METHOD OF ELIMINATION OF THE MANDIBLE DEFECT Russian patent published in 2018 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: this invention relates to medicine, namely to maxillofacial surgery, and is intended for use in the elimination of defects of the mandible body of various origin, with the possibility of further dental implantation in this area. Before the surgery, the size of the defect of the body of the lower jaw and the donor zone of the cranial vault is estimated. Stereolithographic models and templates are produced. Prepare the sensory bed by cutting soft tissues in the submandibular region 3–4 cm below the edge of the jaw, performing layered dissection of soft tissues, skeletonizing the edges of the fragments of the lower jaw in the area of the defect. When the fragments of two paired parietal bones are taken from the previously planned line, the parietal-occipital incision is performed. Flake the skin-aponeurotic flap. On the contours of the incision the periosteum is dissected. By the method of blunt and acute dissection in the subperiosteal layer they pass to the level of the coronal suture, the external surface of the parietal bone is skeletonized. From the fragments of paired parietal bones, two fragments of the outer cortical layer are sampled in accordance with stereolithographic patterns. Defect of the donor zone of the skull is covered with bone shavings. Obtained fragments from the outer cortical layer of the parietal bones are joined together by two titanium mini-screws. Cavity inside the resulting biconvex cortical autograft is filled with bone chips and perforated on its outer surface. Biconvex cortical autograft is fixed into the formed bed in the area of the defect of the mandible body by means of four titanium mini-plates. Fistula of the revascularized cortico-periosteal femoral flap is performed as follows: a cut of the skin and subcutaneous fat is performed along the projection of the femoral artery. Dissect the tendon part of the leading canal. Pass in the intermuscular layer between the medial abdomen of the quadriceps and the large adductor muscle to the medial surface of the femur. Mobilize and bandage the muscle branches from the superficial femoral artery. On the medial surface of the femur at the level of the condyles and at 2.0–2.5 cm above it, a descending knee artery with bone perforators is distinguished. Mobilize and retain the periosteum of the anterior-medial surface of the femur. Isolate the vascular pedicle consisting of the femoral artery and vein, and the periosteum covering the femur section before departing from the descending knee artery. Periosteum is cut along the perimeter of the cortico-periosteal femoral graft, retreating 1.5–2.0 cm from the distal side and 4.0–4.5 cm from the proximal margin. Fistula of the cortico-periosteal femoral flap with the inclusion of the bone part of length and width of 1.0–1.5 cm, a thickness of 0.4–0.6 cm and a vascular pedicle is performed. Flap is cut off with a preliminary stitching of the vascular pedicle. Ratio of the size of the periosteum and the bone portion of the flap is 7.0–8.0:1.0–1.5. Length of the vascular pedicle is 8.0–8.5 cm. Resulting cortico-periosteal femoral flap is moved to the sensory bed, covered and fixed to the previously installed biconvex cortical autograft in the area of the defect of the lower jaw. By the method of blunt and acute dissection, a tunnel is created in the soft tissues from the chewing to the submandibular region, in which the vascular pedicle of the flap is carried. With the use of microsurgical techniques, end-to-end anastomoses are superimposed on the femoral artery and vein of the vascular pedicle of the flap and the facial artery and vein of the sensory bed. Prepared soft tissue is put in place. Perform layered closing of surgical wounds.

EFFECT: method allows to reduce the rate of resorption of the autograft that eliminates the defect of the lower jaw, and also reduces the risk of possible damage to the dura mater.

1 cl, 6 dwg, 1 ex