RU-2861357-C1 - METHOD FOR ELIMINATING MANDIBULAR ATROPHY IN PATIENTS WITH ECTODERMAL DYSPLASIA

Abstract

FIELD: medicine; maxillofacial surgery. SUBSTANCE: this invention is intended for eliminating mandibular atrophy in patients with ectodermal dysplasia with the possibility of subsequent dental implantation in this area. An incision of the mucosa and periosteum is made along the entire length of the alveolar ridge of the mandible, followed by reflecting mucoperiosteal flaps to both sides. The surface of the alveolar part of the mandible is skeletonised on the lingual and vestibular sides by blunt and sharp dissection. Parietal bone autograft fragments are positioned sequentially one after another on the lingual and vestibular sides of the mandible and fixed to the skeletonised surface of the mandible using titanium mini-screws, the space between the bone autografts is filled with a mixture of autogenous bone chips and xenogeneic material (in a 70:30 ratio), the bone structure is covered without gaps with free periosteal grafts of the calvaria, followed by mobilisation of the mucoperiosteal flap and suturing of the wound. Here, the plastic material used is bone autografts from the parietal region, obtained by making a semilunar incision of the skin, subcutaneous fat, and periosteum in the parieto-occipital region, followed by peeling and reflecting a cutaneous-aponeurotic-periosteal flap to the frontal region, obtaining the planned number of bone autografts 25-32 mm long, 20-25 mm wide and 1.5-2.5 mm thick from both sides of the sagittal suture, retreating 10-15 mm from it, followed by dividing the autografts into bone fragments of the required length and width. In addition, outside the donor zones of the bone autografts, free periosteal flaps from the calvaria are obtained, the size of which is approximately twice the size of the surface of the bone autografts. Defects of the donor zone for bone autograft harvesting are filled with bone chips, which are covered with bone wax for haemostasis. The cutaneous-aponeurotic-periosteal flap is returned to its anatomical position, followed by suturing. EFFECT: increase in the volume of mandibular bone tissue for subsequent dental rehabilitation of patients with ectodermal dysplasia due to the use of high-density parietal bone autograft fragments similar in biological properties to mandibular bone tissue, as well as the use of a free donor calvarial periosteum as a barrier membrane, furthermore, providing early trophism of parietal autografts transplanted to the mandibular area, because early vascularisation of the transplanted periosteum occurs. 1 cl, 11 dwg

Inventors

• Ponomarev Artemij Enestovich
• BUTSAN SERGEJ BORISOVICH
• JIGITALIEV SHUKHRATBEK NUMONZHON UGLI

Dates

Publication Date

20260505

Application Date

20250207

Claims (1)

1. A method for eliminating mandibular atrophy in patients with ectodermal dysplasia by incising the mucosa and periosteum along the entire length of the crest of the alveolar portion of the mandible, folding back the mucoperiosteal flap to both sides, followed by plastic surgery of the mandible with parietal bone autografts, filling the space between the bone autografts with a mixture of autogenous bone chips and xenogeneic material, covering the bone structure without gaps or tension with free periosteal flaps of the cranial vault, followed by mobilization of the mucoperiosteal flaps and suturing the wound, characterized in that in patients with ectodermal dysplasia, bone autografts of the parietal region are used as plastic material, obtained by performing a semilunar incision of the skin, subcutaneous fat, periosteum in the parietal region, followed by peeling off and folding back skin-aponeurotic-periosteal flap in the frontal region, obtaining the required number of bone autografts 25-32 mm long, 20-25 mm wide and 1.5-2.5 mm thick, obtaining free periosteal flaps from the cranial vault outside the donor zones of parietal bone autografts, the size of which is twice the size of the surface of the bone autografts, dividing the bone autografts into fragments of the required length and width, which are positioned one after another on the lingual and vestibular sides of the lower jaw and fixed using titanium mini-screws.

