RU2198623C2 - Nose implant and method for manufacturing it - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has thickened back part smoothly transiting into more thin neck part and tip. To avoid lifting of implant end portion under cicatrix pulling force, rigidity rib is designed in neck directed along axis and internal implant surface on rectangular cartilage projection. Method involves molding implant using wax model that is modeled in personal mode placing nose in position when it is pulled downward. Pattern back part length is selected to be longer than patient nose back. Pattern height is personally modeled depending on deformation and its internal surface is congruent to patient nose back. EFFECT: high degree of functional and cosmetic properties of implant. 3 cl

Description

 The invention relates to surgery and can be used to restore the shape of the nose when it is shortened. Such a deformation of the nose manifests itself after the purulent-inflammatory processes in the septum region (boils, festering hematomas) are transferred in early childhood, after removal of the neoplasm of the nasal cavity. A feature of this pathology is scarred external and internal tissues of the nose, which are difficult to stretch, and at the same time, the degree of shortening of the nose is not so sharp that it was possible to apply the plastic with a flap on the leg.

 The well-known standard dimethyl polysiloxane back implants with a nasal tip have several disadvantages. Among them: too much flexibility due to the small thickness (up to 1-3 mm) and width (5-7 mm). On palpation, the nose had unnatural softness and mobility in different directions [1].

 The closest prototype are silicone standard implants of the L-shaped form, consisting of a back and a tip. The company "Silastic" produces implants of two types - large and small, consisting of upper - more rigid and lower - soft segments [2]. Such implants can restore significant retention in the nasal dorsum with its simultaneous lengthening.

 The disadvantages of these designs is that the implant models are standard, performed without taking into account rhinometric measurements and the nature of the contours of the bone-cartilaginous frame of the nose. One of the models of the set has a long hard upper segment and a soft tip, such a model is non-physiological, providing immobility to the cartilaginous part of the nose.

 The objective of the invention is the creation of an implant to lengthen the nose and increase its volume, taking into account individual data. Such an implant should be motionless in the tissues, graceful and physiological.

 The applicants proposed an implant for the nose, containing silicone segments for the back and tip of the nose, an isthmus is provided between the back and the tip of the implant, the back is thickened relative to the tip, and a stiffener is provided in the area of the isthmus along the axis along the inner surface of the implant.

 Figure 1 presents a vertical section of the implant for plastic shortened nose and its saddle deformation. Figure 2 - horizontal sections of the implant. Figure 3 presents the location of the implant under the external tissues of the nose.

 The implant is: 1 - back; 2 - isthmus; 3 - tip; 4 - stiffener.

A method of manufacturing an implant consists in casting the latter according to a wax model, which is individually modeled in the position of pulling the nose down. The required height of the model is determined by the amount of retraction in the region of the back and tip of the nose and is modeled taking into account the deformation of the nose. The length of the model is also individually selected, previously with the help of the patient the soft tissues of the nose are pulled down and fixed in this position until the end of the simulation, so the length of the model slightly exceeds the length of the back of the patient's nose. The inner surface of the wax model is congruent to the back of the nose - this is achieved due to the accuracy of the impression and the elasticity of the material. If the irregularities of the deformed bones of the nose are taken into account and they exactly correspond to the counterforms on the implant, this contributes to additional fixation of the implant. The wax model accurately compensates and eliminates deformation of the nose, restoring its anatomically correct shape. The model is subsequently gypsum into the dental cuvette, and then the silicone implant is molded. An additional feature of the proposed implant is the creation of a stiffener 4, which is located on the inner surface, respectively, of the projection of the quadrangular cartilage and combines the thick part of the back of the implant 1 with its tip 3. This part (stiffener) will provide anti-traction to scars, which in the postoperative period always tend to return tissue to previous position and move the tip of the nose up. Thus, the most "weak spot" - the isthmus 2 of the implant is protected and the movement of the end of the nose upward is impossible. But at the same time, the movements of the tip of the nose to the sides and downward under the influence of the hand are preserved, which ensures the physiology of the nose. For better fixation and quick restoration of blood supply to tissues, the finished implant is perforated. Before surgery, the implant is sterilized in a dry oven at T = 180 ^o C or autoclaved.

 The implant shown in FIG. 3 is intended to lengthen the nose and eliminate retraction in the area of the nasal bridge.

