RU2639811C1 - Method for soft tissues ptosis removal from middle face area and nasolabial fold formation in case of mimic muscles palsy - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: incision is made in the pilar part of the upper the temporal region of the head with a length of 1.5-2.0 cm. Further, an additional incision is made along the natural fold in the region of the lateral corner of the eye with a length of 0.8-1.0 cm. The soft tissues in the region of the lateral corner of the eye are dissected to the periosteum, the periosteum is dissected, subperiosteal, and the soft tissues of the middle face are mobilized by subperiosteal dissection of the malar and suborbital areas to the upper arch of the anterior oral cavity, freeing the wing of the nose. Then, from the incision in the lateral corner of the eye, under the mobilized soft tissues, a non-absorbable suture is drawn, which is punctured at the base of the nasolabial fold at the attachment site of the muscle that lifts the nose wing and upper lip leaving one end of the thread in the wound in the region of the lateral corner of the eye, the other end directed out in the area of the nasolabial fold base, is injected at the point of thread exit, which is then subcutaneously carried along the line of the nasolabial fold formed, the thread is punctured 0.8-1.0 cm apart. Then the thread is directed under the previously mobilized soft tissues to the cut in the lateral corner of the eye through the site of the last prick-out. The second non-absorbable suture is drawn from the incision near the lateral corner of the eye under the previously mobilized soft tissues in the subperiosteal layer, which is pricked out at a distance of 0.8-1.0 cm from the prick-out place of the first suture thread in the projection of the created nasolabial fold. One end of the second thread is injected into the same hole through which this filament exits, then the thread is conducted subcutaneously along the line of nasolabial fold formation and pricked out 0.8-1.0 cm apart, the end of the second thread is passed through its prick-out site under the previously mobilized soft tissues in the subperiosteal layer to the incision at the lateral corner of the eye, the ends of both threads are taken out in the subcutaneous layer of the temporal region and removed from the incision in the temporal region, the necessary depth of the nasolabial fold is created and the wing of the nose is set in the symmetry position by pulling up both sutures and fixing them to a deep leaf of the temporal fascia.EFFECT: method allows to effectively eliminate soft tissues ptosis of the middle face area and form a nasolabial fold in case of mimic muscles palsy of various etiology, thereby increasing the functional and aesthetic effect of treatment.1 ex, 2 dwg

Description

This invention relates to medicine, namely to maxillofacial and plastic surgery, and can be used to eliminate ptosis of soft tissues of the middle zone of the face and the formation of a nasolabial fold in paralysis of facial muscles of various etiologies.

A known method of eliminating ptosis of soft tissues of the middle zone of the face, which consists in endoscopic lifting of soft tissues of the middle zone of the face. Endoscopic lifting of the middle zone of the face according to the method is carried out through accesses in the lateral angle of the eye up to 1 cm.The tissue is dissected to the periosteum and periosteal is prepared and mobilized to release the retention ligaments, the lower pole of the tarsoorbital fascia and periosteum along the periphery. Soft tissue is displaced upward and fixes the lower part of the circular muscle of the eye in the region of the lateral wall of the orbit above the cantal ligament [Hester, T.R. Codner, Evolution of Technique of the Direct Transblepharoplasty Approach for the Correction oh Lower Lid and Midfacial Aging: Maximizing Results and Minimizing Complications in a 5-Year Experience / T.R. Hester, A. Mark // Plast. Reconstr. Surg. - 2000. - Vol. 105. - No. 1. - P. 393-404].

The disadvantages of this method are the duration of the operation; the risk of aggravation of lagophthalmus; short-term result.

Closest to the proposed method is a method of eliminating ptosis of soft tissues of the face and the formation of a nasolabial fold during paralysis of facial muscles using a thread based on polytetrafluoroethylene "Gore-tex". In the temporal region, anterior to the base of the legs of the ear curl, make a pre-abdominal incision. A subcutaneous tunnel is created to the second incision located in the proposed new nasolabial fold. Then the specified thread is sutured to the circular muscle of the mouth, if any, or to the subcutaneous tissues and lateral parts of the upper and lower lips. Next, the thread is pulled up and laterally until symmetry is achieved with the counter lateral side. The thread is sutured to the periosteum of the zygomatic bone with non-absorbable suture material [Paper A.D. Plastic and reconstructive surgery of the face. - M .: BINOM. - 2007. - S. 717].

