METHOD OF ELIMINATING SEVERE ATROPHY OF BODY MANDIBLE

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to maxillofacial surgery, and is intended to eliminate severe atrophy of the body of the mandible with the possibility of subsequent installation of dental implants and the manufacture of orthopedic structures based on dental implants. Prepare the perceiving bed by cutting the mucosa and periosteum along the entire length of the atrophied body of the mandible, folding the vestibular and lingual mucous-periosteal flaps and skeletonizing the body of the mandible, osteoplastic occlusal surface of the body of the mandible, the formation of a tunnel in the soft tissues between the vestibular surface of the body of the mandible, at the anterior margin of the masticatory muscle, and the recipient vessels – the facial artery and vein in the submandibular region. Carry out the fibula autograft with a muscle cuff on the vascular pedicle – the peroneal artery and veins, its modeling and wedge-shaped osteotomy, fixation of the simulated fibula autograft to the body of the mandible, carrying out the vascular pedicle of the peroneal autograft through the formed tunnel, revascularization of the peroneal autograft by applying a vascular anastomosis between its artery and veins and the facial artery and vein. When preparing the perceiving bed, only the upper third of the body and the lower third of the branches of the mandible with osteoplasty in the anterior part of the mandible body are skeletonized; fibula autograft is taken on the vascular pedicle with the inclusion of deepidermized skin site with the lateral surface of the tibia and muscular cuff on the back and medial surfaces of the fibula, simulation of fibular autograft by performing a wedge-shaped osteotomy with an angle of 70–80° in its central part to obtain two bone fragments 4–6 cm long, which in the place of osteotomy are applied to each other, create a frontal section of the body of the lower jaw, forming a bone pad with dimensions of 20–25×10–18 mm by osteotomy of the acute angle of the peroneal autograft formed at the junction of bone fragments, and in the terminal sections of the peroneal autograft, grooves 10–15 mm long and 5–7 mm wide are formed parallel to the front edges of the mandible branches, cutting off the vascular pedicle from the donor bed with the subsequent application of the fibular autograft with the lateral surface of the fibula to the occlusal surface of the mandible body with the fixation of the bone site of the peroneal autograft to the anterior part of the body of the lower jaw during their tight contact and the emphasis of the grooves located in the end sections of the peroneal autograft, to the front edges of the mandible branches and ensuring a 3–4 mm diastasis between the lower surface of the fibula autograft and occlusal surface of the lateral parts of the mandible, followed by the vascular pedicle of the peroneal autograft through a tunnel formed in the soft tissues to the submandibular region and revascularization of the peroneal autograft by imposing anastomoses between the artery and the veins of the vascular pedicle of the peroneal autograft and the facial artery and a vein with further hemming of the edges of the dermal area to the edges of the vestibular and lingual mucoperiosteal flaps in the anterior mandible and suturing between the edges of the vestibular and lingual mucoperiosteal flaps in the lateral mandible.;EFFECT: method allows to reduce the invasiveness of the method and reduce the time of rehabilitation of patients.;1 cl, 6 dwg