 During the operation, the required volume of surface tissues is obtained due to the wide mobilization of the skin, subcutaneous tissue of the nose with the transition to the nose and cheeks, as well as the periosteum in the bone part of the nose. An increase in the length and volume of the inner lining of the nose is achieved as follows: lateral legs of the wing cartilage are secreted from mucoperichondria to the level of the arches of the medial legs, the liberated mucous membrane of the nose is pulled down along with the medial legs and fixed to the edge of the end section of the implant placed in the prepared bed. The implant holds the nasal tissue in a new elongated position due to the presence of a stiffening rib located in the space of the inter wing tissue above the hypoplastic quadrangular cartilage. The immobility and good fixation is ensured by both congruence of the lower surface of the implant and its subperiosteal location in the area of the nasal bridge.

 Example 1. Patient N., 34 years old. The diagnosis is shortening and saddle deformation of the nose after the inflammatory process. History: a boil of the nasal septum at the age of 6. In the ENT department at the place of residence, an abscess of the septum was opened, a partial melting of the quadrangular cartilage occurred. Subsequently, the underdevelopment of the septum led to hypoplasia of the bone-cartilaginous part of the nose, which was manifested by retraction in the region of the nasal dorsum, its shortening and upturned tip. The patient was individually made an implant of the proposed model on the back with the tip of the nose and stiffener. Operation. Under endotracheal anesthesia, the tissues of the nose were hydrotreated. A section in the form of a bird is drawn from the center of the columella, with the transition to the upper edges of the nasal openings. To create the required volume of tissues, the skin-subcutaneous layer above the surface of the nose and nose was widely mobilized with a transition to the slopes and buccal areas. The periosteum is dissected in an arc-shaped incision above the bones of the nose and the nose pyramid is skeletonized. With the help of an elevator located strictly in the center of the nasal bridge, the periosteum is raised, under which the implant is placed, with the simultaneous removal of the instrument. Preliminarily, for free placement of the stiffening rib, the inter-wing fatty tissue was dissected according to the projection of the quadrangular cartilage. Then, the lateral legs of the wing cartilage are identified to the arches, the liberated mucous membrane of the nose is elongated while pulling it down to the medial legs of the wing cartilage. In this stretched state, the medial legs are fixed to the end portion of the implant. Next, the integumentary tissues were moved over the implant, nodal sutures were put on the edges of the wound. Semi-tubular drainages for blood outflow are withdrawn. The nasal passages are plugged with iodoformed turundas soaked in petroleum jelly. Outside - a plaster cast is applied to prevent edema.

 In the postoperative period, anti-inflammatory, antibacterial and antihistamine therapy was performed. Sutures were removed on the 5-7th day, nasal turunds were removed on the 5th day (by the time the edema subsided), and the plaster cast was removed on the 10th day after the operation.

 Long-term examination of the patient did not reveal deformation of the nasal bridge and displacement upward of the end section. Good rhinometric results of the operation were obtained: the length of the nasal dorsum from root to tip was increased by 0.8 cm to 4.3 cm, and the height of the nasal dorsum was increased by 1.4 cm.

 Example 2. Patient B., 36 years old. The diagnosis is saddle deformation of the bone-cartilaginous part of the nose after removal of the neoplasm. History: neurofibroma of the nasal septum. After removal of the neoplasm as a result of a through defect in the nasal septum, a retraction of the nasal dorsum and shortening of its length appeared, retraction of the columella and the tip of the nose upturned. The patient was made an individual silicone implant for the back with the tip of the nose, having a stiffener. To eliminate columella retraction, a silicone rafter was used, placed between the medial legs of the wing cartilage and fixed between them by U-shaped seams. The rafter is planted on spina nasalis due to the area with a recess in its lower section. Deformation of the nose is eliminated with a silicone implant similar to the above example.

 A good cosmetic effect was obtained. Nose length increased by 0.5 cm.

 Thus, the results of the treatment confirm the possibility of technical application and implementation of this implant in the practice of rhinoplasty surgery.

Sources of information
1. Furukawa M., Phinoplasty. Septoplasty. M., Gonzasez-Ulloa et al. Aesthetic plastic surgery: in 5 vol. Vol. 3. 1988. P. 447.

 2. Shirakabe Y., Shirakabe T., Takayanagi S. / A new type of prothesis for augmentation rhinoplasty. Our experience in 1600 cases // Brit. J. Plast. Surg. - 1981. Vol. 34. P.383-357.

Claims (2)

 1. An implant for the nose, containing silicone segments for the back and tip of the nose, characterized in that an isthmus is provided between the back and the tip of the implant, the back is thickened with respect to the isthmus and tip, and a stiffener is provided in the area of the isthmus along the axis along the inner axis implant surface.  2. A method of manufacturing an implant, which consists in casting the latter according to the wax model, characterized in that the wax model is modeled individually in the position of pulling the nose down, with its inner surface congruent to the nose, the length slightly exceeds the length of the patient’s nose, and the height of the model is determined by the amount of retraction the back of the nose.

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