METHOD OF SURGICAL TREATMENT OF HARD AND SOFT PALATE CLEFTS WITH SIMULTANEOUS RECOVERY OF NASAL BREATHING Russian patent published in 2012 - IPC A61B17/24 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to maxillofacial surgery, and is intended for surgical treatment of inherent clefts of hard and soft palate with recovery of nasal breathing. Cleft edges are freshened and in region of lateral parts of hard palate mucosa and periosteum are cut. Cuts are made in anterior and medium parts of hard palate to form mucous-periosteal flaps. Mucous-periosteal flaps are detached from palatine and alveolar processes of upper jaws and horizontal plates of palatine bones. Mucous-periosteal flaps are formed and mobilised in anterior and medium parts of hard palate. Vascular-nervous bundles from large palatal canals are brought out and mobilised after resection of their posterior walls. Mucous membrane of lower part of nasal cavity is mobilised, mucous-periosteal flaps are separated from nasal mucosa in region of hard and soft palate border forward. Mucous membrane and submucous layer are cut in retromolar zones to tongue surface of alveolar process of lower jaw and hooks of pterygoid processes of main bone. Soft tissues are separated from the latter in the layer of interfascial space and from internal surface of internal plate of main bone to attachment m. pharingo-palatini, without changing the place of attachment m. tensor veli palatini. In case of insufficient tissue mobility upper poles of tendons of said muscles are cut. In the area of vomer defect, mucosa of vertical plate of ethmoid bone is separated subperiosteally from both sides on 0.4-0.8 cm, and subperiosteally into zone of vomer and hard palate bones defect from lower surface installed is tissue nickelide-titanium implant made from nickelide-titanium thread with 50-60 mcm diameter with cell size 10-1000 mcm, consisting of two parts of L-like shape, fixed to each other in upper part with nickelide-titanium thread. Upper part of implant corresponds to the shape of vomer defect, lower - to total width of mucous-periosteal flaps of hard palate. Flaps of soft palate are sewn to each other in three layers. Mucous-periosteal flaps of hard palate are sewn to each other. Wounds are sutured in zone of pterygoid-mandibular spaces by interrupted sutures tightly taking into account retransposition of palate. Additional fixation of mucous-periosteal flaps with iodoform strips and detachable protective plate is carried out. Above hypertrophic regions of mucous membrane of posterior end of lower nasal turbinate by means of tip of laser optic fibre light conductor with diameter 400 mcm of semi-conductor laser with wavelength 980 nm and power 8 W in contactless way at the distance 1,5 mm from the surface of lower nasal turbinate in pulse mode with frequency 0.2 s performed is application coagulation with movement of light conductor along hypertrophic regions of mucous membrane of lower nasal turbinate at rate 1 mm per second. Haemostatic tampons are introduced into nasal cavity.

EFFECT: method makes it possible to simultaneously eliminate anatomic and physiological defects of dentoalveolar apparatus and nasal cavity due to application of tissue nickelide-titanium implant, isolating nasal cavity from oral cavity with formation in zone of former defect of nasal cavity bottom and vomer of integral with implant material tissue regenerate.

6 dwg