Lesson content:

Orthopedic in reconstructive facial surgery and plastic surgery on the face and jaws are effective only with a combination of surgical and orthopedic methods of treatment. Thus, in case of bone grafting of defects of the lower jaw, good fixation of its fragments is necessary, and in case of plastic surgery of the soft tissues of the face, forming devices are used to attach the transplanted tissues of the corresponding contours. Orthopedic devices are also used for plastic surgery on the hard palate and reconstructive nose operations, without which the operation may not give the desired result.

ORTHOPEDIC MEASURES FOR BONE GRAFTING OF THE LOWER JAW

The effectiveness of bone grafting of the lower jaw is achieved by reliably fixing its fragments, providing rest. Otherwise, graft engraftment will not occur. In the presence of teeth on the fragments of the jaw, fixing devices of laboratory manufacture with interdigital fixation of fragments are used. So, A. I. Betelman used an apparatus consisting of counter crowns mounted on antagonist teeth. Tetrahedral tubes are soldered on their buccal surface. In the tubes of the apparatus with closed jaws, an oval P-06 stainless steel bracket with a thickness of mm is inserted in the anteroposterior direction (Fig. 75).

With bone grafting of the lower jaw with toothless fragments, the apparatus of I. M. Oxman can be used. In the same cases, you can use the Vankevich tire and devices with extra-oral fixation of jaw fragments (V. F. Rudko, V. P. Panchokha, V. M. Uvarov). The method of choice is fixing fragments of jaws and graft with metal frames on screws (B. L. Pavlov).

Orthopedic assistance in reconstructive facial surgery

Fig. 75. Fixing devices for lower jaw bone grafting according to Betelman (a) and Oxman (b)

FORMING DEVICES,

USED IN FACIAL PLASTIC SURGERY

Forming devices are used to create support for the mixed tissues and prevent their reduction during plastic surgery of the lower and upper lips, chin. They consist of two parts — fixing and forming. Fixing these devices is not an easy task. When the upper or lower lip is plasticized, the forming apparatus is strengthened on the corresponding jaw. It can be removable or non-removable, but the forming part of it is always removable. In the presence of all teeth on the jaw, the fixation of the device can be drained using crowns, mouthguards or removable cast tires. Bushings are soldered to crowns or tires. The forming part is strengthened in them with the help of pins.

In case of defects of the dentition, the forming apparatus can be a removable plate prosthesis with a clamp fixation. In soft tissue plastic surgery

Forming devices for plastic surgery of the vestibule of the oral cavity

the lower lip and chin in the presence of teeth on the lower jaw, the forming prosthesis is strengthened with the help of clamps. With a large defect of the lower jaw and the absence of teeth, the fixation of the device is provided by the upper jaw. This is achieved with the help of crowns fixed on the lateral teeth of both halves of the jaw, or a dental splint. On the crowns and on the splint from the buccal side, the tubes are reinforced by the rods connected to the forming part of the apparatus. The latter has the appropriate contours, taking into account the thickness of the restored soft tissues.

FORMING DEVICES

WITH PLASTIC SURGERY OF THE VESTIBULE OF THE ORAL CAVITY

To eliminate the scars of the mucous membrane along the transitional fold, free transplantation of thin skin or mucous flaps is used, A. A. Limberg recommended an aluminum wire splint, made in the form of a brace with loops facing the wound, as a forming apparatus for this plastic surgery. During the operation, a thermal mass is layered on the hinges, a splint is inserted, bending along the dental arch, and an imprint of the wound surface is obtained. After that, the tire is removed from the oral cavity, the thermomass is cooled in saline solution. dried and the patient's blood is glued to it with a thin skin flap with the wound surface upwards. Then the splint is inserted into the oral cavity and tied with a ligature wire. The device is left in the oral cavity for 8-10 days.

Removable prostheses are also used as a forming device, which are made before the operation to get the patient used to it. Then, a steel zigzag wire with a diameter of 0.8 mm is fixed in the area of the operating field. A thermomass is applied to the wire, giving it the shape of a wound-

Fig. 76. A removable forming prosthesis for plasticizing the transitional fold (according to the Shield)

Orthopedic assistance in reconstructive facial surgery

howl of the surface. A skin flap is glued to the thermomass, which is inserted after excision of the scars together with the prosthesis (Fig. 76).

Correction of the shape of the vestibule of the oral cavity can be carried out by another method. A removable prosthesis with an elongated edge is made in the area of the scar-altered transitional fold. The edge of the prosthesis should be twisted and have a thickness of at least 2 mm. After dissection of the scar, the prosthesis is applied to the wound.

ORTHOPEDIC MEASURES FOR PALATE PLASTIC SURGERY

A protective fixing plate is used to fix the flaps, protect the surgical field from injury and oral fluid, and retain the dressing material during uranoplasty. After the surgical wound is healed, it is used to form the vault of the sky.

Manufacturing technology of the protective plate. An impression is taken from the upper jaw with alginate impression materials with preliminary tamponade of the cleft. On the wax model, a protective plate is formed, it covers the hard and soft palate and all the teeth of the upper jaw from the vestibular side to the equator. To create a place for the dressing material before modeling, a layer of gypsum is applied to the roof of the sky of the plaster model to the middle of the slope of the alveolar process. The jaw model is plastered into a cuvette and plastic polymerization is carried out. The protective plate can also be made from fast-hardening plastic, as well as by pressing from standard polymethylacrylic plates in special molds. A thermoplastic mass is periodically layered on the plate, which contributes to the formation of the arch.

When plastering acquired defects of the hard palate with the Filatov stem, special devices are used that protect the stem from the tongue and teeth and keep the lower jaw in a pubescent state. They are monoblocks, in the upper part of which there is a hole for the Filatov stem.

 Orthopedic measures for nose plastic surgery

ORTHOPEDIC MEASURES FOR NOSE PLASTIC SURGERY

Forming devices for nose plasty are used to create a nasal cavity and airways. A simple device for nose plasty is a plastic liner reinforced with a rod on a plaster headband. Z. Ya. Shur proposed a device for the formation of the nose, consisting of a soldered splint on the teeth of the upper jaw and a removable arch with extra-oral rods for fixing the frame and pelot (Fig. 77).

Fig. 77. Forming a prosthesis of iri giasgike nose (according to Shur)