METHOD FOR ABOLITION OF CLEFT OF UPPER ALVEOLAR RIDGE Russian patent published in 2018 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, maxillofacial surgery, and is intended for use in abolition of the cleft of the upper alveolar ridge in patients with cleft lip and palate. Prepare the sensory bed. After the fringing incision is made, the scar-altered mucosa along the edges of the cleft of the upper alveolar ridge is sutured to close the mouth-nose anastomosis by the lapping sutures. Spread and mobilize mucosal flaps from the vestibular and palatal sides along the perimeter of the cleft of the alveolar ridge, skeleton the anterior surface of the upper jaw to the pear-shaped aperture. Then, the isolation and preparation of the recipient vessels (facial artery and vein) is carried out. On the same side, a vertical incision is made in the region of the mucous cheek, the buccal muscle is stripped by blunt dissection, visualized, and the facial artery and vein are extracted and taken to the holders. Form a tunnel under the cheek mucosa from the allocated vessels towards the cleft of the alveolar process along the vestibular surface of the upper jaw. After the preparation of the receiving bed and vascular isolation, a femoral periosteal cortical autograft is taken through the access line in the lower third of the thigh. From the anteromedial epiphysis of the femur, an L-shaped incision of the skin, 10–12 cm long subcutaneous fat (SCF), along the projection of the femoral artery from the medial epiphysis of the femur to the top, is performed. Dissect the skin, SCF, superficial fascia of the thigh without damaging the medial cutaneous nerve and the large saphenous vein. Mobilize the inner edge of the medial belly of the quadriceps muscle of thigh and extend along it to the bone. Isolate the vascular pedicle, including the descending knee artery and vein, extending from the superficial femoral arteries and veins, which are taken on the holder. Cut the periosteum over the surface of the thigh bone retreating 1–2 cm along the edges of the planned autograft. Osteotomy lines along the anterior medial epiphyseal surface of the thigh bone are made in accordance with the intraoperative template 2–3 cm in length, 1.5–2 cm in width, 0.5–1 cm in thickness. Conjugate the vascular pedicle in the proximal part. Vascular pedicle of the autograft is cut off. Adapt and fix the femoral periosteal cortical autograft in the area of the alveolar ridge cleft with micro-screws and/or mini-plates. Vascular pedicle of the autograft is guided through a previously formed tunnel under the mucous membrane of the cheek. Anastomoses are imposed: the facial artery and the vein with the descending articular artery and autograft (9) of the end-to-end type.

EFFECT: method makes it possible to increase the functional and aesthetic result of osseous surgery of the alveolar process of the upper jaw in patients with cleft lip and palate, thanks to the use of a revascularized femoral periosteal cortical autograft having an independent diet independent of the blood supply to the sensory bed, cicatricial changes in the mucous tissues, with the possibility of prosthetics with a permanent orthopedic design with support for dental implants in the area of bone cleft.

1 cl, 3 dwg, 1 ex