RU2512957C2 - Method for making splint for extra-oral temporary immobilisation of maxillary and mandibular fragments - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maxillofacial surgery, and can be used for temporary immobilisation of maxillary and mandibular fragments using a splint. A method of making the splint for temporary immobilisation of maxillary and mandibular fragments from a synthetic polymer material 'plastic gypsum' for rigid immobilisation is that the splint is made of two strips of gypsum. One is sized after the patient's lower jaw, and the other one has a size of the patient's head; they are watered at temperature 20-24°C. Thereafter one strip is applied and modelled on projecting contours of the lower jaw, and the other strip - around the head; both are set for 5-8 minutes and forming inverted U-slots on the periphery of the splint at the level of a lower border of the jaw symmetrically at the level of 33, 36, 38, 43, 46, 48 teeth and inverted T-slots along an upper border of the splint to fix rubber circular straps. The extra-oral immobilisation is carried out by a traction of the rubber circular straps applied to the lower border of the lower jaw. Arranging the inverted U-slots along the lower border of the lower jaw shaped and additional inverted T-slots along the upper border ensures reposition and reliable fixation of the bone mandibular along the full length and pulling the fragments to the opposite teeth using a head ring cap made of the same gypsum with 3 inverted T-slots formed from the temporal sides to fasten the rubber circular straps.

EFFECT: invention enables providing the reduction properties of the structure, the rigid immobilisation of the fragments with the complete relaxation of the mandibular muscles.

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Description

The invention relates to medicine, namely to maxillofacial surgery, and can be used for temporary extraoral fixation of fragments in fractures of the upper and lower jaws.

Currently, the following extraoral methods of temporary immobilization are known:

1) A simple bandage (or kerchief) parietal chin dressing [1, 3]. It is applied during fractures of the upper and lower jaws as a method of temporary immobilization. In this case, a wide gauze bandage is used, circular rounds of which pass through the chin and parietal bones, bypassing the auricles alternately in front and behind. You can use a mesh sleeve, scarf or scarf for this purpose, but this is much worse, since it does not provide the necessary stiffness. Apply an elastic bandage, applying it without tension. Unlike a gauze bandage, it does not stretch after 1-2 hours and does not loosen the bandages. The disadvantages of a simple bandage dressing are that it is not firmly held on the head and often slides onto the forehead or back of the head, there is no immobilization rigidity, and it does not perform any reponizing function.

2) Parieto-chin bandage of Hippocrates [1, 3]. It is used for fractures of the upper and lower jaws. One or two horizontal rounds are made with gauze bandage around the head in the fronto-occipital plane, always below the occipital protuberance. The tour goes to the chin along the back of the neck, after which several vertical rounds are applied without much pressure in the parietal-chin plane, alternating around the auricles in front and behind. Next, on the back of the neck, the next round is transferred to the head and two more horizontal rounds are placed in the fronto-occipital plane. The first horizontal rounds in the fronto-occipital plane create a rough surface for vertical rounds, and the last rounds fix vertical rounds, preventing them from slipping off. It is very securely fixed on the head and does not require correction for several days. But it does not create the necessary rigidity of fixation and does not perform any reponing function. 3) Standard soft chin sling of Pomerantseva-Urban [1, 3]. It is used for fractures of the upper and lower jaws. The sling consists of a fabric chin pad, to which wide elastic bands are sewn from two sides, turning into fabric ribbons with holes for the lace. A lace connects the ends of the sling and serves to regulate its length in accordance with the size of the patient's head. This method is convenient to use, simple, provides good immobilization, but there is no reponitive effect and traction is applied only to the chin of the jaw.

Closest to the proposed invention in technical essence is a standard dressing for transport immobilization - a rigid chin sling of Entin, used for fractures of the lower and upper jaws [1,2]. It consists of a standard dimensionless hat (bandage) and a rigid chin sling with tongue-shaped protrusions and slots used to fix the rubber rings and the victim's tongue, as well as to drain the wound contents. The cap has loops for fixing long rubber rings made of rubber tubes. To prevent squeezing of the soft tissues of the face, cotton rolls are introduced into the pockets under the loops. The cap is put on the head and with the help of ribbons adjust the length of its circumference to the size of the head by pulling it and then tying it with a knot on the victim’s forehead, providing good immobilization, but again, for the most part, the traction force is applied to the chin of the lower jaw, the necessary stiffness effect is not achieved and repositions of jaw fragments.

It should be noted that all methods of jaw fixation involve tight compression of the teeth in a forced position for the entire course of treatment, this contributes to the development of various dysfunctional disorders of the temporomandibular joint (TMJ), and the constant stress state of the masticatory muscles violates their microcirculatory blood flow, which lengthens the time fracture consolidation, the formation of contractures and, ultimately, affects the quality of treatment of patients [2].

The aim of the invention is to accelerate and facilitate the reposition and temporary fixation of fragments in fractures of the upper and lower jaws.

The goal is achieved as follows. An extraoral fixation tire is made of polymer synthetic material (“plastic gypsum”) a bandage immobilizing polymer Scotchcast (artificial gypsum) 7.5 cm × 3.6 m colorless Scotchcast (for rigid immobilization) of 3M company). Two strips of gypsum are measured, one in the size of the lower jaw of the patient, the other in the circumference of the head.

