RU2533963C1 - Method for performing surgical operation for high nasal dorsum correction according to nasal dorsum modelling by pedicle hump - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: endonasal separation of soft tissues of the nasal dorsum is performed. Cartilaginous and bone portions of the nasal hump are transected with the hump left attached on a distal soft-tissue cartilaginous pedicle within an internal valve of the nose. The hump is brought out from the wound bending on the preserved pedicle backwards. That is followed by an external surgical modelling of the brought-out hump, the hump reattachment and fixation with percutaneous sutures. A cephalic portion of the hump is transfixed with an absorbable suture, and an end knot is tied up. The hump is bent to the previous position with tracing the free suture end under soft tissues of the hump. The suture is brought out through a nasal point percutaneously into the glabella centre and fixed to the skin. The reattached hump is additionally fixed with two side percutaneous sutures arranged from both sides of the nose at the level of the middle of a triangular cartilage.

EFFECT: more effective surgical operation, namely the safety of the natural contours of osteocartilaginous structures of the nasal dorsum and structures of the internal valve of the nose, the absence of undesired secondary changes accompanying the reattachment of the hump by preserving the residual blood supply through the distal pedicle, the absence of the postoperative displacement of a structure of the nasal dorsum by preserving the initial fixation of a tissue flap in the distal portion and the additional suture percutaneous fixation in three points.

1 ex, 7 dwg

Description

The invention relates to the field of plastic surgery, specifically to rhinoplasty.

There is a method of performing surgery to correct the high nasal dorsum, including endonasal separation of the soft tissues of the nasal dorsum, intersection of the cartilaginous and bone parts of the hump of the nose, removing the hump from the wound, external surgical modeling of the extracted hump, replanting the hump and fixing it with percutaneous sutures: see Skoog Rhinoplasty Revisited / Aesthetic Plastic Surgery. Vol 35, Issue 5, pp. 808-813. Oct 2011.

The specified method is an analogue and prototype of the invention. The known prototype method has a number of significant drawbacks: a replanted nasal hump can be displaced, a nose shape change in the postoperative period due to resorption or scarring is possible, with excessive tissue resections, a violation of the internal valve structures leading to a violation of the function of nasal breathing is possible. Thus, the prototype method does not fully provide the expected positive effect of the surgical operation of rhinoplasty, the purpose of which is to correct (normalize the shape) of the nose for aesthetic purposes. The present invention prevents undesirable phenomena inherent in the prototype method, that is, it solves the technical problem of increasing the efficiency of a surgical operation to correct a high nose.

The stated technical problem is solved by the fact that in the method of performing a surgical operation to correct the high back of the nose, including endonasal separation of the soft tissues of the nose, intersection of the cartilaginous and bone parts of the hump of the nose, removing the hump from the wound, external surgical modeling of the hump, replanting the hump and fixing it percutaneous sutures, according to the invention, when crossing the cartilaginous part of the hump, it is left attached to the distal soft tissue-cartilaginous leg in the region of the inner valve of the nose, after crossing the bone part, the hump is bent outward on the left leg for modeling, after modeling, the cephalic part of the hump is sutured with an absorbable thread with an end knot tied up and the hump is bent to its previous position, dragging the free end of the thread under the soft tissues of the nasal bridge and the thread is pulled out through the nasion point percutaneously into the center of the glabella and subsequent fixation to the skin, then the replanted hump is fixed additionally by two lateral percutaneous sutures located on the sides of the nose in the uro outside the middle of the triangular cartilage.

A technical result is expected from the implementation of the invention, which consists in increasing the effectiveness of a surgery to correct a high nose.

The invention is illustrated in FIGS. 1-7, where successive stages of performing a surgical operation to correct a high nose are presented (profile images of the tissues of the operated nose and its appearance with surgical sutures are shown):

- FIG. 1 represents the intersection of the cartilaginous part of the hump of the nose;

- FIG.2 represents the beginning of the intersection of the bone part of the hump of the nose;

- FIG.3 represents the completion of the intersection of the bone part of the hump of the nose;

- FIG.4 represents the removal of the hump of the nose from the wound;

- FIG.5 represents the conduct of the filament loop through the cephalic part of the hump removed from the wound;

- FIG.6 is the imposition of percutaneous surgical sutures;

- FIG.7 represents the appearance of the nose with percutaneous sutures.

