Low-traumatic maxillary osteotomy technique

摘要

FIELD: medicine.SUBSTANCE: midline incision of the mucosa and periosteum is made in the hard palate area, in the anterior part, ten mm behind the alveolar process of the upper jaw and to the hard palate posterior edge. The mucosal-periosteal flaps on both sides are prepared in the lateral directions in the anterior and middle regions, eight mm each, prepared to the alveolar processes of the upper jaw and circular ligaments of the eighteenth and twenty-eighth teeth in the posterior sections with formation of subperiosteal tunnels. Then the mucosa and the periosteum incisions are made in the region of the upper jaw transitional, intermittently from the twenty-eighth tooth to the twenty-fifth tooth, from the twenty-third tooth to the upper lip bridle, stopping five mm away from it. Then, five mm apart from the other side of the brodle, to the thirteenth tooth and from the fifteenth tooth to the eighteenth tooth. Mucosal-periosteal flaps are prepared up and down, five mm each. In the anterior sections, the lower lateral sections of the pyriform aperture and the anterior nasal spine are reached, in the posterior sections, the eighteenth and twenty-eighth teeth are completely released from the circular ligaments. Then the eighteenth and the twenty-eighth teeth are removed, followed by maxillary sinus anterior walls osteotomy, in the pyriform aperture area, five mm above the anterior nasal spine, from two sides, with preliminary nasal cavity mucosa exfoliation on the lower lateral and lower medial walls, five mm each, continuing backwards to the projection of the eighteenth and twenty-eighth teeth holes using endoscopic devices. Then, using the sinus lifting instrumentation, the maxillary sinus mucosa is exfoliated in the area of the lower walls, medial and lateral walls up to five mm. Then the front transverse palatal osteotomy is begun in the hard palate area stepping five mm backward from the incisor opening in the transverse direction along the edges from the hard palate median seam, three mm each, with septum osteotomy from the oral cavity, deepening upwards parallel to the incisal canal in the anterior section of the nasal septum to a depth of up to five mm, continuing the hard palate osteotomy in the longitudinal direction of the hard palate posteriorly to the hard palate median seam with a divergence of up to five mm to the outside, stopping eight mm away from the hard palate posterior edge; posterior transversal hard palate osteotomy is performed, turning outward towards the medial walls of the eighteenth and twenty-eighth teeth holes on the subperiostic tunnel five mm anterior from the anterior palatine foramen, deepening the osteotomy upward in the posterior nasal cavity of the inferior lateral nasal wall (the lower medial wall of the posterior part of the maxillary sinus) to five mm. Then the septum osteotomy is performed from the nasal cavity in the lower anterior part of the nasal septum, beginning to dissect the cartilaginous part of the nasal septum parallel to the nasal spine upwards and backwards, five mm anterior to the anterior nasal spine, turning backwards, dissecting the cartilaginous and bone parts of the nasal septum, connecting it to the previous nasal septum osteotomy in the oral cavity. Further, the osteotomy of the inferior lateral nasal cavity wall (the lower medial wall of the maxillary sinus) is carried out, starting from the osteotomy of the anterior maxillary sinus walls, backwards, 5 mm above the inferior nasal cavity wall and to the osteotomy of the inferior lateral wall of the nose in the posterior section. Then the osteotomy of the anterolateral walls of the maxillary nasal sinuses is carried out, starting from the osteotomy of the maxillary sinuses anterior walls, moving backwards along the lateral wall of the maxillary sinus, not reaching the projection of the medial walls of the eighteenth and twenty-eight teeth holes, turning down to the medial walls of the eighteenth and twenty-eighth teeth holes, the upper jaw becomes movable, its fixation is begun after moving it in the prescribed position and imposing the premaxillary traction. Mini-plates are typically imposed through the mouth vestibule. Then the intermaxillary traction is removed and mini-plates are applied to the hard palate.EFFECT: method allows to reduce traumatism, ensure reliable fixation of the lower part of the upper jaw after osteotomy.6 dwg