OPTIMAL METHOD OF CONTOURING PLASTIC IN CASE OF MIDFACE DEFORMATION Russian patent published in 2016 - IPC A61B17/58 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maxillofacial surgery. Spiral computed tomography of maxillofacial area is performed. Stereolithographic model is made on obtained data. Its analysis and planning of maxillofacial configuration of the patient are made to make templates, replacing the defect on this model. Wherein, an individual collapsible design is made consisting of zygomatic-frontal, zygomatic-suborbital, zygomatic-alveolar, zygomatic-temporal parts, which have the form of mini boards with holes for self-tapping screws on the entire length; at the end, leading towards the center of the structure, a fixing bed with holes for screw-lock is placed. Fixation unit is made individually; it has four receiving beds for parts with threaded holes for screw-locks, as well as with holes for self-tapping screws. After making of said structure the collapsible structure is fitted to the model; places are marked for osteotomy and for fixation of component parts, where there is no movement of bone tissue, and sufficiently stable place in maxillofacial area are marked too. Minimum incisions of skin, subcutaneous fat, fascias and periosteum are made. Wherein, incision in zygomatic area is made at a distance of 10 mm outside from outer edge of the orbit in parallel with goose foot of up to 10 mm length, where fixation unit is planned to be applied at the zygomatic area. As for zygomatic-frontal part, incision with length up to 8 mm in the frontal area along the zygomatic process of frontal bone along its outer edge in relation to the zygomatic seam. As for zygomatic-suborbital part, incision with length up to 8 mm is made medially in the suborbital area below the lower medial orbit edge. As for zygomatic-temporal part, incision with length up to 8 mm is made in temporal area along the zygomatic process of temporal bone along its upper edge. As for zygomatic-alveolar part, incision is made in the mucous membrane along the transient fold of upper jaw from the third tooth to the fourth tooth inclusive. Zygomatic incision is endoscopically connected to frontal, suborbital, temporal and intraoral incisions with subperiosteal tunnels. Then osteotomy is made in specified places with the help of ultrasonic osteotome. Then refracture of fragments is made, fixation unit is applied through the zygomatic incision prefixed to the displaced fragment with self-tapping screw; zygomatic-frontal part is also moved through the zygomatic incision in subperiosteal tunnel with the output in frontal incision. Zygomatic-suborbital part of the structure is moved through the zygomatic incision with an output to suborbital incision; zygomatic-temporal part is also moved through the subperiosteal tunnel from the zygomatic incision, then through subperiosteal tunnel with output in the temporal incision. Zygomatic-alveolar part is moved through the zygomatic incision with output to the intraoral incision passing through subperiosteal tunnel; and zygomatic-temporal part is moved through the zygomatic incision with output to the temporal incision passing through subperiosteal tunnel; beds of components are inserted into beds of the fixation unit. Then they are fixed to connecting unit with fixator-screws after its fixation with self-tapping screws. After fitting of collapsible structure free ends of components are fixed with self-tapping screws through holes to specified stable places of maxillofacial area. Fixator-screws are finally fixed, final reposing of bone fragments is made after final fitting of collapsible structure, and they are fixed with fixator-screws to collapsible structure; wounds are closed.

EFFECT: method allows to perform reliable, anatomically correct and optimal reposing of fragments after refracture of fragments.

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