• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    Prosthesis for the mandibular side of a temporamandibular joint, comprising a head part replacing the condylar head, in particular at the anatomical location, and one. mounting plate, wherein the mounting plate is saddle-shaped with a lateral portion and a medial portion formed and intended to abut on either side of the rising branch of the lower jaw, directly below the arcuate recess in the upper end of the rising branch of the lower jaw.
    公开号:NL1042368A
    申请号:NL1042368
    申请日:2017-05-11
    公开日:2017-11-15
    发明作者:Yves Mommaerts Maurice
    申请人:Cadskills Bvba；
    IPC主号:
    专利说明:

    Prosthesis for a temporomandibular joint
    BACKGROUND OF THE INVENTION
    The invention relates to a jaw joint prosthesis, or prosthesis replacing a temporomandibular joint (TMG).
    In a jaw joint and its surroundings, the connecting area of the lower jaw (mandibula) and the sleeping leg (os temporal), in particular, of the lower jaw, the processus condylaris, with neck and (jaw) head (caput mandibula) can be distinguished. , and of the sleeping leg the joint bowl (fossa glenoidalis), formed behind the yoke arch (arcus zygomaticus), with these interconnecting muscle and connective tissues and the joint disc (discus articularis).
    Patients with significant jaw joint damage due to ankylosis, rheumatoid arthritis, bone arthritis, tumors and trauma suffer from chewing and speech problems. To remedy these problems, partial or complete replacement of the jaw joint may be required.
    U.S. Patent 3,178,728 discloses a one-sided prosthesis. This is formed by a chromium-cobalt casting for covering the joint cup, including the anterior “bone nodule” (tuberculum articulare), to provide a bearing for the jaw head. A similar but shorter one-sided prosthesis is known from US patent 3,579,643. This prosthesis releases the glenoidal cavity. A more recent proposal is described in US 2009/0222102.
    Two-sided prostheses are known from, for example, US patents 4,693,722, 4,778,472, 4,917,701, 5,549,680, 5,989,292 and FR patent application 2,558,721.
    A more recent design of a double-sided prosthesis is the subject of US patent 6,132,466, including a replacement for the jaw head and a bearing therefor. The jaw prosthesis comprises a downwardly extending strip for fixing by means of screws on and below the neck of the condylaris process. A similar design is the subject of US patent application 2009/0138092.
    Another two-sided prosthesis is known from WO 2014/023903, in which the part replacing the jaw head is two-part, with a faintly bent pin with prosthesis jaw head to be fixed in the jaw bone and a holder part comprising a downwardly extending strip for attachment by by means of screws on and below the neck of the condylaris process and a holder ring formed as a whole for holding the pin in the correct orientation.
    SUMMARY OF THE INVENTION
    An object of the invention is to provide a prosthesis for a jaw head in a temporomandibular joint, which in many cases can be fitted with less risk for the patient.
    An object of the invention is to provide a prosthesis for a jaw head in a temporomandibular joint, which in many cases can be fitted with less effort.
    An object of the invention is to provide a bilateral prosthesis for a temporomandibular joint.
    From one aspect, the invention provides a prosthesis for the mandibular side of a temporomandibular joint, comprising a head portion replacing the condylar head at the anatomical location and a mounting plate for attachment to the lower jaw, the mounting plate being formed with a lateral portion that and is intended for abutment against the lateral side of the rising branch of the lower jaw, directly below the arcuate recess (incisura semilunaris) in the upper end of the rising branch of the lower jaw, the lateral portion being provided with holes for mounting on the lateral side of the rising branch of the lower jaw and wherein the mounting plate comprises an upper portion integral with the lateral portion and formed and intended for abutment on the concave upper edge of the arcuate recess in the upper end of the rising branch of the lower jaw.
    Hereby a displacement of the locations of transfer of the forces exerted on the jaw head, which is situated at a location corresponding to the anatomical location, to the lower jaw can be realized, from the areas known below the condylar neck in the prior art, often to near the jaw angle, to higher and more forward areas on the rising branch of the lower jaw, on the upper edge of the arc-shaped mandibular recess and below that on the lateral side of the rising branch of the lower jaw. By moving the attachment area to the rising branch of the lower jaw, the area at the jaw angle can be left untouched when placing the prosthesis, because the vertical downward extension can remain limited, so that also outside the area of the buccal branch of the facial can remain nerve. Vertical forces need not only be transmitted via shear-loaded bone screws, but can also be transmitted to the lower jaw via the bearing on the naturally provided arcuate upper edge of said recess. The abutment in the vertical direction and in the medial direction against the upper edge of the arcuate recess and the lateral side of the lower jaw, respectively, can facilitate placement.
