SU1718840A1 - Method of surgical treatment of the neuralgia of the inferior alveolar nerve - Google Patents

Abstract

The invention relates to medicine, namely to neurosurgery. The method allows to reduce the invasiveness of the operation and the number of postoperative complications, which is achieved by removing the distal and intracranial nerve sites in a single block, followed by decortication of the walls of the mandibular canal and filling it with allogeneic embryonic material.

Description

The invention relates to medicine, namely to neurosurgery.

The aim of the invention is to reduce the morbidity of the operation and postoperative complications.

The method is carried out as follows.

The operation is performed under endotracheal anesthesia. Two cuts are made — one along the transitional fold in the pre-molar region of the mandible on the affected side, the other along the anterior margin of the coronary process. The disintegrant removes the mucoperiosteal flap downward, exposing the chin hole with the neurovascular bundle coming out of it, which is carefully removed from soft tissues, the wire is not intersected at the outlet, the marked end of the nerve is dyed (brilliant green ). In the second operative wound, soft tissues are peeled off from the inner surface of the jaw branch. The mandibular nerve is located in the region of the mandibular foramen, its proximal region is extracted to the level of the lateral pterygoid muscle, and then captured by the Kocher clamp and posteriorly, the nerve is pulled out of the canal into the wound, removed from it and cut off with a razor. At the same time, the quality of removal is controlled by the appearance of the colored nerve end from the canal. A cylindrical hollow cutter with a diameter of up to 1 cm removes a section of the outer cortical plate together with the chin opening, decorting the walls of the mandibular canal from the resulting defect with a shank with a diameter of 1-1.5 mm with the shank fixed in the straight tip of the drill at 3000 rpm. min, after which the canal is filled with allogeneic embryonic material ground to a pastelike consistency. Sealing is continued until the embryoplast appears from the mandibular orifice. Surgical wounds are sutured tightly with catgut.

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Example. Bona P., 60 years old, diagnosis: neuralgia 111 of the trigeminal nerve on the left.

Concomitant diseases: Ateroscopic cardiosclerosis, hypertensive disease of the II degree, chronic pyelonephritis on the background of renal stone disease, diabetes mellitus, II obesity.

He complained of sharp, near-jaw-like pains in the lower jaw on the left, which are aggravated by touching the lower lip or gum at the level of premolars, which makes it difficult to eat.

She was treated repeatedly by conservative methods.

The examination revealed the presence of a trigger zone on the skin of the lower lip and chin and the mucosa of the alveolar sprout of the mandible on the left. Painful with palpation chin hole area. Pain sensitivity of the skin of the face saved. On the radiograph of the lower jaw on the left, the walls of the mandibular canal are determined only in the posterior part. Densitometric evaluation of radiographs recorded a reduction of 55% of the width of the channel on the left compared with the opposite side.

Operation: under general anesthesia, 2 intraoral incisions were made on the left, a distal nerve fragment from soft tissues was isolated and mobilized. In the pterygoid-chelyu-

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In this space, the nerve is depleted, extended from the canal by the Kocher clamp, and cut off.

The anterior section of the canal was decorticated and the chin aperture was expanded with a fissure bur, followed by loose filling of the canal with a pasty allogeneic embryonic material. Wounds are sutured tightly with catgut. The postoperative period was uneventful. Immediately after surgery, the pain stopped and is absent at the present time (6 years). At the control examinations, there are no complaints. In densitometry of the R-gram 5 of the lower jaw on the left 8 months after the operation, the mandibular canal is not detected, in the area of its projection the bone tissue does not differ in structure from the surrounding one. There is no re-innervation of the allogeneic zone.

Claims (1)

Formula inventive method for surgical treatment of neuralgia of the lower moon nerve, including resection of the peripheral part of the neurovascular bundle and closure of the mandibular and chin opening, characterized in that, in order to reduce the traumatic operation and postoperative complications, the distal and intracanal nerve areas are removed by a single block , decorticates the walls of the mandibular canal and seals it with allogeneic embryonic material.