The strips are moistened with water (the water temperature should not exceed 20-24 ° C), then folded in half, one is applied and modeled along the protruding contours of the lower jaw, the other around the circumference of the head. The dressing hardens within 5-8 minutes, after 20-30 minutes a load can be applied to the dressing. After the inverted U-shaped tire at the level of the lower edge of the lower jaw, the inverted U-shaped slots and additional T-shaped along the upper edge erupt symmetrically at the 33, 36, 38, 43, 46, 48 teeth at the level of the lower edge of the lower jaw to fix the rubber traction. Due to the location of the slits-hooks on the lower edge of the lower jaw and additional on the upper, reposition and reliable fixation of fragments of the lower jaw along its entire length is achieved by pulling the fragments to the teeth of the opposite jaw. The head-hoop with 3 T-slots on each side is made of the same gypsum to fix the rubber traction. Rubber traction can be made from ordinary stationery rubber rings. Thus, extraoral immobilization is carried out. In this case, the traction force is applied to the lower edge of the entire lower jaw, and not separately to the chin, dentition or alveolar process, as in the known devices. The proposed device provides sufficient rigidity for fixing fragments and does not require special skills when installing and removing. In addition, complete relaxation of the patient’s lower jaw muscles is achieved - physiological rest sets in, but the rigidity of the immobilization and the repairing properties of the structure are not lost. The appearance of the proposed device in different angles is shown in Figures 1-3.

The present invention provides the following advantages and amenities for the patient and doctor:

1) It can be used for temporary extraoral immobilization in fractures of both the upper and lower jaws.

2) Apply modern polymer synthetic material ("plastic gypsum"), the feature of which is:

- a combination of strength and lightness of the material (4-5 times lighter than gypsum) due to the cellular, mesh structure;

- the material lets vapor through the skin and oxygen from the outside (“breathes”), prevents itching and maceration;

- the elastic properties of "plastic gypsum", along with fixing the damaged segment, retain the ability to work muscles, this reduces the likelihood of muscle atrophy;

- "plastic plaster" is not afraid of moisture;

- the material is completely non-toxic, does not cause allergic reactions;

- an esthetic look.

3) Fixation and reposition of fragments of the lower jaw is carried out by inverted U-shaped hooks along the lower edge of the lower jaw and additional L-shaped along the upper edge along the entire length of the jaw, and not by the chin section, as in other methods of extraoral immobilization.

4) Simplicity and ease of construction. Speed of manufacture.

5) The ability to remove and impose the design on the jaw, even by the patient himself.

6) The possibility of use in patients with mental illness, epilepsy and combined traumatic brain injury.

7) The possibility of free examination and manipulation in the oral cavity, in the submandibular areas.

8) Creating the necessary strength and direction of the rubber traction.

9) Does not interfere with additional methods for diagnosing jaw injuries, including radiological, MRI, CT.

Information sources

1. Afanasyev V.V., Ostanin A.A. "Military dentistry and maxillofacial surgery." Tutorial. Moscow. Publishing Group "GEOTAR-Media", 2009

2. Patent for invention No. 21113833, A61F 5/01, А61С 8/02 "Method for the temporary immobilization of fragments in fractures of the lower jaw and device for its implementation." Application number: 94011256/14, application filing date: 04/06/1994, publication date: 06/27/1998. Applicant: Donetsk State Medical University named after M. Gorky (UA), authors: Tsentilo Vitaliy Grigoryevich (UA); Sailor-Taranets Igor Nikolaevich (UA); Pristrom Mikhail Vladimirovich (UA). Patent holder: Donetsk State Medical University Gorky.

3. A guide for doctors. M.B.Shvyrkov, V.V. Afanasyev, B.C. Starodubtsev. "Non-articular jaw fractures." Publishing house "Medicine", Moscow, 1999

Claims (1)

A method of manufacturing a tire for temporary fixation of fragments during fractures of the upper and lower jaws of a plastic plaster of plastic material for rigid immobilization, which consists in the fact that the tire is made of two strips of gypsum, one according to the size of the lower jaw of the patient, the other around the circumference of his head, which are moistened with water with a temperature of 20-24 ° C, after which one strip is applied and modeled along the protruding contours of the lower jaw, and the other along the circumference of the head, followed by hardening for 5-8 minutes and carrying along the edge of the tire at the level of the lower edge of the lower jaw symmetrically at the level of 33, 36, 38, 43, 46, 48 teeth of inverted U-shaped slots and additional inverted T-shaped slots along the upper edge of the tire to fix the rubber ring bundles, perform extraoral immobilization with the help of the traction force of the rubber ring bundles applied to the lower edge of the entire lower jaw, while due to the location of the inverted U-shaped slots along the lower edge of the lower jaw and additional inverted T-shaped slots along the upper cr they achieve reposition and reliable fixation of fragments of the lower jaw along its entire length and pulling the fragments to the teeth of the opposite jaw using a head cap-hoop made of the same gypsum with 3 inverted T-shaped slots on the temporal sides for attaching rubber ring bundles

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