    In a further development thereof, the mounting plate comprises a medial portion which is integral with the lateral portion and the upper portion, and is formed and intended for abutment against the medial side of the rising branch of the lower jaw, preferably directly below the arcuate recess in the upper end of the rising branch of the lower jaw. This promotes stability in the lateral direction. Furthermore, the placement of the prosthesis is facilitated.
    In a further development, viewed in a direction parallel to dorsal-ventral, at least partially concave, the upper portion is formed with the cavity upwards.
    From another aspect, the invention provides a prosthesis for the mandibular side of a temporomandibular joint, comprising a head portion replacing the jaw head at the anatomical location and a mounting plate, the mounting plate comprising a lateral portion and a medial portion formed and intended to abut on either side of the rising branch of the lower jaw, directly below the arcuate recess in the upper end of the rising branch of the lower jaw, and having an integral upper portion, which is concave, with the cavity upwards seen in a direction transverse to the lateral portion and concave, with the cavity down, is formed viewed in a cross section. In one embodiment the mounting plate has the appearance of a horse saddle or the appearance of the hyperbolic paraboloid. The mounting plate may have a double concave shape, with both concave shapes facing opposite (up and down) and rotated about 90 degrees relative to each other.
    In one embodiment, only the lateral portion is provided with holes for attachment to the lateral side of the rising branch of the lower jaw.
    Dorsal, ventral, lateral, medial, top, bottom, bottom, etc. point to the position of use placed in a standing patient.
    As noted, the extension of the lateral portion / wing can remain limited in the downward direction, in particular the lateral portion in a direction parallel to the direction of projection of the head portion can have a length that is less than its length in a (ventral -dorsal) direction transverse thereto.
    The shape of the lateral portion or lateral wing will be aligned with the anatomy of the bone. The lateral portion can be, for example, sickle-shaped, for example include an L-shaped lip, or comprise multiple lips, for example one lip near the condylar neck and one lip near the coronoid protrusion. This is not an exhaustive list, other forms are also possible.
    The shape of the medial portion or medial wing will be aligned with the anatomy of the bone. The medial portion can form with the upper portion an overhanging edge abutting the bone. The medial portion can be, for example, sickle-shaped, for example comprise an L-shaped lip, or comprise several lips, for example one lip near the condylar neck and one lip near the coronoid protrusion. This is not an exhaustive list, other forms are also possible.
    The upper part can be continuous in the combing direction or comprise several parts, in which case it is interrupted. The length in the combing direction may be of the order of magnitude of the spacing of the necks of both protrusions, or a fraction (e.g., 1/4, 1/3) thereof.
    In one development, the lateral portion is designed to extend, in the deployed state, in the ventral direction beyond the lowest point of the arcuate upper edge, thus into the region that is directly below the portion of said upper edge that is ascending in the ventral direction ( coronoid protrusion).
    In one development, the upper portion is designed to extend in the vented direction in ventral direction beyond the lowest point of the arcuate upper edge, thus into the region of said upper edge that rises in the ventral direction (toward the coronoid protrusion).
    In one development, the medial portion is designed to extend, in the deployed state, in the ventral direction beyond the lowest point of the arcuate upper edge, thus into the region that is directly below the portion of said upper edge that is ascending in the ventral direction ( coronoid protrusion).
    If desired, the lateral portion may be formed and intended to extend to the coronoid protrusion. This may, for example, be desirable in connection with the number of screws to be installed. The extension in the frontal direction does not cause a conflict with nerve bundles. The medial portion can also be shaped and intended to extend to the coronoid branch. The medial portion can remain free of the sphenomandibular ligament.
    There is also room for the upper portion, and this may be shaped and intended to extend to the coronoid protrusion.
    In one embodiment the head part and the mounting plate form one whole with each other.
    The prosthesis can be made in alignment with the relevant patient. The shape and condition of the rising branch of the upper jaw, in particular the coronoid protrusion thereof and the condylar neck, can be determined by scanning. Based on this, the optimal prosthesis can be designed for that patient and recorded in a CAD file. With that file, a computer-controlled device can make the prosthesis, in a machining operation such as milling, or in an additive production technique such as injection molding, laser sintering, stereolithography, in particular FDM, SLM, SLS or another 3D printing technique, for example of titanium or PEEK (polyether-ether-ketone). The jaw head can be provided with a titanium-nitride layer or a thin ceramic layer.
