RU2794219C1 - Method for fixing of the fixing plate in fractures of the lower jaw without the fragments' displacement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to maxillofacial surgery and surgical dentistry, and is intended for the treatment of fractures of the lower jaw without displacement of fragments if there are teeth retained. A plastic plate with four metal mini-plates is applied to the teeth of the lower jaw from the chewing surface, which, after applying the plastic plate, are located on the vestibular surface of the lower jaw. At the same time, mini-plates have through holes in the projection between the roots of teeth 2, 3 and 5, 6. Through the through holes in the mini-plates, four burr holes are made using a drill within the cortical layer of the bone through the mucous membrane. Screws are inserted into the through holes of metal mini-plates and tightened, fixing the plate on the lower jaw.

EFFECT: method, due to the use of a fixing plate, allows for stable fixation of the lower jaw, excluding displacement of fragments in the vertical and horizontal directions, retains the possibility of opening the mouth throughout the treatment, which makes it possible to carry out a full oral hygiene.

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Description

The invention relates to medicine, namely to maxillofacial surgery and surgical dentistry. The method can be used in the treatment of fractures of the lower jaw without displacement of fragments in the presence of teeth.

There are numerous ways of splinting the lower jaw in case of its fractures, when fragments are fixed behind the teeth using metal or plastic caps, metal or plastic arc splints. Their common disadvantage is that these structures do not eliminate the horizontal displacement of fragments, do not provide sufficiently rigid fixation, or require mandatory intermaxillary traction. Also, most of the fixing devices inside the mouth are made of aluminum, stainless steel, which does not favorably affect the periodontium and the body as a whole.

Known, proposed by Sauer, is a method in which a wire splint is applied to the vestibular and lingual surfaces of the dentition of the lower jaw and both parts of the splint are fixed to each other with a thinner wire passed through the interdental spaces. Such a splint is bent according to a plaster model, which is first sawn at the fracture sites and glued along the bite with the model of the upper jaw.

However, the above technology has significant disadvantages:

1. The fixing ability of these tires and their subsequent modifications is insufficient, they do not eliminate the horizontal displacement of fragments.

2. With micromovements of fragments that occur during the act of swallowing and during conversation, the fracture gap becomes infected with the contents of the oral cavity.

3. Satisfactory oral hygiene is difficult.

The closest in essential features to the claimed method is the method of single-jaw splinting for fractures of the lower jaw within the dentition, including the imposition of an aluminum bent tire with hook loops on the lower jaw and its fixation with metal ligatures to the teeth. Next, I put a plastic plate with hook loops made in the laboratory on the occlusal surface of the lower jaw. Rubber rings are put on the tire loops and plates, which ensure reliable fixation of fragments in the structure (Patent No. 2735258, authors Mellin Ruslan Viktorovich, Sivolapov Konstantin Anatolyevich, Malkov Nikolai Vasilyevich, publ. 2020.10.29).

This method has several disadvantages:

1. The design adopts an aluminum tire, which adversely affects the periodontal tissue.

2. The manufacture and fixation of an aluminum tire takes a lot of time from the doctor.

3. The metal ligatures fixing the aluminum tire lose their strength over time, loosen, and tear.

The purpose of the present invention is to create a method for stable fixation of the lower jaw, excluding the displacement of fragments in the vertical and horizontal directions with the help of a fixing plate, the possibility of opening the mouth throughout the treatment, which makes it possible to carry out a complete oral hygiene.

The purpose is achieved by fixing the fixing plate for fractures of the lower jaw without displacement of fragments. Under conduction and / or infiltration anesthesia, a plastic plate with metal mini-plates is applied to the teeth of the lower jaw from the chewing surface, having occlusal impressions on both sides. Through through holes in metal mini-plates, four milling holes are made using a drill within the cortical bone layer through the mucous membrane between teeth 2, 3 and 5, 6 on both sides. Screws are inserted into the through holes of the metal mini-plates. Novelty of the invention:

1. A plastic plate with metal mini-plates with through holes for fixation allows you to firmly fix it to the lower jaw, thereby preventing horizontal displacement.

2. A plastic plate with metal mini-plates with through holes is installed on the teeth of the lower jaw, having occlusal impressions on both sides. Using titanium screws, a plastic plate is fixed through through holes to the lower jaw from the vestibular side between the roots of teeth 2, 3 and 5, 6.

The proposed method allows to obtain a new technical result:

1. A plastic plate with metal mini-plates with through holes prevents the displacement of fragments in the horizontal and vertical planes.

2. The plastic plate is fixed on the lower jaw by means of screws, thereby firmly fixing the plastic plate to the lower jaw, avoiding double-jaw splinting.

3. The method allows the patient to open his mouth at the entire stage of treatment, in contrast to the methods of double-jaw splinting, which greatly facilitates oral care.

4. Since with the proposed method there is no intermaxillary fixation, in case of regurgitation, the patient is not threatened with aspiration asphyxia.

5. The method is easy to use and does not exceed the time of treatment of patients in comparison with double jaw splinting, and is also less traumatic.

6. Standard screws of the company "Konmet" are used, which are included in the standard equipment of the department of maxillofacial surgery.

Thus, this method can be used in all regions of the country where there are departments of maxillofacial surgery.

7. The possibility of immobilization of the lower jaw without involving the upper jaw.

8. Opening the mouth throughout the treatment.

The method is illustrated by the drawings shown in Fig. 1-2.

On FIG. 1 - lower jaw with a plastic plate.

On FIG. 2 - fixation of a plastic plate by means of metal mini-plates with through holes.

On the figures: 1 - plastic plate, 2 - metal mini-plates with a through hole, 3 - occlusal impressions.

