HYPER-EXTENSIBLE CONSTRUCTIONS IN SURGICAL TREATMENT OF HIGH MANDIBULAR CONDYLE MEDIALLY DISLOCATED FRACTURES

Y.А. MEDVEDEV, N.S.BEDIRCHANLI

Moscow State Medical University I.M.Sechenov, Moscow, RUSSIA

Treatment and rehabilitation of patients with mandibularcondylar fractures (C) is one of the most urgent and difficult challenges of maxillofacial trauma. A special group of fractures of the mandibular condylar fractures is formed by high condylar fractures (HCF)and condylar fractures with a complete medial dislocation of the head of the mandible, according to characteristics of their clinical course, diagnosis and treatment.

The aim of the study is to evaluate the effectiveness of the method of replantation of the head of the mandible, by using hyper-extensible NiTistructures as fixing devices, in cases of HCF and condylar fractures with medial dislocation of the head of the mandible.

Materials and methods: we carried out examination and subsequent surgical treatment, of 16 patients (5 women (33%), men 10 (67%)) aged between 18-59 years for the replantation of the head of the mandible, in the Maxillofacial Surgery clinic of I.M.Sechenov First MSMU (Moscow) for the period from 2007 to 2009.Surgical treatment of patients with mandibular HCF was performed strictly according to indications, after detailing of the nature of the fracture by using computer tomography. All types of treatment of such fractures should provide artificial support and stabilization of bone fragments. The type of thefixing device plays a certain role in the creation the required mechanical conditions in the fracture zone. Mini-bracket made of NiTi with the length of 6.0 mm and with working legs of 4.0 mmwere used as fixing elements for the head of the mandible and osteotomied fragment of the ramus ofjaw. In the majority of observationthe use of two clampswas sufficient. Some patients have insertedintraosseous pin with length of 1.0 cm or a third striker on the other area. Fixation of the osteotomiedfragment to the ramus of the jaw was carried outwith the help of mini-brackets made ofNiTi with the length of 6-8,0 mm, with working feet up to 4.0 mm. Along the vertical line of osteotomy there wereset two fixators, along the horizontal - one, rarely - two. Thus, there were carried out 19 (in 3 patients operations were carried out on both sides) surgical interventions in the TMJ with the application of structures made of NiTi. Long-term results were traced within up to 3 years. In assessment of the results of treatment early and late complications, the nature of pain syndrome, volume of movements in the temporomandibular joint, the force of the masticatory muscles, the function of the lower jaw, radiologic data was into account. All clinical observations on control radiographs reported no symptoms of secondary displacement ofreplantatedfragments and migration of fixing structures. In operated patients, no early postoperative complications were observed. Late complications were recorded: mild pain syndrome (11%), incomplete joint movement (14.3%), decreased function of the mandible (10.7%). These mentioned symptoms continued within 6-10 months and gradually leveled in the results of appointment of traditional schemes of rehabilitation treatment. Apparently, late complications are mainly connected with the injuries of soft tissue components of the temporomandibular joint. Thus, the method of replantation of the head of the mandible developed by us with the application of hyper-extensible structures made of NiTigives excellent and good clinical results. The worked out method alloys to reducetraumatism of operation, facilitate fixation of bone fragments, increasegeneral quality of osteosynthesis. In terms more than 14 days after injury,effectiveness of the operation reduces. In such cases, the degree of risk of avascular necrosis shall be considered. Primary arthroplasty is considered to be a good alternative, however, in this case biomechanical aspects shall be taken into consideration.

Date: 2014-12-28; view: 962