[Surgical-associated expansion of the jaws with asymmetric deformations]. / Khirurgicheski-assotsiirovannoe rasshirenie chelyustei pri asimmetrichnykh deformatsiyakh.

One of the most common abnormalities in the development of the jaw is the narrowing of the alveolar process of the maxilla. In childhood, the elimination of such a deformation is quite common. But with age, the only effective option is the inclusion of a surgical procedure in the rehabilitation plan. The medial and parasagittal osteotomy of the maxilla for the purpose of its expansion by a distraction device has a number of important nuances which can significantly affect the result. These include: localization of sagittal osteotomy of the palate and alveolar process; the direction of cutting the walls of the maxillary sinus; type of fixation of the device (dental-borne or bone-borne). The article summarizes the experience of 74 surgical-associated expansions of the jaws with asymmetric deformations performed over 2 years. A retrospective analysis according to cone beam computed tomography is given. of complex treatment with the inclusion of sparing osteotomy of the maxilla in the rehabilitation plan and a differentiated approach to performing surgical manipulation allow to achieve optimal aesthetic and functional results and to correct the asymmetry to the greatest extent.

[Operative access for treatment of pilon fractures]. / Operative Zugänge für die Versorgung von Pilonfrakturen.

BACKGROUND: Under optimal conditions, fractures of the tibial pilon can be definitively managed operatively within 6 h after the trauma. Under suboptimal conditions, preoperative antiphlogistic treatment, possibly after approximate correction and external fixation of the alignment, is a reasonable option. Osteosynthesis implies reconstruction of good joint congruency in anatomical orientation. The soft tissue coverage of the distal lower leg is relatively poorly constructed and there is a high risk of devascularization, necrosis and ensuing infection. THERAPY: Several local accesses with complete visual control of the joint surface enable a strain-free soft tissue handling and thus reduction of the incidence of complications. Besides a specific access to the fibula fracture, two anterior and two posterior accesses are proposed based on normal vascularization. These accesses can be simultaneously combined. Using a bone distractor facilitates control of the joint surface. CONCLUSION: Open reduction and stabilization of pilon fractures enables rapid restoration of joint mobility. After having analyzed the fracture and setting the priorities, the treatment strategy should include a well-thought out selection of possible accesses.