The method is carried out as follows.

In case of a fracture of the lower jaw without displacement of fragments, a plastic plate is applied to the teeth of the lower jaw from the chewing surface under conduction and / or infiltration anesthesia to the patient

1 with metal mini-plates 2, having occlusal impressions 3 on both sides (Fig. 1). Through the through holes in the metal mini-plates 2, using a drill, four milling holes are made within the cortical layer of the bone through the mucous membrane between the teeth 2, 3 and 5, 6 on both sides. Through holes of metal mini-plates

2, screws are inserted, thereby tightly fixing the plastic plate 1 to the lower jaw (Fig. 2).

Clinical examples.

Clinical example 1.

Patient I., 33 years old, was admitted to the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kuzbass Regional Clinical Hospital with a diagnosis of a mandibular fracture along the body on the right in the projection of teeth 4.3-4.4 without displacement of fragments. Under conduction anesthesia (torusal anesthesia) on both sides Sol. Lidocaini 2%-8.0 ml on the lower jaw, a ready-made plastic plate obtained from the laboratory with metal mini-plates with a through hole is applied to the lower jaw, the through holes of which are located in the projection between the teeth of the lower jaw 2, 3 and 5, 6, and repeating the chewing surface of the teeth from the upper and lower jaws (Fig. 1). Through the through holes of the mini-plates, which, after applying the plastic lining, are located on the vestibular part of the lower jaw in the projection between the roots of the teeth 2, 3 and 5, 6, four holes are drilled in the bone using a milling cutter, into which the screws of the Konmet company are inserted through the through holes and tightly tightened (Fig. 2). Thus, a rigid fixation was achieved between the plastic plate with metal mini-plates and the lower jaw, eliminating the displacement of the lower jaw fragments in the horizontal and vertical plane. The patient was prescribed a fistula diet (liquid, pureed food). On the 7th day, the patient was discharged for outpatient aftercare at the dental clinic No. 1 in Kemerovo. Outpatient follow-up care was uneventful, on the 27th day from the moment of fixing the plastic plate with metal mini-plates, this construction was removed to patient I. under the control of X-ray images.

Clinical example 2.

Patient V., 21 years old, was admitted to the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kuzbass Regional Clinical Hospital with a diagnosis of a fracture of the lower jaw between teeth 3.1, 3.2 without displacement of fragments. Under infiltration anesthesia Sol. Lidocaini 2%-6.0 ml on the lower jaw, a ready-made plastic plate obtained from the laboratory with metal mini-plates is applied to the lower jaw, the through holes of which are located in the projection between the teeth of the lower jaw 2, 3 and 5, 6, and repeating the chewing surface of the teeth from the upper and lower jaws. Through the through holes of the mini-plates, which, after the application of the plastic plate, are located on the vestibular part of the lower jaw in the projection between the roots of the teeth 2, 3 and 5, 6, four holes are drilled in the bone using a cutter, into which metal screws are inserted through the through holes of the mini-plates firm "Konmet" and tightly tightened. Thus, a rigid fixation was achieved between the plastic plate with metal mini-plates with through holes and the lower jaw, eliminating the displacement of the lower jaw fragments in the horizontal and vertical plane. The patient was prescribed a fistula diet (liquid, pureed food). On the 7th day, the patient was discharged for outpatient aftercare at the dental clinic No. 1 in Mariinsk. Outpatient follow-up care was uneventful, on the 23rd day from the moment of fixing the plastic plate with metal mini-plates, this construction was removed to patient V. under the control of X-ray images.

Clinical example 3.

Patient Zh., 27 years old, was admitted to the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kuzbass Regional Clinical Hospital with a diagnosis of a bilateral fracture of the lower jaw along the body on the left between teeth 3.4, 3.5 and along the body on the right between 4.2-4.3 without displacement of fragments. Under conduction (torusal anesthesia) and infiltration anesthesia on both sides Sol. Lidocaini 2%-10.0 ml on the lower jaw, a ready-made plastic plate obtained from the laboratory with metal mini-plates with through holes is applied to the lower jaw, the through holes of which are located in the projection between the teeth of the lower jaw 2, 3 and 5, 6, and repeating the chewing surface of the teeth from the upper and lower jaws. Through the through holes, which, after the application of the plastic plate, are located on the vestibular part of the lower jaw in the projection between the roots of the teeth 2, 3 and 5, 6, four holes are drilled in the bone using a milling cutter, into which metal screws from the Konmet company are inserted through the through holes of the mini-plates. ' and tightly tightened. Thus, a rigid fixation was achieved between the plastic plate with metal mini-plates and the lower jaw, eliminating the displacement of the lower jaw fragments in the horizontal and vertical plane. The patient was prescribed a fistula diet (liquid, pureed food). On day 9, the patient was discharged for outpatient follow-up care at the regional dental clinic in Kemerovo. Outpatient follow-up treatment was uneventful, on the 29th day from the moment of fixation of the plastic plate with metal mini-plates, this construction was removed to patient G. under the control of X-ray images.

Claims (1)

A method for fixing a fixing plate for fractures of the lower jaw without displacement of fragments, including fixing a plastic plate with occlusal impressions on both sides, under conduction and / or infiltration anesthesia, characterized in that a plastic plate with four metal mini-plates is applied to the teeth of the lower jaw from the chewing surface -plates, which, after applying the plastic plate, are located on the vestibular surface of the lower jaw, while the mini-plates have through holes in the projection between the roots of teeth 2, 3 and 5, 6, four milling cutters are made through the through holes in the mini-plates using a drill holes within the cortical layer of the bone through the mucous membrane, screws are inserted into the through holes of the metal mini-plates and tightened, fixing the plate on the lower jaw.

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