RU2828150C1 - Implant of subperiosteal introduction for chin - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: implant of subperiosteal introduction for chin comprises two parts that can be connected. On the first part there is a smooth projection, and on the second part there is a smooth recess. Protrusion can enter the cavity. Recess and the projection have a conical shape. Each of the above parts in the central part has a slope in thickness, the second part can slide along the slope of the surface of the first part. In each part there is one through hole for screws. Back surface of both parts is made in accordance with the anatomical shape of the patient's chin bones, made using 3D technology.

EFFECT: invention provides simplified design, possibility to lead implant elements through a small incision, tight fit of implant elements to bone tissues, prevention of failure.

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Description

The invention relates to the field of medicine, in particular to reconstructive or plastic surgery, namely to the creation of an implant for subperiosteal insertion, intended for use in reconstructive or plastic surgery of a person to give the lower part of the face aesthetic contours, restore facial harmony, correct horizontal and vertical microgenia, create or restore the contours of the chin.

An implant is known for osteosynthesis of chin fragments during genioplasty, which has a base and two arms, wherein the base and arms are oblong links containing disks connected to each other with holes for screws, the base has three holes forming a first row of holes, each of the two arms has two holes, wherein the holes of both arms form a second row of holes parallel to the first row, the arms are connected to the base by crossbars, wherein the base, arms and crossbars are formed as a single unit from a plate of sheet material that can be bent, and all holes for placing screws for fixing the disks are made with double-sided chamfers (Patent No. RU 2790966. Published on 02/28/2023).

However, the known implant is intended only for osteosynthesis of chin fragments and, despite the presence of holes for screws, is not intended for use in cosmetology for creating or restoring the chin.

A sterile gel for facial modeling is known, implanted subdermally or supraperiosteally in the chin area, the lower part of the facial oval or the nose of a patient in need thereof, containing cross-linked hyaluronic acid (HA) obtained by cross-linking with 1,4-butanediol diglycidyl ether (BDDE) a mixture of low-molecular HA and high-molecular HA, in which the content of low-molecular HA is at least 50 wt.% relative to the total weight of HA in the mixture (Patent No. RU 2715234. Published on 02/26/2020).

However, the known gel does not allow achieving long-term treatment results and does not have a supporting function, since it is in liquid form.

A chin implant is known in the form of a hard crescent formed by the intersection of an internal radius of curvature with an external radius of curvature, wherein the internal radius is slightly smaller than the external radius, the total internal angle of the resulting crescent is approximately forty-five degrees. The external part of the implant is made of a softer material with less hardness than the rest of the implant to imitate the fat layer at the point of the chin (Patent No. US 5195951. Published March 23, 1993).

However, the known chin implant does not have the ability to fit tightly to bone tissue, in addition, the presence of a double-hardness pad at the outer point of the chin prosthesis, to imitate a fat pad at the chin point, creates an uncomfortable tactile sensation for the patient.

A craniofacial implant is known, comprising two parts of a housing made of two separate symmetrical segments having a shape corresponding to parts of the lower jaw, a connecting element made with the possibility of attaching separate segments of the housing to each other, in addition, the existing flange rests with its supporting surface against the oriented bone element of the lower jaw (Patent No. US10470863. Published 2019-11-12).

However, the known implant has a rather complex design and, as a consequence, a complex traumatic technology of surgical intervention when installed on the chin bone, the fixation of the halves of the implant is not rigid, which leads to the divergence of the elements and distortion of the result, there are no holes for fixation.

An ornamental design of a surgical chin implant is known, consisting of two parts and having a dovetail connection feature (Patent No. USD743032S. Published 2015-11-10).

However, the known surgical chin implant requires the connection of two parts using a dovetail joint by moving one part relative to the other in the vertical plane, which does not allow stabilization of the implant in the horizontal plane, leading to instability of the product after installation (there are no holes for fixation).

The objective of this utility model is to expand the range of surgical implants for chin modeling.

The technical result is manifested in the manufacture of an implant based on a three-dimensional model, which allows achieving congruence, namely: the ideal ratio of the back surface of the implant and the contour of the patient's jaw, in the design of the lock, which allows achieving stability in the horizontal and vertical planes, by installing two small elements, in the ability to insert implant elements through a small incision, in preventing distortions of the clinical result.

The technical result achieved is that in a subperiosteal chin implant comprising two parts capable of being connected, a smooth protrusion is made on the first part, and a smooth depression is made on the second part, wherein the protrusion is capable of entering the depression, the depression and the protrusion are conical in shape, each of the said parts has a slope in the central part in thickness, the second part is capable of sliding along the slope of the surface of the first part during installation, each part has one through hole for screws, the back surface of both parts is made in accordance with the anatomical shape of the patient's chin bones, made using 3D technology.

It is advisable, in order to preserve the anthropometric characteristics of a female patient, to make the implant in the central part of a round shape.

