RU2380051C1 - Osteosynthesis technique for guerin's fracture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns maxillofacial surgery and can be applied for osteosynthesis of Guerin's fractures. The intraosseous screws are inserted: one screw - into a maxillary bone region close to the fracture line, or posterior side of the zygomatic process of frontal bone, or into the body of zygomatic bone, another screw - into the maxillary ridge between the first and the second molars in the oral cavity. The screws are ligatured in the form of a wire loop which is delivered under the zygomatic bone into the oral cavity with using a vascular needle. The ligature ends are fixed to the inserted screws.

EFFECT: method allows reducing risk of secondary fragment displacement and operative injuries.

2 dwg

Description

The method relates to medicine and can be used for osteosynthesis in the treatment of fractures of the upper jaw.

A known method of treating fractures of the upper jaw according to Le Fort III (SU 921538, publ. 1982). According to a known method, fragments of the jaw are repositioned and subsequently fixed by metal ligatures to the infraorbital edge of the frontal bone. To do this, in the area of the outer third of both eyebrows, cuts are made with a length of 1.5-2 cm. The upper outer edge of the orbit is distinguished. One hole is drilled in each fragment by boron, through which a stainless steel wire ligature is made of 0.6 mm diameter, 20-25 cm long and is advanced until it connects to its second end. The ends of the double ligature are threaded into the Kerger needle, which is advanced along the posterior surface of the zygomatic bone body and brought into the oral cavity anterior to the maxillary tubercle. Then the ligature is removed from the needle, the wounds in the area of the eyebrows are sutured. After reposition of the fragments, through the alveolar ridge at the level of the ends of the ligatures removed into the oral cavity in the horizontal plane, a spoke is drawn, the free ends of which are bent down. Ligatures on both sides are brought under the curved ends of the knitting needles and twisted. After 4-5 weeks, the retaining structure is removed.

When using the known method, involving the fixation of fragments of the jaw with metal ligatures to the infraorbital edge of the frontal bone, the possibility of damage to the eyeball and the development of inflammatory complications of the orbit is not excluded. The manipulations used with the wire ligature, such as inserting it into the hole drilled in the upper outer edge of the orbit and leading it to twist one end with the other, as well as moving it through the Kerger needle along the inner surface of the zygomatic bone and removing it into the oral cavity anterior to the maxillary tuber, complicate process of surgical intervention. The complex of these manipulations as a whole, as well as the presence in the oral cavity of a retaining structure made of knitting needles and ligatures for more than a month are traumatic for the patient and can contribute to the development of inflammatory complications. In addition, the known method of treatment has low aesthetic results.

The objective of this solution is to simplify the operation of osteosynthesis of the upper jaw, reduce the time of its implementation, reduce the morbidity of surgical intervention, as well as improve the aesthetic and functional results of treatment.

Unlike the prototype, in the claimed method of osteosynthesis, the reposition of jaw fragments is carried out using ligatures and intraosseous screws inserted into the area of the bone of the upper jaw adjacent to the fracture line and into the alveolar bone between the first and second molars in the oral cavity. A ligature is put on the screws in the form of a wire loop, with the help of a vascular needle, it is carried out under the zygomatic bone in front of the oral cavity and after reposition of fragments of the upper jaw, the ends of the ligatures are fixed to the inserted screws in the areas of the bone of the upper jaw and frontal bone.

A similar surgical intervention is performed on the opposite side of the jaw. As a result, the structure that fixes the fragments is a ligature "recessed" under the skin and mucous membrane, which, in a month, as well as screws, are removed. When using the proposed method, the possibility of damage to the eyeball and the development of inflammatory complications of the orbit is excluded, secondary displacement of the fragments is prevented, the quality of the reposition is increased, the operation is simplified, the time of its implementation is reduced, the invasiveness of the surgical intervention is reduced, the functional and aesthetic treatment results are improved. In addition, the method is applicable for the treatment of fractures of the upper jaw according to L. Le Fort I and L. Le Fort II, during which an intraosseous screw is inserted into the body of the zygomatic bone, which in this case is the site of the bone of the upper jaw adjacent to the fracture line, and also L. Le Fort III, in which the intraosseous screw is inserted into the area from the posterior surface of the zygomatic process of the frontal bone and under the mucosa of the alveolar process of the upper jaw.

A new technical result achieved by using the claimed method is to reduce the morbidity of the operation of the osteosynthesis of the upper jaw through the use of self-cutting screws that do not require pre-drilling holes, as well as to improve the aesthetic and functional results of treatment due to the fact that the fixing structure is completely immersed in soft tissue under the oral mucosa.