The surgery to correct the high nasal bridge according to the invention is carried out in a hospital of plastic surgery, under dissociative and local anesthesia. The operation is preceded by septoplasty according to one of the known methods. Access to the end part and back of the nose is through anterior endonasal skin incisions in anticipation of the nose.

First, using a scalpel, scissors and raspator, perform endonasal separation of the soft tissues of the nasal dorsum; then, as shown in FIG. 1, a scalpel 1 is inserted under the separated tissues and the cartilaginous part of the nasal hump 2 is moved in a caudal direction. In this case, the distal soft tissue-cartilaginous leg 3 is kept intact in the region of the inner valve of the nose, which corresponds to the external reference point of the supra-tip lowering the nose.

Further, as shown in FIG. 2, a chisel 4 is inserted into the section of the cartilaginous part of the hump with an emphasis on the bone part 5 and is crossed with a hammer. After which the hump of the nose remains attached only to the aforementioned soft tissue-cartilaginous leg: FIG. 3.

At the next stage of the surgical operation, as shown in FIG. 4, the nasal hump is grabbed (with forceps or a clamp) and it is bent (turned) around the leg (usually 180 degrees) outward, thus removing the hump from the wound. This provides the opportunity for the necessary modeling of the hump, that is, for the proper change of its geometric shape and size. External surgical modeling of the hump is carried out using scissors, a scalpel and a cutter (it models the bone and cartilage parts of the hump). In this case, the hump is reduced in height and width.

At the last stages of the surgical operation, the hump is implanted, bending it to its previous position, and fixed with percutaneous sutures (FIGS. 5-7). To do this, first, the cephalic part of the hump in the bent state is stitched with absorbable thread 6 (usually Vikril 4/0 or 3/0) with a knot tied, as shown in FIG. 5. The other free end of the thread - under visual control provided by an endoscopic retractor - is carried out under the soft tissues of the nasal bridge through the anthropometric nasion point (point 7 in FIG. 6), and transcutaneously output to the area between the eyebrows, in the center of the glabella (point 8 in FIG. 6, FIG. 7). Next, the hump is bent back to its previous position, injected under the soft tissue of the nasal bridge, pulling the thread, and placed on the bone pyramid of the nose. The thread in a state of tension is fixed with a sterile strip of adhesive tape to the skin in the region of the glabella, trimming the end of the thread (usually to a length of 3-5 cm).

Fixation of the implanted hump is completed with two lateral percutaneous sutures 9 located on the sides of the nose (FIG. 6, FIG. 7). To do this, an injection is made on each side through the skin at the level of the middle of the triangular cartilage, an absorbable thread (usually Vikril 4/0 or 3/0) is passed sequentially through the skin, subcutaneous soft tissue, a triangular cartilage, a replanted hump and the thread is removed near the injection site ( usually 3-5 mm from it), tying a knot. Thus, the replanted hump receives three fixation points: cephalic and two lateral, which ensures the desired shape of the nasal bridge and good patency of the internal valve area.

When performing hump fixation, his position is controlled by the surgeon both visually, with the help of an endoscopic retractor inserted under the soft tissue of the nasal bridge, and palpation, with his hands through the skin. As a result, the correct position of the "hump on the leg" is achieved.

At the end of the surgical operation, nodal sutures (absorbable or non-absorbable suture 4/0 or 5/0) are applied to the skin incisions, and an adhesive-plaster bandage is applied to the operated nose (including the glabella region). It is removed after 7-10 days, simultaneously with the removal of cutaneous fragments of absorbable threads.

The following is an example implementation of the proposed method for performing surgery to correct a high nose.

