FIELD: medicine.
SUBSTANCE: invention refers to medicine, namely to surgical dentistry. Preoperative cutaneous marking is applied in the patient’s preauricular region with drawing anatomical landmarks and points of introduction of medical instruments for performing an arthroscopic operation. Periarticular tissues of the temporomandibular joint (TMJ) are infiltrated, expanding the intraarticular space of the TMJ. Upper joint space of the temporomandibular joint is punctured in the area of a point located along the line perpendicular to the frankfurter horizontal line, in the deepest point of the joint fossa of the temporomandibular joint. Arthroscope is inserted through the trocar, and the TMJ is continuously washed through the trocar with Ringer’s solution. Distal clivus of the TMJ articular tubercle is punctured at a point located at the intersection of a line parallel to the frankfurter horizontal line at the height of the articular tubercle of the temporomandibular joint and a line perpendicular to the frankfurter horizontal line and passing through the posterior border of the articular tubercle of the temporomandibular joint. Puncture is performed at an anterior clivus of an articular tubercle of the TMJ at a point located at the intersection of a line parallel to the frankfurter horizontal line at the height of the articular tubercle of the temporomandibular joint, and a line perpendicular to the frankfurter horizontal line at the anterior border of the articular tubercle of the temporomandibular joint. Arthroscope is inserted into the point with the best visualization of the joint space of the temporomandibular joint. Temporomandibular joint disc is mobilized. Then, the intra-articular disc of the TMJ is repositioned. For this purpose, the arthroscope is placed at a point located at the intersection of a line parallel to the frankfurter horizontal line at the height of the articular tubercle of the temporomandibular joint, and a line perpendicular to the frankfurter horizontal line on the anterior border of the articular tubercle of the temporomandibular joint. Upper joint space of the temporomandibular joint is inflated by increasing the pressure of Ringer's solution. Lower jaw of the patient is pulled downwards and the molars of the lower teeth are continuously applied. Then, to the point located at the intersection of the line parallel to the frankfurter horizontal line at the height of the articular tubercle of the temporomandibular joint, and the line perpendicular to the frankfurter horizontal line on the anterior border of the articular tubercle of the temporomandibular joint, an arthroscopic blunt probe is introduced to press on the bilaminar zone of the TMJ to reposition the TMJ disc at 12 o’clock relative to the position of the posterior pole of the TMJ disc relative to the apex of the condyle. Further, the pin is fixed. For this purpose, the probe is held on a bilaminar zone of the temporomandibular joint and a cannula with a window in the distal part is introduced into a point located along a line perpendicular to the frankfurter horizontal line, in the deepest point of the joint fossa of the temporomandibular joint. Temporomandibular joint disc is positioned by pressing the cannula with a window to the apex of the condyle head through the upper joint space of the temporomandibular joint. Under the video control of the arthroscope installed at the point located at the intersection of the line parallel to the frankfurter horizontal line at the height of the articular tubercle of the temporomandibular joint, and the line perpendicular to the frankfurter horizontal line on the anterior border of the articular tubercle of the temporomandibular joint, with continuous irrigation, a drill is inserted into a point located along a line perpendicular to the horizontal line, in the deepest point of the glenoid fossa of the temporomandibular joint, and drilling is performed through the temporomandibular joint disc and the head of the condyle. Further, the drill is removed, a pin is inserted on the pin holder, and the pin is hammered until the pin head is level with the articular disc of the temporomandibular joint. Further, a fibrin clot made from the patient’s autoblood is placed into a TMJ capsule, and hyaluronic acid preparations are introduced. That is followed by layer-by-layer suturing of the wound, starting from the TMJ capsule, then matching the soft tissues in the area of the ear tragus and the skin at the incision site with interrupted sutures.
EFFECT: method allows increasing efficiency and efficiency of elimination of degenerative changes in temporomandibular joint, restoring kinematics of lower jaw movements.
6 cl, 23 dwg, 2 ex