    From a further aspect the invention provides an assembly of a prosthesis according to the invention and a prosthesis for the glenoidal fossa as bearing part of the head part. The bearing member allows both rotation of the jaw head about the medial-lateral axis and translation thereof in anterior posterior (ventral-dorsal) direction, according to a natural situation.
    From a further aspect the invention provides a method for replacing the jaw head in a patient with a prosthesis therefor, wherein the shape of the edge of the arcuate recess in the upper end of the rising branch of the lower jaw is determined and partly on the basis of thereof, the prosthesis according to the invention is designed and manufactured, whereafter the prosthesis is placed on the relevant rising branch of the lower jaw.
    It is noted that a double-sided TMG prosthesis is known from JP H 11 146889, wherein in an embodiment in which the condylar head is replaced at the anatomical location and the attachment on the lateral side of the rising branch of the lower jaw takes place with a fastening strip which extends up to the area of the jaw angle extends.
    U.S. Pat. No. 4,726,808 discloses a mandibular component with a prosthetic head for a TMG, which is provided with two fastening strips to be attached to the lateral and medial side of the rising branch of the lower jaw, which extend into the region of reach the lower jaw, while releasing the edge of the (semisunar incisura).
    The aspects and measures described in this description and claims of the application and / or shown in the drawings of this application can, where possible, also be applied separately from each other. These individual aspects can be the subject of split-off patent applications that are aimed at this. This applies in particular to the measures and aspects that are described per se in the subclaims.
    BRIEF DESCRIPTION OF THE DRAWINGS
    The invention will be elucidated on the basis of an exemplary embodiment shown in the accompanying drawings. The views are named from the relevant side, so a lateral view is a view from the lateral side. Shown is:
    Figures 1-E respectively a medial side view, a lateral side view, a postera-lateral view, a postera-medial view and a sectional view along plane IE in Figure 1B on the mandibular component of a jaw joint prosthesis for placement on a lower jaw;
    Figures 2A and 2B show respectively a postera-lateral view and a postera-medial view of a fossa component of a jaw joint prosthesis for placement on an upper jaw;
    Figures 3A and 3B show a postera-lateral view and a postera-medial view of an assembly of the mandibular component of Figures 1A-E and the fossa component of Figures 2A, B; and
    Figures 4A and 4B show a lateral and a medial side view, respectively, of an assembly according to the invention in the placed state.
    DETAILED DESCRIPTION OF THE DRAWINGS
    Figures 1A-D show the mandibular component 1 of a temporomandular joint prosthesis (TMG prosthesis), which comprises a lateral wing 3 and a medial wing 4, which are connected to each other by an integral upper part or comb 5. The lateral wing 3 is provided with bone screw holes 6. It can clearly be seen that the component 1 is saddle-shaped, U-shaped inverted in the ventral and dorsal view and U-shaped in the side view (seen transversely to the lateral part, see Figure 1D). The mounting plate here has a double concave shape, with both concave shapes facing opposite (up and down) and rotated about 90 degrees relative to each other. The mounting plate also has the appearance of a hyperbolic paraboloid.
    An artificial jaw head 2 protrudes upwards as a kind of saddle button at the rear end via a neck 8. In figure 1C the rear edges 3a and 4a of both wings are indicated. As can be seen in figures 1A and 1C, a downwardly extending pin 7 is provided within the component 1 at the rear end, which pin remains at a distance from both wings 3 and 4. This pin 7 is optional and can be provided as intramedullary pin.
    The mandibular component is made integrally from, for example, titanium or tantalum, or from an alloy thereof, from PEEK or UHMWPE, or a composition of these or other materials, preferably manufactured with additive manufacturing and / or CNC robotic milling.
    The mandibular component is designed and manufactured in alignment with the shape and condition of the rising branch of the lower jaw of the patient in question, such that both wings fit flush with the rising branch of the upper jaw, with the artificial jaw head 2 the condylar head on the anatomical location, and the upper part is fittingly against the upper edge of the semisunaris incisura.
    The medial wing may be shaped differently depending on the circumstances, for example be narrower, be L-shaped, or consist of several lips, for example one lip near the condylar neck and one lip near the corionoid protrusion.
    The lateral wing may be shaped differently depending on the circumstances, for example, be narrower, be L-shaped, or consist of a plurality of lips, for example one lip near the condylar neck and one lip near the corionoid protrusion.