It is advisable to make the implant square in the central part in order to preserve the anthropometric characteristics of a male patient.

It is advisable to use the bioinert material polyetheretherketone to prevent rejection of the implant from the patient's tissues.

The present invention is explained by a detailed description of its implementation, examples and illustrative material, in which:

Fig. 1 – main view of the subperiosteal implant for the chin (hereinafter referred to as the implant) from the outside, according to the invention;

Fig. 2 – view of the implant from the inside, formed using 3D technology;

Fig. 3 – view of the implant from the inside, which has a slope in the central part along the thickness;

Fig. 4 - selection of an implant using 3D technologies;

Fig. 5 - location of both parts of the implant with fixation elements;

Fig. 6 - examples of implant implementation depending on the patient’s gender, A - implant for women, B - implant for men;

Fig. 7 – location of the first part of the implant;

Fig. 8 – insertion of part 2 of the implant;

Fig. 9 – example 1 – result of surgical intervention. The face of patient A is located: a) 3/4 of the profile on the right before treatment; b) frontal view after treatment; c) 3/4 of the profile on the left after treatment;

Fig. 10 – example 2, result of surgical intervention of patient B: a) - before treatment; b) - after treatment.

Fig. 11 – example 3 – the result of surgical intervention of patient B: a) – photo in 3/4 angle, b) photo in profile from the left, c) photo in 3/4 angle shows a square shape of the chin, after surgical intervention, d) photo in profile from the left, after surgical intervention.

The subperiosteal chin implant (hereinafter referred to as the implant) is made of the first and second parts connected with a lock in the form of a three-dimensional puzzle (Fig. 1, 2). On the first part 1, a smooth conical protrusion 2 is made. On the second part 3, a smooth conical depression 4 is made. In the upper region of the first part 1 and the second part 2, one through hole is made, 5 and 6, respectively. In this case, the first part 1 in the central region along the thickness has a slope 7, located from top to bottom (Fig. 3). The second part 2 in the central region along the thickness has a slope 8, located from bottom to top. The back surface of the first part 1 and the second part 2 is made in accordance with the anatomical shape of the skeleton of the bones 9 of the patient's chin (Fig. 4). The anatomical shape is made using 3D technology. Each through hole 5 and 6, respectively, is equipped with screws 10 and 11 (Fig. 5).

The implant for use in women has a more rounded central part (Fig. 6a). The implant for use in men has a more square central part (Fig. 6b).

To prevent rejection of the implant from the patient's tissue, the bioinert material polyetheretherketone PEEK was used.

The chin modeling implant is used as follows.

An implant is made using 3D technology from part 1 and part 2 made of bioinert material - polyetheretherketone PEEK. The back surface of the first part 1 and the second part 2 is made in accordance with the anatomical shape of the skeleton of the patient's chin bones 9 (Fig. 7, 8). The anatomical shape is made using 3D technology. A small incision is made in the vestibule of the mouth, 4-6 mm from the transitional gingival fold of the area. A supraperiosteal detachment is performed from the mental protrusion to the base of the lower jaw to form a sufficient pocket for installing the implant. Part 1 is inserted up to the bone tissue of the chin, then part 2 is smoothly brought in until the conical protrusion 2 of part 1 enters the conical depression 4 of the second part 3. Fixation is achieved by means of a three-dimensional puzzle lock. For this purpose, the cone-shaped projection 2 of the first part 1 (the right "male") is inserted into the cone-shaped depression 4 of the second part 3 (the left "female"). During installation, the second part 3 slides along the surface of part 1. Sliding is carried out due to slopes 7 and 8 in the horizontal direction. Then, fastening is carried out through through holes 5 and 6 using screws 7 and 8, respectively. Screws 7, 8 have a length of 14 mm and a diameter (Ф) of 1.2 mm. Part 1 and part 3 are securely fixed relative to each other, both horizontally and vertically. The cone-shaped depression 4 prevents the second part 3 from falling down.

Clinical examples of implant use.

Example 1.

Patient A, a 26-year-old woman, came to the clinic with complaints of insufficient projection of the chin and an unclear cervicomental angle (Fig. 9 a), b), c).

Correction of the chin deformity and liposuction of the neck and chin area were recommended.

To select the implant, the patient's biometric data were used, based on computer tomography, an implant was selected using 3D technology of a round shape. The implant was made of bioinert material polyetheretherketone PEEK.