Description

This invention relates to medicine, namely to maxillofacial surgery, and is intended to eliminate atrophy of the alveolar part of the lower jaw in patients with ectodermal dysplasia with the possibility of further dental implantation in this area. It is known that severe jaw atrophy, typical for patients with ectodermal dysplasia, presents a clinical and surgical challenge for achieving good functional and aesthetic results. Severe alveolar ridge atrophy requires bone augmentation not only horizontally but also vertically. A method proposed by F. Curie (Khory F., Antoun, A.M.P. Bone angmention in oral implantology, 1 st ed. Quintessence: London, UK; Berlin, Germany, pp. 115-213) is known. It consists of collecting a bone block from adjacent areas of the lower jaw (chin, mandible branch), including a trapezoidal incision in the area of the alveolar process defect, a linear incision in the area of the external oblique line or chin, collecting an autograft, sawing it longitudinally into two plates, fixing one plate with screws from the outer surface of the alveolar process. Using a mill, bone chips are obtained from a part of the autoblock and placed in the defect area. Then, in case of vertical and combined atrophy, the second plate is fixed with a screw from above, and the wound is sutured. The disadvantage of this method is the impossibility of obtaining bone blocks from the lower jaw, due to its underdevelopment in patients with ectodermal dysplasia, the impossibility of achieving the specified parameters of the transplant and its rigid fixation. A method for eliminating atrophy of the distal alveolar part of the lower jaw is known (Patent RU 2709735 C1; Yigitaliev Sh.N.U. et al.). An incision is made in the oral mucosa along the crest of the alveolar portion of the mandible. The mucoperiosteal flap is reflected buccally, followed by grafting of the mandible with a bone autograft, perforation of the outer cortical plate of the mandible, and filling the space between the mandible and the bone autograft with a mixture of autogenous bone chips and osteoplastic material chips. The bone surface is covered with a collagen membrane, followed by mobilization of the mucoperiosteal flap. The wound is sutured. Atrophy is corrected in the distal alveolar portion of the mandible by creating an opening 25-32 mm long, 1.5-2.5 mm wide, and 5-6 mm deep. An osteotomy is performed along its chewing surface. Bone autografts are obtained by making a crescent-shaped incision through the skin, subcutaneous fat, and periosteum in the parieto-occipital region, followed by separation and reflection of the cutaneous-aponeurotic-periosteal flap toward the frontal region. The autograft is harvested and placed into the resulting opening, followed by filling the space between the mandible and the autograft with a mixture of autogenous bone chips and Bio-Oss osteoplastic material chips. The bone surface is covered with a collagen membrane. The mucoperiosteal flap is mobilized, and the wound is sutured. The disadvantage of the method is its use only in the distal parts of the alveolar part of the lower jaw and the use of a synthetic barrier membrane. The closest to the claimed method is the method for eliminating atrophy of the lower jaw of various origins (congenital absence of teeth, atrophy, jaw injuries, with the possibility of further dental implantation in this area (Patent RU 2715677 C1; Yigitaliev Sh.N.U. et al.). An incision is made in the oral mucosa along the alveolar ridge of the mandible. A mucoperiosteal flap is reflected buccally, followed by grafting of the mandible with autologous bone grafts and perforation of the outer cortical plate of the mandible. The space between the mandible and the autologous bone graft is filled with a mixture of autogenous bone chips and osteoplastic material chips. The bone surface is covered with a collagen membrane, the mucoperiosteal flap is mobilized, and the wound is sutured. In this case, a bone autograft is used as a bone autograft from the cranial vault, obtained by performing a semilunar incision of the skin, subcutaneous fat, periosteum in the parietal region, followed by peeling off and folding back the skin-aponeurotic-periosteal flap to the frontal region, obtaining two bone autografts 25-32 mm long, 20-25 mm wide and 1.5-2.5 mm thick on both sides of the sagittal suture, retreating from it by 10-15 mm, with further division of the autografts into bone fragments 10-15 mm long and wide and bone fragments 20-25 mm long, 10-15 mm wide, which are placed alternately one after the other. Moreover, fragments of bone autografts 10-15 mm long are placed at the edges with the edges of fragments of bone autografts 20-25 mm long superimposed on fragments of bone autografts 10-15 mm long, followed by filling the space between the lower jaw and the bone autograft with a mixture of autogenous bone chips and osteoplastic material chips, closing the bone surface with a collagen membrane, mobilizin