[Treatment method of patients with chronic recurred mandibular dislocation].

Original method treatment of patients with chronic recurred mandibular dislocation is offered. Limitation of oral opening within the bounds of physiology was made with nailon ligature which jointed mandible with malar bone. The operation is effective, simple and may be done in out-patient conditions under local anesthesia.

[Stages of bone regeneration and foundation of pharmacоlogical correction of the mandible reparative osteogenesis].

Influents of some medicines on the mandible reparative regeneration in experimental investigations are present in the manuscript. It was discovered that application of parathyroid hormone (PTG) in first 3 days after the mandible fracture decreases of quantity complications on 30% and contributes strong consolidation of bone fragments. Metiluracil in the same period increases complications quantity on 36% and bone fragments consolidation strength was for sure less than after PTG. It was found PTG and vitamin D3 in first resorbtion stage accelerate bone consolidation, retabolil (nandrolone), dexametasone, testosterone and vitamin E slow down bone consolidation. Role of vitamin A, indometazin and calcitonin was doubtful. Practical doctors and experimenters co-ordination efforts are necessary for elaboration of new tactic and strategy of patient treatment with bone trauma.

[Rational (injection) of calcitonin for stimulation of the mandibular reparative regeneration].

This investigation permit to detect, that first resorption stage of the mandible reparative regeneration terminats after fracture 5 days later. Calcitonine injection during 5 days after fracture i.e. in paratiroid hormone dependent stage distorts normal reparative process. Rats with traumatic osteomielitis become 1.5 times more and rats with normal regeneration become 3 times less. Injection calcitonine in KT-dependent stage, i.e. in 6-11 days after fracture increases quantity of rats with normal regeneration in 7 times and decreases quantity animals with traumatic osteomielitis on 50%. There's recommendation to inject KT from 6 days after trauma.

[Titanium implants integration into mandible distract regenerate].

In experiment on 20 rabbits with distract regenerates in the region of mandible body osteotomy the correlation between the efficacy of titanium implants (introduced into regenerate) integration and the degree of regenerate osseous material differentiation was investigated. Implants integration fixed in 7 and 20 days after distraction process discontinuance passed considerably more efficiently than in rabbits with implants fixed 1 day after distraction process discontinuance. It expressed itself with intensive development and maturation of osseous regenerate around implants and with tendency to "solder" of newly formed bone and implant's surface, i.e. to osteointegration. Higher the level of newly formed osseous material maturity in the implantation moment - more effective implant integration will be.

[Elimination of mandibular defects with dosed distraction. Part III. Use of dosed distraction for restricted osteoplasty in subtotal and end defects of the mandible].

Two variants (3(rd) and 4(th)) of non-free mandible osteoplasty with the use of compression-distraction apparatus (CDA) elaborated during the war in Afghanistan are described by the author. The 3(rd) variant was used in cases of vast combined defects of lower part of the face when two-sided osteotomy of both mandible stumps in order to create mobile mandible fragments of the length of 2.5 cm and their follow-up shift to the middle line of the face with the help of CDA is made. Distraction of callosity and soft tissues stimulated histogenesis that led to substitution of big osseous-soft tissue defect of lower part of the face. The 4(th) variant had two stages: 1(st) stage resulted in reconstruction of mandible branch, the 2(nd) -- in reconstruction of mandible head. In such a way the new temporomandibular joint using own tissues of the patient was created without application of allotransplant or titanium explant.

[Repair of mandibular defects using dosed distraction. Part II. Bound osteoplasty of the mandible by distraction osteogenesis]. / Ustranenie defektov nizhnei cheliusti s ispol'zovaniem dozirovannoi distraktsii. Chast' II. Nesvobodnaia osteoplastika nizhnei cheliusti posredstvom distraktsionnogo osteogeneza.

Five variants of bound osteoplasty based on the distraction osteogenesis phenomenon were developed by the author for the treatment of patients with gunshot mandibular defects during the war in Afghanistan. Three of these variants are described in this paper; indications for their use and the technique of operation are presented. In fact, bound osteoplasty for gunshot wounds is primary early osteoplasty of the mandible -- the target of several generations of maxillofacial surgeons.

[Repair of mandibular defects by dosed distraction. Part I. Distraction of the callus for osteoplasty of the mandible by local tissues]. / Ustranenie defektov nizhnei cheliusti s ispol'zovaniem dozirovannoi distraktsii. Chast' I. Distraktsiia kostnoi mozoli dlia osteoplastiki nizhnei cheliusti mestnymi tkaniami.

During the war in Afghanistan the author repaired gunshot defects in the mandible using a compression-distraction device (CDD) which he designed in cooperation with A. Kh. Shamsudinov. Osteoplasty of the mandible is based on the distraction osteogenesis phenomenon. Proceeding from this phenomenon, the author developed several variants of mandibular osteoplasty in 1982-1983, one of these variants being osteoplasty with local tissues, permitting bloodless repair of mandibular defects of up to 5 cm long. Osteoplasty with local tissues can be used not only for repair of mandibular defects of any origin, but for enlarging the mandible in congenital or acquired abnormalities as well.

