RU231886U1 - Compression-distraction device for the treatment of patients with maxillary micrognathia - Google Patents

Abstract

The utility model relates to the field of medicine, in particular to dentistry and maxillofacial surgery, and can be used to treat patients with micrognathia of the upper jaw. A compression-distraction device made of titanium, consisting of a housing in which a threaded hole is made and a cylindrical rod, where a bar with an oblong hole is installed on the cylindrical rod, an upper bone plate with fourteen holes for fastening screws located at an equal distance from each other is welded to the bar, wherein the four middle holes are higher than the side ones, a washer is welded to the upper part of the cylindrical rod, which holds the bar and the upper bone plate on the housing, a lead screw is installed in the threaded hole of the housing, which consists of a section with an external screw thread, a flange, a cylindrical section and a cylindrical rod, a cardan coupling is rigidly installed on the cylindrical rod, which consists of two forks with holes, a crosspiece with holes through which the axle passes and two half-axles, a rod with a hexagon is attached to the front fork, on which during activation a key is installed in the compression-distraction device, wherein the axle and half-axles are welded to the forks with the ability to rotate in the holes of the crosspiece, the cardan coupling allows changing the position of the rod relative to the axis of the lead screw when activating the drive of the compression-distraction device, between the flange of the lead screw and the fork on the cylindrical section of the lead screw a bushing is installed, to which the lower bone plate with eleven holes for fastening screws located at an equal distance from each other is welded.

Description

The utility model relates to the field of medicine, in particular to dentistry and maxillofacial surgery, and can be used to treat patients with micrognathia of the upper jaw.

Anomalies of the facial bones, including anomalies of the upper jaw, require combined orthodontic and surgical treatment. The surgical stage of treatment is a critically important link in achieving stable and predictable treatment results for this group of patients.

As a result of the conducted patent and information studies, it was established that distraction osteogenesis is a convincing method of choice in the treatment of anomalies and deformations of the facial skeleton bones (Rami P Dibbs, Andrew M Ferry, 2021).

For distraction osteogenesis of the maxilla, various distraction devices, both intraoral and extraoral, are used in clinical practice.

For example, the "Palatine Distraction Apparatus" (Patent No. 2613089) includes a distraction housing equipped with a fixing element, inside which a pair of rods with end parts protruding from the ends of the housing are placed along the housing. The rods are mounted inside the housing with the possibility of movement during its rotation relative to each other in the direction of approaching or moving away from each other along the axis of the housing. The end part of each rod is equipped with a plate with spikes made on the opposite side of the plate facing the rod. A through hole is formed in each plate for fixation on the palate (palatine bone) by means of a fixing screw. Each plate and the corresponding rod are equipped with a detachable connection unit, which contains a protrusion made on the plate on the side opposite to the side with spikes, having a cavity extending outward on the side opposite to the side of the plate with spikes. The part of the plate body that limits the cavity has a recess of a polyhedral shape limited by faces with ribs between adjacent faces. The end part of the corresponding rod has spherical projections with ribs between adjacent spherical projections arranged sequentially along the perimeter. In the assembled position of the spherical shape, the projections of the rod are located in the recess of a polyhedral shape of the cavity of the corresponding plate until they stop in it with the possibility of rocking relative to each other.

A "Distraction apparatus" is known (patent No. 2597281), comprising a supporting rod, a fork and means for moving an osteotomized bone fragment of the patient's jaw from the basal bone mounted thereon, wherein said means for moving the bone fragment are made in the form of a movable plate and an activation pin located in the rod and a fixed plate rigidly fixed on the fork, wherein each plate is provided with holes for installing fastening screws, and the movable plate is connected to the rod by means of a carriage with the possibility of longitudinal reciprocating movement in the rod, characterized in that the fork consists of two left and right parts having hemispherical surfaces that are rigidly connected to each other and form an internal spherical surface at the base of the fork, and the rod has a spherical base movably connected to the internal spherical surface of the base of the fork, providing rotational movement of the rod around its axis.

The general disadvantages of the said inventions are that these devices allow distraction in one direction, without the possibility of simultaneous use of other intraoral devices for distraction of the jaw in other planes; in such cases, extraoral devices are used, which are bulky and uncomfortable for the patient, which can be associated with both physical and emotional discomfort for adolescent patients.

The technical task of the claimed invention is to develop a device for distraction of the upper jaw in the sagittal plane, which would allow for one-stage distraction in the transverse plane with a palatal distractor, which makes it possible to transition to the surgical stage of treatment in patients at an earlier age.

The technical result of the claimed invention is the possibility of simultaneous distraction of the upper jaw in two planes - sagittal and transverse in adolescence, which will ensure the restoration of chewing function, eliminate the aesthetic defect of the face in adolescence, and eliminate the need for orthognathic interventions upon reaching adulthood.

The technical result is achieved due to the fact that the developed device performs distraction of the upper jaw in the sagittal plane, while due to its design it does not interfere with distraction of the upper jaw in the transverse plane by a palatal distractor.