In the operating room, a small incision was made in the vestibule of the mouth, 4-6 mm away from the 4-cm long transitional gingival fold from teeth 22 to 27. A supraperiosteal detachment was made from the mental protrusion to the base of the lower jaw to the right and left to form a pocket sufficient for implant placement. After trying on a stereotaxic model to confirm the sufficiency of the pocket and to understand the final positioning of the implant, part 1 was inserted until the conical protrusion 2 of part 1 entered the conical depression 4 of the second part 3. Fixation was achieved using a three-dimensional puzzle lock. For this purpose, the conical protrusion 2 of the first part 1 (right "father") was inserted into the conical depression 4 of the second part 3 (left "female"). During installation, the second part 3 slid along the surface of part 1. Sliding was achieved due to slopes 7 and 8 in the horizontal direction.

Then the fastening was carried out by means of through holes 5 and 6 using screws 7 and 8 respectively. Screws 7, 8 were used with a length of 14 mm and a diameter of 1.2 mm.

Part 1 and part 3 were securely fixed relative to each other, both horizontally and vertically. The cone-shaped depression 4 did not allow the second part 3 to fall down. The wound in the vestibule of the mouth was sutured layer by layer with a 4-0 resorbable monofilament thread, a pressure bandage was applied. Patient A is satisfied with the quality of treatment.

Example 2.

Patient B., a 52-year-old woman, came to the clinic complaining of age-related changes in the face, insufficient chin volume, and irregular contours of the lower jaw. (Fig. 10 a), b). Correction of the chin deformity was recommended.

To select the implant, the patient's biometric data were used, on the basis of which an implant of a round shape was selected using 3D technology. The implant was made of two parts 1 and 3 from bioinert material polyetheretherketone PEEK.

In the operating room, a small incision was made in the vestibule of the mouth, 4-6 mm away from the 4-cm long transitional gingival fold from teeth 22 to 27. Part 1 of the implant was inserted to the bone tissue of the chin, then its second part 3 was smoothly inserted until the conical protrusion 2 of part 1 entered the conical depression 4 of the second part 3. Fixation was achieved using a three-dimensional puzzle lock. For this purpose, the conical protrusion 2 of the first part 1 (right "father") was inserted into the conical depression 4 of the second part 3 (left "female"). During installation, the second part 3 slid along the surface of part 1. Sliding was achieved due to slopes 7 and 8 in the horizontal direction. Then fastening was carried out through through holes 5 and 6 using screws 7 and 8, respectively. Screws 7, 8 were used with a length of 14 mm and a diameter of 20 mm. Part 1 and part 3 were securely fixed relative to each other, both horizontally and vertically. Cone-shaped depression 4 prevented the second part 3 from falling down. Patient B is satisfied with the quality of treatment.

Example 3.

Patient V. is a 36-year-old man, was treated in the plastic surgery department from 12/25/2023 to 12/26/2023 (Fig. 11 a), b), c), d).

Complaints upon admission: an undefined chin, changes and deformation of the neck contours, deformation of the contours of the cheek areas.

Medical history: sought surgical correction. Hospitalized in the plastic surgery department for surgical treatment.

Local status: the chin is not expressed. Deformation of the neck contours in the anterior sections is visualized in the form of excess subcutaneous fat. Deformation of the contours of the cheek areas.

Main diagnosis: Micrognathia. Deformation of the neck contours. Deformation of the cheek contours. K07.0.

Treatment: On 25.12.2023, a planned operation was performed: mentoplasty, under KETN + local anesthesia: lidocaine 1% - 7.0 + adrenaline 1:200000. After antiseptic treatment of the oral cavity, a linear incision was made along the transitional fold from 32 to 42 teeth, subperiosteal detachment, a pocket was formed for a custom-made square-shaped chin implant. From two parts 1 and 3. Taking into account the square shape, the implant was made of bioinert material polyetheretherketone PEEK. The implant was installed without any features, fixed with metal screws 5 and 6. Nodal sutures on the wound edges with monofilament resorbable thread 4-0, liposuction of the neck, removal of Bish's lumps. The postoperative period is uneventful. Discharged in a satisfactory condition. The wounds show no signs of inflammation. No blood transfusion was performed.

The proposed invention has a simple design, which allows for its convenient positioning, reducing the operation time to 15-20 minutes. The material used, tight fit to bone tissue, streamlined shapes and smooth transitions in places of contact with the bone do not cause bone resorption.

In addition, the proposed implant is easily subject to revision. There are no problems of asymmetry or failure.

Claims (4)

1. A subperiosteal implant for the chin, comprising two parts that can be connected, the first part has a smooth protrusion, and the second part has a smooth depression, wherein the protrusion can enter the depression, characterized in that the depression and the protrusion have a conical shape, each of the said parts has a slope in the central part in thickness, the second part can slide along the slope of the surface of the first part during installation, each part has one through hole for screws, the back surface of both parts is made in accordance with the anatomical shape of the patient's chin bones, made using 3D technology. 2. An implant according to item 1, characterized in that it is made in a round shape in the central part. 3. An implant according to item 1, characterized in that it is made in a square shape in the central part. 4. The implant according to item 1, characterized in that it is made of polyethercorticone.