[Use of distraction osteogenesis in reconstructive surgical interventions on the temporomandibular joint]. / Primenenie metoda distraktsionnogo osteogeneza pri rekonstruktivnykh khirurgicheskikh vmeshatel'stvakh na visochno-nizhnecheliustnom sustave.

Preserved cadaveric orthotopic grafts, osteocartilagenous autotransplants from the rib, ceramic, plastic, carbon, and titanium explants, etc. are used for osteoplasty of the condylar process. Osteoplasty based on distraction osteogenesis was used in 3 patients for osteoplasty of the condylar process and mandibular head with good results.

[Morphogenic processes in dosed distraction]. / Morfogeneticheskie protsessy pri dozirovannoi distraktsii.

Dosed distraction of bone regenerate is paralleled by distraction of soft tissues (skin, muscles, nerves, etc.), which is particularly obvious during liquidation of medium-sized and extensive mandibular defects. Such distraction of soft tissues leads to their regeneration and growth. However regeneration of soft tissues is paralleled by dystrophic processes, which are never observed in bone regenerate. Dosed distraction can be used in repair of combined bone and soft tissue defects and deformations of the face of different etiology.

[Primary surgical treatment of gunshot wounds of facial skeleton]. / Pervichnaia khirurgicheskaia obrabotka ognestrel'nykh ran litsevogo skeleta.

The author criticizes the traditional strategy of sparing treatment of gunshot wounds of the face involving the bones, formulated as long ago as in 1943, and suggests radical primary surgical treatment of such wounds. The author used such treatment with good results during 4 years in Afghanistan war.

Non-free osteoplasty of the mandible in maxillofacial gunshot wounds: mandibular reconstruction by compression-osteodistraction.

We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time. Twenty-eight of the patients presented within a few hours of injury, and the remaining five had old injuries. The only complications were in the group with old injuries where four patients developed abscesses that required drainage, but these did not interfere with the process of osteogenesis. All 33 patients had good functional and aesthetic results within 3-4.5 months. The method allows a bloodless minimally traumatic procedure which can be carried out in one stage. The results compare very favourably with the classic methods of the treatment of mandibular gunshot injuries.

[Experience in conducting course exams on assignments in test form]. / Opyt provedeniia kursovykh ékzamenov po zadaniiam v testovoi forme.

Analysis of the results of examinations in oral surgery making use of tests in 319 fourth-year students showed that such a method of assessing students' knowledge is highly objective.

[Experience in conducting course exams in test form]. / Opyt provedeniia kursovykh ékzamenov v testovoi forme.

Examinations including tasks presented as tests were carried out in 319 fourth-year students of dental surgery. This method for assessing the knowledge and skills of students proved to be highly objective.

Osteoplasty of the mandible by local tissues.

Thirty three patients with 0.5 to 4.5 cm gunshot defects of the mandible were treated. The ends of the fragments of the bone were initially compressed, then distracted with the help of a compression-distraction device. The immature callus was distracted at a rate of 0.25 mm four times a day. During the process of distraction the defects of bone and soft tissues are replaced. Lack of soft tissue, which make insertion of a free bone graft impossible, is the main indication for an osteoplasty by local tissues.

[The dependence of the osteoinductive activity of the bone matrix on the mass and area of the transplant]. / Zavisimost' osteoinduktivnoi aktivnosti kostnogo matriksa ot massy i ploshchadi transplantata.

White rat experiments have demonstrated that bone matrix osteoinductive activity (the matrix ability to induce ectopic osteogenesis) is in direct proportion with the transplant mass in cases when this mass is within 0 to 0.16% b. m. A higher transplant mass is not associated with elevated osteoinductive activity. When the transplant masses are equal, their osteoinductive activities are in proportion with their sizes. These regularities should be borne in mind when choosing the transplant mass and shape.

[Role of the destructive phase of regeneration in reparative osteogenesis]. / Rol' destruktivnoi fazy regeneratsii v reparativnom osteogeneze.

Experiments were conducted on mongrel male rats to study the dependence of the character of maxillary fracture consolidation on the content of osteo-inducing (01) and osteo-inhibiting (I) proteins in the bone tissue as well as the effect of agents intensifying (parathormone) or reducing (methyluracil) the resorption phase of bone regeneration. It is shown that the ratio of OI and I proteins in the bone tissue determines the healing of the fracture according to the type of uncomplicated or slow consolidation in untreated animals, whereas parathormone administration increases the number of animals with uncomplicated consolidation of the fracture and raises the strength of union of the fragments. Methyluracil fails to produce such on effect. It is suggested that improved regeneration of bone in intensification of the phase of resorption is due to more effective excretion of OI proteins from the injured bone tissue.

[The elimination of mandibular defects by an osteoplasty method using local tissues]. / Ustranenie defektov nizhnei cheliusti metodom osteoplastiki mestnymi tkaniami.

Mandibular body defects 0.5 to 4.5 cm long were eliminated in 33 patients. Fracture edges were brought together to meet by means of compression distraction apparatus; when the surfaces were congruent, they were compressed. 10-12 days later distraction was started at a rate of 0.25 mm 4 times a day. Bone and soft tissue defects were replaced in the course of distraction. Soft tissue insufficiency that usually prevents free osteoplasty in this case favors local tissue osteoplasty.