The essence of the utility model is presented in Fig. 1-10, where a view of the compression-distraction device is shown, namely:

Fig. 1 shows a front view of the Compression-Distraction Device.

Fig. 2 shows the compression-distraction device, left view.

Fig. 3 shows a compression-distraction device, top view.

Fig. 4 shows the compression-distraction device, bottom view.

Fig. 5 shows section A-A.

Fig. 6 shows the body.

Fig. 7 shows the lead screw.

Fig. 8 shows the cardan coupling fork.

Fig. 9 shows the crosspiece.

Fig. 10 shows the lower bone plate with the sleeve assembled.

The compression-distraction device consists of a housing 1, in which a threaded opening 2 and a cylindrical rod 3 are made. A bar 4 with an oblong opening 5 is installed on the cylindrical rod 3. An upper bone plate 6 with 14 openings for fastening screws located at an equal distance from each other is welded to the bar 4, with 4 middle openings higher than the lateral ones for passing bone screws with which this plate is fastened to the bone. A washer 8 is welded to the upper part of the cylindrical rod 3, which holds the bar 4 and the upper bone plate 6 on the body 1. A lead screw 9 is installed in the threaded hole 2 of the body 1. The lead screw 9 consists of a section with an external screw thread 10, a flange 11, a cylindrical section 12 and a cylindrical rod 13. A cardan coupling 14 is installed on the cylindrical rod 13. The cardan coupling 14 consists of two forks 15 and 16 with holes 17, a crosspiece 18 with holes 19 and 20, through which an axis 21 passes and two half-axles 22. A rod 23 with a hexagon 24 is attached to the front fork 16. A key is installed on the hexagon 24 during activation of the KDU. The axis 21 and the half-axles 22 are welded to the forks 15 and 16, and in the holes 19 and 20 of the crosspiece 18 they can rotate. The cardan coupling allows changing the position of the rod 23 relative to the axis of the lead screw 9 when activating the KDU drive. Between the flange 11 of the lead screw 9 and the fork 15 on the cylindrical section 12 of the lead screw 9, a bushing 25 is installed. The lower bone plate 26 with 11 holes for fastening screws located at an equal distance from each other 27, as in the upper bone plate 6, is attached (welded) to the bushing 25. All parts of the apparatus are made of titanium.

The device is used as follows.

In the operating room, under combined endotracheal anesthesia, after performing osteotomy of the upper jaw along the Le FortI lines, two distractors are installed on the upper jaw - the distractor we have declared - the upper bone plate along the lateral edge of the piriform aperture, the lower bone plate along the lower edge of the piriform aperture. Namely, a key is installed on the hexagon 24 of the rod 23. When it rotates, the torque is transmitted through the forks 15 and 16, the axis 21 and the half-axles 22, the crosspiece 18 to the lead screw 9. The lead screw 9 is unscrewed from the housing 1 forward, and pulls the sleeve 25 with the lower bone plate 26 behind it. A fragment of the lower jaw bone is attached to the lower bone plate 26 with bone screws. Thus, the distraction of this fragment forward is carried out. The presence of an oblong hole 5 in the bar 4 allows for the forward distraction to be accompanied by a lateral displacement of the bone fragment. The second device installed on the upper jaw, on the hard palate area, is a palatal distractor with an expansion screw. After installation, the distractors are fixed with screws, the edges of the surgical wound are aligned and sutured with a continuous suture using Monocryl 5-0 thread. In the postoperative period, the activation of distraction devices is performed on the 7th day after the operation.

Using the claimed device, 15 patients were treated. All patients showed a reduction in the treatment period and rapid rehabilitation.

Claims (1)

A compression-distraction device for treating patients with upper jaw micrognathia, made of titanium, consisting of a housing made with a cylindrical rod and a threaded hole, a bar with an oblong hole and a welded upper bone plate is installed on the cylindrical rod, and a washer is welded to the upper part of the cylindrical rod, which holds the bar and the upper bone plate on the housing, a lead screw is installed in the threaded hole of the housing, which consists of a section with an external screw thread, a flange, a cylindrical section and a cylindrical rod, a cardan coupling is rigidly installed on the cylindrical rod, which consists of two forks with holes, a crosspiece with holes through which the axis passes and two half-axles, a rod with a hexagon is attached to the front fork, on which a key is installed during activation of the compression-distraction device, while the axis and half-axles are welded to the forks with the possibility of rotate in the holes of the crosspiece, the cardan coupling allows changing the position of the rod relative to the axis of the lead screw when activating the drive of the compression-distraction device, between the flange of the lead screw and the fork on the cylindrical section of the lead screw a sleeve is installed, to which the lower bone plate is welded, wherein the upper bone plate can be installed on the lateral edge of the pear-shaped aperture and is made with fourteen holes for fastening screws located at an equal distance from each other, with four middle holes higher than the lateral ones, and the lower bone plate can be installed on the lower edge of the pear-shaped aperture and a fragment of the lower jaw and is made with eleven holes for fastening screws located at an equal distance from each other.

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