, M.cl. A 61 F 2/02) containing a head and a plate with fixing holes made of porous titanium nickelide, an annular groove in which a wire ring of cast titanium nickelide is placed, wherein the surface of the articular part of the endoprosthesis head is covered with a layer of composite material (plastic).

The disadvantages of the known endoprosthesis are the complexity of manufacturing and its individual fit.

The objective of the invention is to simplify the manufacturing technology of the endoprosthesis and the possibility of hemming to the endoprosthesis of tissues of the joint bag, ligament fragments and the distal fragment of the lateral pterygoid muscle.

The problem is solved due to the fact that the endoprosthesis of the condyle of the mandible, containing the head of porous titanium nickelide, the fixation elements, according to the invention, has two crossed and twisted branches of nickel-titanium wire, which are a continuation of the open wire ring of titanium nickelide, the head is made ellipsoid with a smooth articular surface and an annular groove for a wire open ring located along the perimeter of a small circle, and through a hole in the loop, about azovannoy crossed wire branches threaded mesh fabric of monofilament TiNi chance bandaging it around the condylar surface of the head portion and entourage wire branches and the possibility of suturing the distal fragment of the lateral pterygoid muscles, the joint capsule and fragments of the articular ligaments.

The fixation elements of the endoprosthesis can be made in the form of twisted towards each other ends of twisted wire branches.

The invention is illustrated in the drawing, which shows:

figure 1 - ellipsoidal head condyle of the lower jaw with an annular groove made along the perimeter of its small circumference (front view);

figure 2 is the same side view;

figure 3 is the same, with freely hanging branches of nickel-titanium wire, which are a continuation of the open ring laid in the annular groove;

figure 4 is the same, with crossed branches of nickel-titanium wire;

figure 5 - ellipsoidal head of the condyle of the lower jaw with twisted branches - front view;

figure 6 is the same side view;

Fig.7 is the same, with a threaded mesh web of monofilament titanium nickelide;

on Fig - the same, after bandaging the mesh fabric around the condylar surface of the head and the reticulated part of the wire branches;

figure 9 is the same, with the distal end of the twisted part, which is given the configuration of the latch with shape memory adapted to a particular bone fragment;

figure 10 is the same, when used in combination with an implant of the lower jaw with the formation of a similarity of a threaded connection.

An endoprosthesis of the condyle of the lower jaw includes an ellipsoidal head, consisting of the upper articular part 1 with a smooth (non-porous) surface and the lower condyle part 2 with a porous surface. The ellipsoidal head is usually made of a permeable porous preform with a pore diameter of 150-300 microns. The joint part 1 is ground to a smooth surface, and the bottom 2 is left porous. Across the ellipsoidal head around the perimeter of its central small circle, a recess is formed in the form of a groove 3 corresponding to the cross section of the used wire 4, to perform the prosthesis of the mouse process. The condylar process prosthesis is made of wire 4, which, covering the head product, is placed in the groove 3, forming a ring 5, the continuation of which is the branch 6, twisting of which forms a twisted part 7, designed to replace the condylar process defect of the lower jaw.

When twisting the branches 6, a hole 8 is formed through which a mesh web of titanium nickelide monofilament 9 is threaded, to the surface of which lateral pterygoid muscle, fragments of the joint bag, articular ligaments can be reinserted.

An operation using a patentable endoprosthesis can be carried out as follows.

After operative access to the branch and condyle of the lower jaw, the lateral pterygoid muscle is mobilized, the articular bag is dissected, the jaw is resected of the required volume, and the articulation of the articular head is performed.

After strengthening the condyle of the condyle on the bone fragment or attaching it to the endoprosthesis of the body of the lower jaw, it is given the necessary position and configuration. Then the final implant implantation is performed: the head is placed in the articular fossa, the tissue of the articular bag, ligament fragments, the distal fragment of the lateral pterygoid muscle are sewn to the mesh of the endoprosthesis. The established endoprosthesis is covered with soft tissues, sutured in layers.

The claimed technical solution provides a simplification of the manufacturing technology of the endoprosthesis, because it consists of simple detachable parts that are assembled before and during the operation, if it is possible to stitch the joint bag tissues, ligament fragments, distal fragment of the lateral pterygoid muscle to the endoprosthesis.

The effectiveness of the technical result is confirmed by a number of clinical observations.

Example

Patient O. (case history No. 6894) was in the maxillofacial department of the GB No. 11 in Omsk (case history No. 6894) for a festering ameloblastoma of the lower jaw with a spread from 33 teeth to the articular head on the left. In order to reconstruct the lower jaw, a spiral endoprosthesis was made. For reconstruction of the temporomandibular joint, a separate condyle endoprosthesis was made. They are bonded to each other due to the introduction of the twisted part of the condyle prosthesis into the spiral endoprosthesis of a fragment of the lower jaw. Under intubation anesthesia from the submandibular access on the left, a resection of the affected fragment from 33 teeth was performed with exarticulation of the right TMJ. The lateral pterygoid muscle and elements of the joint TMJ were mobilized on the ligatures.

After fixing the endoprosthesis of the jaw body with a bone fragment, it was assembled with a condyle endoprosthesis, individual optimization of the length and configuration of the endoprosthesis, and reposition of the articular head into the articular fossa. The lateral pterygoid muscle, elements of the articular bag and ligamentous apparatus are ligated to the mesh web and twisted part. Then reposition of soft tissues, their layer-by-layer suturing, installation of drains, sutures on the skin was performed. The postoperative period was uneventful, the range of jaw movements fully recovered after 1 month. The long-term observation period is 1 year. The function of the lower jaw is maintained in sufficient volume without complications, which is confirmed by clinical and radiological data.

Claims (2)

1. Endoprosthesis of the condyle of the lower jaw, containing a head of porous titanium nickelide, fixation elements, characterized in that it has two crossed and twisted branches of nickel-titanium wire, which are a continuation of the open wire ring of titanium nickelide, the head is made ellipsoid with a smooth articular surface and an annular groove for a wire open ring located around the circumference of a small circle, and through a hole in a loop formed by crossed wire branches s, threaded mesh fabric of monofilament TiNi chance bandaging it around the condylar surface of the head portion and entourage wire branches and the possibility of suturing the distal fragment of the lateral pterygoid muscles, the joint capsule and fragments of the articular ligaments. 2. Endoprosthesis of the condyle of the lower jaw according to claim 1, characterized in that the fixation elements of the endoprosthesis are made in the form of twisted towards each other ends of twisted wire branches.

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