RU2119774C1 - Method for performing primary rhinoheiloplastic reconstruction in cases of double-sided incomplete hiatus of upper lip - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves reconstructing the lower half of the lip using tissues from prolabium mucosa and oral cavity. Prolabium and oral cavity defects are covered with mucomuscular grafts taken from lateral segments of the upper lip having lower fascicles of orbicular muscle of the mouth and then joined by applying mattress suture. Skin part of nasal partition is removed using branching grafts. EFFECT: improved functional results.

Description

 The invention relates to medicine, namely to plastic reconstructive surgery.

 A known method of surgery for congenital bilateral incomplete clefts of the upper lip by T-shaped cuts at right angles to the skin of the side fragments of the upper lip and linear cuts at an obtuse angle on the middle fragment, while the length of the cut on the skin of the side fragments is equal to the length of the cuts on the middle fragment, and the length of the perpendicular sections on the side fragments is equal to the length of the defect of the middle fragment.

 However, in this way, the correct shape of the “Cupid's bow” and the median tubercle of the upper lip are not restored, the deformation of the cartilaginous part of the nose and the shortening of the skin of the nasal septum are not eliminated, and the continuity of the circular muscle of the mouth in the upper part of the lip is not restored.

 The closest solution to the purpose and technical essence, taken as a prototype (it is also the basic object), is a method of chelorinoplasty with bilateral incomplete cleft of the upper lip, including rotational incisions on the atrophied central fragment of the lip, lowering prolabium to the level of the lateral segments and phasing it with lateral segments and cut out of them by skin-muscle flaps with the simultaneous restoration of the skin septum of the nose with flaps cut in the upper sections of the side segments.

 However, this method has several drawbacks: the operation is carried out in two stages, the cartilage of the nose is not corrected, which requires additional surgery, the muscle ring of the circular muscle of the mouth is restored only in the lower third of the lip, the vestibule of the oral cavity remains small, the upper lip is elongated, narrowed in lower third.

 The purpose of the invention is the restoration of the shape and function of the upper lip and nose.

 This goal is achieved by the fact that the mucous membrane and the “muscle” tissue of the prolabium are used to restore the lower third of the upper lip, the resulting defect of the prolabium from the oral surface is closed with mucus-muscle flaps from the side fragments of the upper lip containing the lower bundles of the circular muscle of the mouth, the vertices of which go to opposite sides, the middle muscle bundles are sutured to the tissues of the prolabium along its edges, the upper bundles of the circular muscles of the mouth are connected with a mattress suture that displaces the tissues of the base of the noses th partition up: on the filter bed and side fragments on both sides, equilateral dovetail flaps are cut in the form of a dovetail with a side length equal to 1 / 2-2 / 3 of the height of the column of the filter, the width of the flaps cut on the side fragments is wider than the flaps cut on the filter , by the existing elongation of the lateral fragments compared to the central, the lateral parts of the bifurcated flaps are used to create the bottom of the threshold of entry into the nose, the medial parts moved under the base of the wings of the nose are used to lengthen the skin of the nose th partition.

Comparative analysis with the prototype shows that the claimed method of primary rhinocheyloplasty with congenital bilateral incomplete clefts of the upper lip is characterized in that:
- on the lateral fragments, mucus-muscle flaps are cut out, not including the skin;
- the lower third of the central part of the upper lip is created from prolabium tissue, restoring the inner surface with flaps from the side fragments, getting the correct shape of the upper lip and the natural line of "Cupid's bow";
- the continuity of the circular muscles of the mouth is restored at the level of the upper, middle and lower bundles, which restores its function along the entire length of the upper lip;
- the mutual movement of the mucus-muscle flaps from the lateral fragments to the defect on the oral mucosa of the prolabium creates a deep vestibule of the oral cavity;
- asymmetrically applied mattress suture displaces the base tissue of the nasal septum upward, creating conditions for the growth and development of the cartilaginous part of the nose;
- flaps cut in the form of a dovetail, create a threshold for entry into the nose and lengthen the skin of the nasal septum and align the length of all fragments of the lips.

 Thus, the proposed method meets the criteria of the invention of "novelty." Comparison of the proposed method with the prototype and other methods known in plastic surgery did not allow us to identify signs that distinguish the proposed solution from the prototype, which allows us to conclude that the invention meets the criterion of "significant differences".

 The operation is performed under endotracheal anesthesia as follows.

 1. After applying the scheme for the upcoming operation, incisions are made along the edges of the prolabium along the line of transition of the skin into the mucous membrane from the lower points of the split columns of the filterum to the bases of the medial legs of the large wing cartilage of the nose. The cuts continue to the red border and mucous membrane and are connected in the area of the transitional fold. The flap of the mucous membrane of the central fragment, together with the underlying tissues and muscles, is peeled from the intermaxillary bone and turned anteriorly to form the lower third of the filter.