Patient I., 24 years old, complained of a high humpback in the nose, pronounced asymmetry, a wide and lowered tip of the nose. Before the surgery, the patient underwent the necessary clinical examination, including rhinomanometry, computed tomography of the nose and paranasal sinuses, preoperative photo analysis and computer simulation of the results of the upcoming intervention, a standard set of preoperative laboratory tests. Immediately prior to the surgery, the patient in supine position undergoing endotracheal anesthesia underwent local infiltration anesthesia with a 0.5% solution of lidocaine with an adrenaline of 1: 100000 in an amount of 10 ml. After plastic surgery of the frenulum of the upper lip, work on the internal structures of the nose and paranasal sinuses, and correction of the terminal section of the nose, we started correcting the high back of the nose: using a raspat, we performed the subperiosteal and supraperiosteal mobilization of the soft tissues of the nose. By means of a scalpel and chisel, an incomplete resection of the hump of the nasal bridge was performed, leaving it on a soft-tissue-cartilaginous leg in the region of the lower parts of the lateral cartilage. The hump on the leg was brought out of the wound. Using scissors and a scalpel, we modeled this scaphoid bone-cartilaginous flap: the hump was reduced in height by 3 mm and in width by 2 mm, its contours were symmetrical, and irregularities were smoothed out by the cutter. Then, the cephalic part of the flap was stitched with Vikril 4/0 thread with a knot tied, the free end of the thread was held under the soft tissues of the nasal bridge and brought to the surface of the skin in the center of the glabella. By pulling the thread, a bone-cartilaginous flap was implanted, after which the thread was fixed on the skin with an adhesive plaster. The implanted hump was additionally fixed with two percutaneous interrupted sutures in the region of triangular cartilage - by sequentially passing Vikril 4/0 filaments through the skin on both sides, triangular cartilage and a “hump on the leg" with the filaments being brought out to the skin surface 5 mm from the injection site and tying cutaneous nodes.

Then, with Prolen 5/0 synthetic thread, interrupted sutures were placed on the wounds, tampons were inserted into the nasal passages. A sterile adhesive bandage was applied to the nose and a plaster cast was applied over it. The postoperative period was uneventful. The tampons were removed on the second day, the sutures on the skin were removed on the seventh day, the bandage with the sponge was removed on the tenth day with the simultaneous removal of cutaneous fragments of fixing absorbable sutures.

From the above description it is clear that when performing a surgical operation to correct the high nose, the proposed method ensures the preservation of the natural contours of the bone-cartilaginous structures of the nose and the structures of the internal nasal valve; there are no unwanted secondary changes during replantation of the hump of the nose - due to the preservation of the residual blood supply through the distal pedicle; there is no postoperative displacement of the structures of the nasal dorsum due to the preservation of the initial fixation of the tissue flap in the distal section and additional suture percutaneous fixation at three points. The above positive effects are confirmed by experimental surgical practice.

Thus, the expected technical result from the implementation of the invention is confirmed, which consists in increasing the effectiveness of a surgical operation to correct a high nose.

The present invention is feasible in the conditions of existing therapeutic agents and medical equipment.

Please assign the name to the proposed method for performing surgery to correct the high back of the nose, "Modeling the back of the nose using the" hump on the leg "technique."

Claims (1)

A method of performing a surgical operation to correct a high nasal dorsum, including endonasal separation of soft tissues of the nasal dorsum, intersection of the cartilaginous and bone parts of the nasal hump, removing the hump from the wound, external surgical modeling of the extracted hump, replanting the hump and fixing it with percutaneous sutures, characterized in that when at the intersection of the cartilaginous part of the hump, it is left attached to the distal soft tissue-cartilaginous leg in the region of the inner valve of the nose, after the intersection of the bone part, it is bent on the left the hump of the hump outside to allow modeling, after modeling, the cephalic part of the hump is sutured with an absorbable thread with the end knot tied up and the hump is bent to the previous position, pulling the free end of the thread under the soft tissues of the nasal bridge and the thread is pulled out through the nasion point percutaneously to the center of the glabella and then fixed to skin, then the replanted hump is fixed additionally by two lateral percutaneous sutures located on the sides of the nose at the level of the middle of the triangular cartilage.

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