The method is applicable both in the presence of teeth on the upper jaw, and in partial or complete absence thereof. Using the proposed method eliminates the possibility of damage to the eyeball and the development of inflammatory complications of the orbit. Given that in 95% of cases, injuries of the upper jaw are accompanied by traumatic brain injury of varying severity, the proposed method allows in most cases to abandon the general types of pain relief, which reduces the risk of surgery for the patient.

The claimed method is illustrated by drawings, where figure 1 shows a diagram of the use of osteosynthesis of maxillary fractures according to L. Le Fort I and L. Le Fort II; figure 2 - diagram of the osteosynthesis of fractures of the upper jaw according to L. Le Fort III.

The osteosynthesis of maxillary fractures according to L. Le Fort I and L. Le Fort II was carried out as follows. A mucosal incision was made along the transitional fold of the upper jaw in the projection of a fracture line three centimeters long. The fracture line was exposed and nearby fragments of the upper jaw were skeletonized, retreating from it by 1.5-2 cm and screwed into the alveolar bone between the first and second molars and into the body of the zygomatic bone 1 titanium screws 1 in each of the fragments. It is desirable to arrange the screws perpendicular to the fracture line 2. After reposition of the fragments, a loop of 3 nichrome ligature wires with a diameter of 0.4 mm was introduced under the screw heads and the ends of the ligatures were twisted. The mucoperiosteal flap was put in place, the wound was sutured. A similar surgical intervention was performed on the opposite side.

A method for the treatment of fractures of the upper jaw according to L. Le Fort III was carried out as follows. A mini-access through the eyebrows from a skin incision half a centimeter long in the region of the upper outer edge of the orbit skeletonized the area of the posterior surface of the zygomatic process of the frontal bone. Departing from the fracture line 1 by 1 cm, an intraosseous self-cutting titanium screw 2 was inserted using a screwdriver, a ring loop 3 of a 0.4 mm diameter nichrome ligature wire was put on it, and a double wire was drawn under the zygomatic bone using a vascular needle curved along the arc of a wide diameter ligature on the threshold of the oral cavity between the first and second molars. The wound was sutured with an intradermal suture. After reposition of the upper jaw, an intraosseous screw 4 was screwed into the alveolar ridge between the first and second molars, and the ends of the wire loop 3 were fixed to screw 2. A similar surgical intervention was performed on the opposite side. With sagittal fractures of the upper jaw, an additional compression loop is possible on the screws inserted into the alveolar processes of the last and fixing fragments.

Example. Patient W. 23 years old. Complaints of malocclusion, headache, inability to eat, bleeding from the mouth.

Objectively: the face configuration is disturbed due to post-traumatic edema of the soft tissues of the infraorbital regions on both sides and posterior displacement of the upper jaw. The mouth is half-open, the bite is broken, mobility is determined during palpation, crepitation of fragments of the upper jaw, the symptom of stress is positive. On the roentgenogram of the paranasal sinuses, a fracture of the upper jaw is determined by L. Le Fort II.

Conclusion: fracture of the upper jaw according to L. Le Fort II, concussion of the brain. Under local anesthesia Sol. Septonest SP 4%, 8 ml, incised the mucosa along the transitional fold of the upper jaw in the projection of a fracture line three centimeters long. Fracture line 1 was exposed, nearby fragments of the upper jaw were skeletonized, and 1.5 cm away from it, screwed into the alveolar bone between the first and second molars and into the body of the zygomatic bone 1 titanium screws 1 one in each of the fragments. The screws were perpendicular to the fracture line. After reposition of the fragments under the screw heads, a cap loop 3 of a nichrome ligature wire with a diameter of 0.4 mm was introduced and the ends of the ligatures were twisted under the head of the second screw on the movable fragment (Fig. 1). The mucoperiosteal flap was put in place, the wound was sutured. A similar surgical intervention was performed on the opposite side. After 7 days, the sutures were removed, the wound healed by first intention.

The claimed method operated on 3 patients with fractures of the upper jaw according to L. Le Fort I, two victims and one with a fracture according to L. Le Fort III. No complications were observed.

Claims (1)

A method for osteosynthesis of upper jaw fractures, including reposition and subsequent fixation of jaw fragments using metal ligatures, characterized in that the screws are inserted intraosseously: one screw into the portion of the bone of the upper jaw adjacent to the fracture line or from the back of the zygomatic process of the frontal bone or into the body of the zygomatic bone , another screw in the alveolar process of the upper jaw between the first and second molars in the oral cavity, a ligature is thrown onto the screws in the form of a wire loop, which is carried out under a vascular needle under KULOV bone in the vestibule of the oral cavity, the ligature ends fixed to the pedicle screw.

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