METHOD FOR OSTEOSYNTHESIS IN FRACTURES OF ANGLE AND BODY OF LOWER JAW, USING INDIVIDUAL SURGICAL TEMPLATE Russian patent published in 2022 - IPC A61B17/24 A61B6/03 

FIELD: medicine; maxillofacial surgery; surgical dentistry.

SUBSTANCE: group of inventions relates to medicine, namely to maxillofacial surgery and surgical dentistry; it can be used for osteosynthesis in fractures of an angle and body of the lower jaw. In a method, an individual surgical template is used. At a stage of planning of an operation, MSCT of the facial skeleton is performed with a minimum scanning step of 0.6 mm. Data received from DICOM format is converted to STL file. A volumetric-geometric model of the facial skeleton obtained at the planning stage is loaded into a program for three-dimensional modeling, where virtual comparison of fragments of the lower jaw in the fracture area to an anatomically correct position is carried out, followed by imposition of a graphical analogue of titanium bone mini-plates, which take into account anatomical features of the jaw in the area of absence of tooth roots, the neurovascular bundle of the lower jaw, and subsequent design of an individual surgical template made of biocompatible plastic. At a stage of surgical intervention, submandibular or submental access is performed, depending on the localization of the fracture. Skeletonization of an outer surface of the lower jaw is carried out in the fracture area. After that, bone fragments are repositioned and fixed in accordance with virtual positioning, using a bone clamp. Titanium bone mini-plates (hereinafter – TBMP) are installed in the surgical template. The template is placed in the fracture area. Using a bend in its lower part and an oval hole for visualization of a fracture line, the template is positioned in an anatomically correct position, temporarily fixed with a screw in the area of a lower edge of the lower jaw. Through shafts of the individual surgical template (hereinafter – IST), a bed for a fixing element is formed at angles of 80-100° and a depth of drilling of no more than 14 mm, which is carried out with water cooling. TBMP is fixed through shafts with screws. Then, the bone clamp is removed, the temporary fixing screw and IST are removed, the stability of osteosynthesis and the condition of the bite are assessed. Tissues are sutured in layers with the introduction of glove drainage into the wound. The individual surgical template for osteosynthesis includes a case made of biocompatible plastic with recesses. The manufactured template is sterilized by autoclaving at a temperature of +120°C, pressure of 1.1 atm for 45 min. A thickness of the case is 1.5 mm. There are holes with shafts on a site of titanium bone mini-plates, an angle of inclination is 80-100° to a plane of the case, and a length of shafts is adjusted individually, when designing. In a lower part of the case, there is an oval hole and a bend of no more than 5 mm. There is also a hole in the lower edge area for temporary fixation of the individual surgical template to the lower jaw.

EFFECT: invention provides reduction in traumatism of surgical intervention, as well as reduction in possible iatrogenic complications due to an increase in the accuracy of positioning of TBMN for fixation of bone fragments in fractures of an angle and body of the lower jaw, using a template.

4 cl, 6 dwg, 1 ex