PARTICULARITIES OF BONE PLASTIC OPERATIONS FOR DEFECTS OF MANDIBLE
About the author:
Shuvalov S. M.
Type of article:
The paper presents the experience of treating more than 40 patients with defects of the mandible, which underwent bone plastic operations using autobonegraft from iliac crest. The main aim of this paper was observation and discussion of the methods of transplanted bones fixation during bone plastic with iliac crest. Materials and methods. More than 40 patients with defects of the mandible underwent bone plastic operations using autobonegraft from liac crest. Methods of mandible fragments and transplantat fixation were different. The first is a wireloop and intermaxillary wiring, second one – applying reconstructive titanium plate without intermaxil-lary fixation. Results. It was discovered that every method has its advantages and disadvantages. Using wireloop for bones fixation required long time intraoral intermaxilly fixation that gave patients a lot of troubles. Using the reconstructive titanium plates gave possibility to connect fragments of mandible and transplantat strictly and firmly, but this meth-od required another operation for titanium plates removal. So, the use of Tigeshtedt archbars with intermaxillary fixation is necessary for the fixation with wireloop. This type of immobilization is required within 1. 5-2 months until complete osteointegration of the graft. When applying titanium reconstructive plates, usually intermaxillary fixation is not required. However, the need to remove a plate arises further, as it does not allow the use of the denture on implants as well as removable denture. The timing of reconstructive plates removal, in our opinion, is not fully resolved. Usually we offer to remove a titanium plate in 6-8 months. Some patients refused to remove the reconstructive plate for a long time. During the 2-3 years follow-up after the bone grafting resorbtion in transplant was observed, probably due to a decrease in functional load on the newly formed bone and transferring the pressure on the metal. In this connection, reasonable period of time for removal of reconstructive titanium plate should be considered 10-12 months. We did not use miniplates for fixation of the graft. Of course, the need for reconstructive plate re-moval is a serious drawback, but in our opinion it provides reliable fixation of fragments of the defect and graft dur-ing and after the operation, which leads to early rehabilitation and the patient’s positive psychological perception of direct result of the operation. In addition, the possibility of more precise connection of the resected jaw fragments should be noted if the reconstructive titanium plate is modeled before the jaw resection. Taking into consideration the possibility of purulent wounds after resection of the jaw (we have a follow-up), we often postponed reconstruc-tive osteoplastic operation on 2-3 weeks after the resection of the mandible. Most often we used an autograft from iliac crest. Autorib was used much less frequently. Conclusions. Thus, the main tactic used by us during bone grafting of the mandible is: modeling of perceiving planes, fixing fragments of jaw and graft with reconstructive titanium plate and osteoplastic operation, postponed on 2-3 weeks. Reconstructive plate should be removed in 6-12 months after osteoplastic operation. At later terms, in some cases there is resorbtion of the graft in the angle of the mandible.
defects of mandible, bone plastic, bed perceiving a transplant, osteosynthesis by wireloop and a reconstructive titanium plate
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 part 2 (108), 2014 year, 240-243 pages, index UDK 616. 314:716