 2. In the upper third of the prolabium and in the upper sections of the side fragments, equilateral skin flaps are cut in the form of a dovetail with a side length equal to 1 / 2-2 / 3 of the height of the column of the filtrum, and the flaps cut in the upper part of the side fragments are wider than the flaps cut out on prolabium, on the existing elongation of side fragments compared to the central one. The flaps exfoliate and under their bases stupidly dissect the medial legs of the wing cartilage, reaching the vertical mobility of the septum.

 3. On the lateral fragments, incisions are made on the skin along its transition into the red border from the lower points of the split columns of the filter to the threshold of entry into the nose at the bifurcation points of the dovetail flaps. Cuts are made on the mucous membrane of the lateral fragments, symmetrical to the cutaneous, and mucus-muscle flaps are cut out, containing the lower bundles of the circular muscle of the mouth. Incisions are made in the area of the threshold of entry into the nose on each side to mobilize the bases of the wings of the nose. With wide crevices, poker incisions are made according to Limberg and the bases of the wings of the nose are mobilized above the periosteum.

 4. Dissect the tissue of the side fragments. A tissue defect on the oral surface of the prolabium is covered with mucus-muscle flaps from the lateral fragments, the vertices of which pass to the opposite sides of the lips, creating the mucous membrane of the upper lip and restoring the continuity of the circular muscle of the mouth in the lower third of the lip.

 5. The middle bundles of the circular muscle of the mouth are sutured with symmetrical sections of the prolabium. The upper bundles of the circular muscles of the mouth are connected with a mattress suture applied to the weave of the fibers of the muscles that lift the wings of the nose into the upper bundles of the circular muscles of the mouth and drawn through the filter cloth below the edges of the inner legs of the wing cartilage of the nose so that the tissues of the septum base are displaced upwards .

 6. Skin triangles cut in the upper sections of the lateral fragments are used to create the bottom of the nasal entry threshold, flaps cut in the upper third of the prolabium are sewn into the incisions at the bases of the wings of the nose, extending the skin of the nasal septum.

 Sutures on the mucous membrane are applied with catgut, on the muscles with a thin lavsan, on the skin with atraumatic silk.

 The shape of the wings of the nose is formed by rubber tubes wrapped in iodoform gauze and inserted into the nasal passages.

 Example. Medical history N 4399. 07/07/86. Smirnov Oleg Anatolyevich, 1 year 2 months. Diagnosis: congenital bilateral incomplete cleft of the upper lip, incomplete incomplete cleft palate, deformation of the cartilage of the nose. 07/07/86 - operation: primary rhinocheyloplasty under endotracheal anesthesia, intubation through the mouth.

 Incisions were made along the edges of the prolabium with the transition to the red border and the mucous membrane and connected in the area of the transitional fold. The resulting triangular flap of the mucous membrane with the underlying tissues is detached from the intermaxillary bone and turned out anteriorly to form the lower third of the filter.

 In the upper sections of the lateral lip fragments and in the upper third of the prolabium, flaps in the form of a dovetail are cut on each side: the flaps cut on the lateral fragments are wider than the flaps cut on the filter by the existing elongation of the lateral fragments compared to the central one.

 On lateral fragments, cuts were made along the skin along the line of transition of the skin into the red border and symmetrical to it on the mucous membrane of the circular muscle of the mouth. Incisions were made in the area of the threshold of entry into the nose on each side. The tissues of the lateral fragments are prepared. A tissue defect on the oral surface of the prolabium is covered by mucus-muscle flaps from the side fragments. The middle muscle bundles are stitched with symmetrical sections of the prolabium. The upper bundles are connected by a mattress suture that displaces the tissue of the base of the nasal septum up. The skin triangles cut on the lateral fragments were used to create the bottom of the threshold of entry into the nose, cut on the filter, sewn into the incisions at the base of the wings of the nose, extending the skin of the nasal septum.

 In the nasal passages introduced tubes with iodine gauze. The postoperative course is smooth, the wound healed by first intention, the sutures were removed on day 7.

The proposed method of primary rhinocheyloplasty with congenital bilateral incomplete cleft upper lip allows you to:
- improve the aesthetic results of the treatment of patients with this form of congenital pathology;
- carry out the operation in one stage, which halves the time spent by patients in the hospital;
- restore the continuity of the circular muscle of the mouth along the entire length of the upper lip, which improves its function and positively affects the development of the upper jaw;
- create conditions for further growth and development of the cartilaginous part of the nose, which will reduce the number and volume of corrective operations;
- create a deep vestibule of the oral cavity, which makes it possible to carry out full-fledged orthodontic treatment.

Claims (1)

 The method of primary rhinocheyloplasty in case of congenital bilateral clefts of the upper lip by cutting out the muscular-muscular flaps from the lateral fragments and stitching them with prolabium and simultaneously restoring the skin of the nasal septum with flaps from the excess sections in the upper sections of the lateral fragments, characterized in that in order to simultaneously restore the shape and the functions of the upper lip and nose from the mucous membrane of the prolabium and muscle tissue restore the lower third of the lip, the defect of the prolabium with the oral cavity yvayut mucous-muscle flaps from the side of the upper lip fragments containing lower orbicularis oris muscle bundles were combined mattress suture further removed skin of the nasal septum using bifurcated grafts.