    Furthermore, the upper part can be interrupted in comb direction instead of continuously - as shown in figures 1A-D-.
    Figures 2A and 2B show a temporal side fossa component 10 for a jaw joint prosthesis, which can interact with the mandibular component 1. The fossa component 10 forms an elongated, downwardly opening cup 11 in which the artificial jaw head 2 can rotate and can slide, as much as possible in accordance with a natural jaw joint. Bone screw holes 12 are provided for attachment to the skull base of a patient.
    The fossa component can be manufactured, optionally as a whole, from titanium or tantalum, or from an alloy thereof, from PEEK or UHMWPE, or a composition of these or other materials, preferably manufactured with additive manufacturing and / or CNC robotic milling. In one embodiment, the portion with the holes 12 is made of metal, the portion of the bowl 11 is from UHMWPE. The downwardly facing bearing surface has a horizontal lip 14 at the front end and vertical lips 13 at the rear end and on the medial side to prevent luxation and reankylosis.
    The fossa component is designed and manufactured in alignment with the shape and condition of the yoke arch and the joint cup, including articular bump (tuberculum articularis, and in alignment with the mandibular component.
    In figures 4A and 4B a left lower jaw half 100 is shown, with the rising branch 101 (ramus mandibulae), the coroinoid process 102 and the condylarus process 103. The condylarus process 103 goes in a back-to-front (dorsal-ventral) direction via a concave ridge / ridge or upper edge 104, which delimits the incisura semilunaris 105 downwards, into the coroinoid processus 102. Line 107 still indicates the lower edge of the fossa infratemporalis.
    After preparatory actions, such as surgical resection of the diseased jaw head (part) and after the area has been made accessible by an incision at the level of the sleeping area (leaving the area of the jaw angle 106 virtually unaffected), the mandibular component 1 as if it were a saddle, with the upper part 5 resting on the concave ridge 104 and the two wings 3 and 4 on either side, abutting against both sides of the upper jaw. As seen in Figure 3A, the height h of the lateral wing 3 relative to the lowest point M of the comb is about half or less of the height of the rising branch of the lower jaw 101, and the wing 3 remains above the buccal branch of the facial nerve. It can further be seen that the component 1 extends well beyond the position M of the lowest point of the ridge 104 in the forward direction. The "saddle" 1 is fixed by means of bone screws in the holes 6 in the lateral wing 3 on the rising branch 101, in the upper half thereof.
    The fossa component 10 is also placed and fixed with bone screws in holes 12 on the sleeping leg 110 (os temporal).
    With the saddle-shaped jaw-head prosthesis according to the invention, adjacent contact with the bone is provided on either side of the rising branch of the lower jaw, which is favorable for the stability and the ingrowth of bone tissue. The risk of releasing the prosthesis is therefore considerably reduced.
    The chewing forces are absorbed by the prosthesis 1 and transmitted through them to the lower jaw, namely to the condyle of the rising branch, by pressure on the comb / ridge and by transverse forces on the bone screws on the lateral side.
    The relatively large surface of the lateral wing increases the freedom of choice in number and location of the holes for the bone screws.
    In one embodiment, no medial wing is present in the mandibular component. The upper portion or comb (which is concave in cross-section with the cavity turned downwards, then reaches / rests on the upper edge / ledge / bone). The medial wing can also be short, viewed downwards, for example in the form of an edge just extends over the top edge / ridge / ridge, so that the appearance of a hook is obtained in cross-section.
    The invention (and is in no way limited to the embodiments shown and described in the drawings and description. The above description is included to illustrate the operation of preferred embodiments of the invention and not to limit the scope of the invention. Starting from the above explanation will be clear to a person skilled in the art many variations that fall within the spirit and scope of the present invention. Variations are possible of the parts shown in the drawings and described in the description. They can be used separately in other embodiments of the invention. Invention (s) Parts of various given examples can be combined with each other.
    权利要求:
    Claims (21)
    [1]
    A mandible side prosthesis of a temporomandibular joint, comprising a head portion replacing the jaw head, in particular at the anatomical location, and a mounting plate for mounting on the lower jaw, the mounting plate being formed with a lateral portion formed and is intended for abutment against the lateral side of the rising branch of the lower jaw, directly below the arcuate recess in the upper end of the rising branch of the lower jaw, the lateral portion being provided with holes for mounting on the lateral side of the rising branch of the lower jaw, the mounting plate comprising an upper portion integral with the lateral portion and formed and intended for abutment on the concave upper edge of the arcuate recess in the upper end of the rising branch of the lower jaw.
