METHOD FOR MOBILIZING AN UPPER JAW OF A PATIENT DURING ORTHOGNATIC SURGERY

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to surgical dentistry and maxillofacial surgery, and can be used for mobilizing the upper jaw when performing orthognatic intervention. Before the preoperative period before the orthognatic intervention, the spinal computed tomography is examined for the volume and size of the upper jaw bone deformations subject to surgical treatment. 64 slices are made per one revolution of gantry with cut-off thickness of 0.625 mm, without inclination of gantry with voltage of 120 kV, current intensity of 175 mA, during 2.2 seconds at pitch of 0.516:1. Using an overview scanogram, multi-plane reconstructions of the patient's upper jaw image are performed in three planes – coronary, frontal and sagittal. After performing the endotracheal narcosis and antiseptic treatment of the operating area, conductive and infiltration anesthesia is performed within the upper jaw using 2 % solution of ropivacaine with epinephrine in concentration 1:200,000. Upper patient's upper lip is lifted with application of Langenbeck hooks. V-shaped incision of the mucous membrane from the mesial surface of the first premolar to the frenulum of the upper lip is indented 4–5 mm above the attached gingiva to the middle of the distance between the red rim of the upper lip and the attachment point of the frenulum of the upper lip of the patient. Mucous membrane, the lowering muscle of the nose, the wing and transverse parts of the nasal muscle, the circular muscle of the mouth and the periosteum are dissected in one motion. Mucous membrane after the incision is retained and brought down using Langenbeck hooks. Patient's maxilla is exposed. Raspatory is used to separate from the upper jaw bone a circular muscle of the mouth, a lowering muscle of the nose, a wing and a transverse part of the nasal muscle, a buccal muscle and a nasal muscle. Providing access to upper jaw bone and its visualization before performing orthognatic intervention. Nasal septum is separated from the maxillary bone of the patient using a raspatory or a reciprocating saw. Performing osteotomy of upper jaw of patient with 3–3.5 mm from tops of teeth using reciprocating saws or piezo-knife, starting from distal portion of upper jaw – malar alveolar ridge towards pear-shaped opening on one side of upper jaw. That is followed by osteotomy on the other side of the upper jaw. Before the mucous membrane is incised in the upper jawbone area, a bent bit is inserted into the oral cavity from the vestibule of the vestibule, and its working part is placed in the projection of the pterygomaxillary junction. Mucous membrane and a submucous one are dissected, and an osteotomy of the pterygomaxillary junction is performed, and upper mounds are separated from the horizontal plates of the wedge-like bone within the pterygomaxillary suture. Final mobilization of upper jaw is performed using Rowe forceps. Upper jaw of the patient is positioned along the pre-made splint and fixed in the specified position using miniscrew and miniplates. Nasal wings base width is corrected by overlapping wings of suture nose. At that, the upper lip is turned out to the outside with the surgeon's thumb and forefinger, placing the forefinger outside in the area of attachment of the nose wing. Lateral portion of soft tissues within the nasal wing is located under the forefinger of the surgeon. Upper lip is released and the soft tissues are slightly pulled inside to evaluate a degree of displacement of the wing of nose. Suture is applied on tissues fixed by tweezers with application of resorbable suture material. Suture is threaded through a hole in the base of the anterior nose nasus serially on both sides in the form of an "eight". Suture is tightened to bring together the wings of the nose with the planned hypercorrection by 3 mm taking into account the predicted postoperative expansion of the base of the nose. Soft tissues are closed in layers. Mucosa is sutured together by the resorbable suture material with "V-Y"-technics with obligatory comparison of the center.;EFFECT: method provides mobilization of the upper jaw of the patient with orthognatic intervention, sufficient and necessary visualization of upper jaw bone, minimizing blood circulation disorders in the soft tissues of the perioral, infraorbital and buccal areas, reducing the risk of necrosis of the osteotomized fragment of the upper jaw, avoiding a ragged wound of the muscular fibers, as well as reducing the patient's rehabilitation time ensured by the optimal preoperative and operating procedures.;1 cl, 3 ex