Patent RU-2601701-C1 (RU)
Title: Method for surgical approach to the temporo-mandibular joint during partial intra-articular resection of lower jaw bone condylar process
Inventor: Drobyshev Aleksej JUrevich
IPC: A61B17/24
Filed: 2015-10-22
Granted: 2016-11-10
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to surgical dentistry, and is intended for use when performing operations of a partial intra-articular resection of lower jaw condylar process. Before realization of the common endotracheal anesthesia carry out an epicutaneous marking in pre-ear area of the patient with drawing anatomic reference points. First mark tragorbital line from an ear tragus to an outer corner of eye. Then, with a space of 1.0-1.5 cm from the ear tragus at the tragoorbital line put a point of a median axis of the head of condylar process and the line of lower edge of the maxillary arch. Location of top of the patient's lower jaw condylar process head is determined by palpation of temporomandibular joint during opening and closing of the patient's mouth with the subsequent estimate of a motion kinematics of the temporomandibular joint, degree of breakdown of its anatomy and displacement of the head. Carry out the cut bordering an ear tragus on 2 cm up before transition of a curl to skin of malar area and to 1 cm from top to bottom to an ear lobe. Access is approached in the semi-blunt path with exposing a costal cartilage part of external auditory canal in a projection of the ear tragus with following dissection of soft tissues along the prootic cartilage of the external auditory canal without damaging the superficial temporal artery, veins and their branches, as well as without damaging of the temporal facial nerve branch with the output to the temporomandibular joint with posterolateral side. Then, with a space of 2-3 mm from the lower boundary of the attachment of temporomandibular joint capsule up to the most projecting portion of the head condylar process, vertical incision is made of a capsule of the temporomandibular joint in lateral part of length 7-9 mm with the output directly to the bone in a projection of head condylar process. Access to the lower articular space is performed with preservation of integrity of the upper joint space and attachment of articular disk to the capsule of the temporomandibular joint. Dissection in the place of an attachment of a lateral wing muscle to the inner part of the head condylar process is performed using a raspatory, bent at 90° along the plane. Before carrying out an osteotomy, brain spatulas width of 3-5 mm is brought behind the head of condylar process with the upper pole of the head of the temporomandibular joint, as well as forward and backwards from it for protection of surrounding tissues against damage at the stage of osteotomy, as well as to prevent displacement of the osteotomised fragment inwards with decreasing of lateral wing muscle. After realization of an osteotomy resected fragment is mobilized and finally separated from the lateral wing muscle and removed from the wound. After inspection of the wound, carry out discopecsy of articular disk with its reposition and fixing, as well as with preservation of its physiological mobility by suturing sewing in anterolateral department of monofilament resorbed thread with a long period of biodegradation with diameter 5-0, the suture at the same time stitches a joint capsule joint capsule is pierced at edge of the incision on both sides in the area of the lower boundary of the section of the capsule. At the same time depth of dissection of the weak fabrics makes 2.0-2.5 cm. 
     EFFECT: method, due to preservation during a surgical intervention of all structural elements of the joint, provides decrease of volume of traumatization during dissection, decrease of risk of emergence of intraoperative and postoperative complications. 
     1 cl, 3 ex