    [2]
    A prosthesis according to claim 1, wherein the mounting plate comprises a medial portion integral with the lateral portion and upper portion, and formed and intended for abutment against the medial side of the rising branch of the lower jaw, preferably right below the arcuate recess in the upper end of the rising branch of the lower jaw.
    [3]
    A mandible side prosthesis of a temporomandibular joint, comprising a head portion replacing the jaw head, particularly at the anatomical location, and a mounting plate, the mounting plate comprising a lateral portion and a medial portion formed and intended to on either side of the ascending branch of the lower jaw, abutting directly below the arcuate recess in the upper end of the ascending branch of the lower jaw, and having an integral upper portion formed concave with the cavity upwards, seen in a direction transverse to the lateral portion, and concave, with the cavity down, is formed, seen in a cross section.
    [4]
    A prosthesis according to any one of the preceding claims, wherein only the lateral portion is provided with holes for attachment to the lateral side of the rising branch of the lower jaw.
    [5]
    The prosthesis of any one of the preceding claims, wherein the lateral portion in a direction parallel to the direction of protrusion of the head portion has a length that is less than its length in a direction transverse thereto.
    [6]
    A prosthesis according to any one of the preceding claims, wherein the lateral portion is sickle-shaped.
    [7]
    A prosthesis according to any one of the preceding claims, when dependent on claim 2 or 3, wherein the medial portion is sickle-shaped.
    [8]
    A prosthesis according to any one of the preceding claims, wherein the lateral portion is designed to extend, in the deployed state, in the ventral direction beyond the lowest point of the arcuate upper edge, thus into the region lying directly below the portion of said upper edge which is rising in the ventral direction (in the direction of the coronoid protrusion).
    [9]
    A prosthesis according to any one of the preceding claims, wherein the upper part is designed to extend, in the placed condition, in the ventral direction beyond the lowest point of the arcuate upper edge, i.e. to the region of said upper edge which is rising in the ventral direction (in the direction of the coronoid protrusion).
    [10]
    A prosthesis according to any one of the preceding claims, when dependent on claim 2 or 3, wherein the medial portion is designed to extend, in the deployed state, in the ventral direction beyond the lowest point of the arcuate upper edge, thus into the region that is directly below the portion of said upper edge which is rising in the ventral direction (in the direction of the coronoid protrusion).
    [11]
    A prosthesis according to any one of the preceding claims, wherein the lateral portion is formed and intended to extend onto the coronoid branch.
    [12]
    A prosthesis according to any one of the preceding claims, when dependent on claim 2 or 3, wherein the medial portion is formed and intended to extend onto the coronoid branch.
    [13]
    A prosthesis according to any one of the preceding claims, wherein the upper portion is formed and intended to extend onto the coronoid branch.
    [14]
    A prosthesis according to any one of the preceding claims, wherein the head part and the mounting plate form one whole with each other.
    [15]
    A prosthesis according to any one of the preceding claims, provided with a pin extending downwardly of the jaw head for intramedullary attachment in the coronoid neck.
    [16]
    A prosthesis according to any one of the preceding claims, when dependent on claim 2 or 3, wherein the mounting plate has the appearance of a saddle, in particular the occurrence of a hyperbolic paraboloid.
    [17]
    17. Assembly of a prosthesis according to any one of the preceding claims and a prosthesis for the glenoidalis fossa (jaw joint socket) as a bearing part for the head part.
    [18]
    A method for replacing the jaw head in a patient with a prosthesis therefor, wherein the shape of the edge of the arcuate recess in the upper end of the rising branch of the lower jaw is determined and, partly on the basis thereof, the prosthesis according to one of the claims 1-16 is designed and manufactured, after which the prosthesis is placed on the relevant rising branch of the lower jaw.
    [19]
    19. Prosthesis for a jaw head, provided with one or more of the characterizing measures described in the attached description and / or shown in the attached drawings.
    [20]
    Assembly of a prosthesis according to one of the preceding claims and a prosthesis for the glenoidal fossa as bearing part for the head part provided with one or more of the characterizing measures described in the attached description and / or shown in the attached drawings.
    [21]
    21. Method provided with one or more of the characterizing measures described in the attached description and / or shown in the attached drawings.
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    同族专利:
    公开号 | 公开日
    WO2017195022A1|2017-11-16|
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    US20190192302A1|2019-06-27|
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    法律状态:
    优先权:
    申请号 | 申请日 | 专利标题
    NL1041862|2016-05-12|
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