The disadvantages of this method are additional incisions along the nasolabial fold, an increased risk of ptosis relapse of soft tissues of the face; increased risk of general surgical complications; lack of physiotherapy, due to the high risk of suppuration and thread rejection.

The technical result of this invention is to increase the functional and aesthetic effect.

The technical result is achieved by the fact that in the method of eliminating ptosis of soft tissues of the middle area of the face and forming a nasolabial fold in case of paralysis of facial muscles by incision in the temporal region, pulling and fixing of soft tissues using an non-absorbable suture, the distinctive feature is that the incision is made in the hairy parts of the upper part of the temporal region of the head 1.5-2.0 cm long, then an additional incision is made along the natural fold in the lateral angle of the eye 0.8-1.0 cm long, soft t Ani in the area of the lateral angle of the eye is opened to the periosteum, the periosteum is dissected, periosteal is mobilized, soft tissues of the middle area of the face are mobilized by subperiosteal dissection of the zygomatic and infraorbital regions to the upper vestibule of the vestibule of the oral cavity, freeing the nose wing, then from the incision in the lateral angle of the eye under the mobil the tissues carry out a non-absorbable suture thread, which is punctured in the area of the base of the nasolabial fold at the point of attachment of the muscle that lifts the nose wing and upper lip, leaving one end of the thread in the wound in the area of the lateral angle of the eye, the other end of the thread brought out at the base of the nasolabial fold is punctured at the outlet of the thread, which is then subcutaneously drawn along the line of the formed nasolabial fold, the thread is punctured after 0.8-1.0 cm, then the thread through the place of the last puncture is carried out under previously mobilized soft tissues to the incision in the lateral corner of the eye, then the second non-absorbable suture is carried out from the incision in the lateral angle of the eye under the previously mobilized soft tissues in one periosteal layer, which is punctured at a distance of 0.8-1.0 cm from the place of puncture of the first suture thread in the projection of the created nasolabial groove, one end of the second thread is pierced into the same hole through which this thread comes out, then the thread is subcutaneously along the line formed nasolabial folds and after 0.8-1.0 cm make a puncture, the end of the second thread through the place of puncturing is carried out under previously mobilized soft tissues in the subperiosteal layer to the incision in the lateral corner of the eye, the ends of both threads are carried out in the subcutaneous layer of the temporal region STI and outputted from the incision in the temporal region, creating the desired depth nasolabial folds and mounted wing of a nose in the symmetry position by pulling the two suture strands with subsequent fixing to the leaf of the deep temporal fascia.

The method is as follows (Fig. 1-2).

Under endotracheal anesthesia or intravenous sedation with local anesthesia with a 1% solution of anesthetic (lidocaine), after treating the surgical field with an antiseptic solution, the surgical areas are hydrotreated with a 0.25% solution of anesthetic (lidocaine) with adrenaline (in a ratio of 1: 1000) in the temporal, infraorbital zygomatic areas.

Next, an incision is made (1) of the skin 1.5-2.0 cm in size in the scalp in the upper part of the temporal region at the border with the parietal region and an incision (2) in the lateral angle of the eye along the natural fold 0.8-1, 0 cm. In the area of the lateral angle of the eye, soft tissues are dissected to the periosteum, the periosteum is dissected with a scalpel, pass subperiosteally, without injuring the circular muscle of the eye. With the Molt raspator, periosteal dissection is performed in the zygomatic and infraorbital regions (3) to the upper arch of the vestibule of the oral cavity with the release of the nose wing, bypassing and not injuring the neurovascular infraorbital bundle, mobilizing soft tissues of the middle zone of the face.

Then, from the incision in the lateral corner of the eye, under the previously mobilized soft tissues with a long sharp needle (ski model), a non-absorbable suture thread is carried out (4). A needle with a thread is punctured in the area of the base of the nasolabial fold (5), at the point of attachment of the muscle that lifts the nose wing and upper lip, while one end of the thread remains in the wound in the lateral corner of the eye. The end of the thread, brought out in the area of the wing of the nose, is charged into a curved surgical needle and injected into the same hole in the skin through which this thread comes out. The thread is carried out subcutaneously along the line of the formed nasolabial fold (6), after 0.8-1.0 cm a puncture is performed. Next, the thread is charged into a long sharp needle (ski model) and through the place of the last puncture is conducted back into the subperiosteal layer to the incision in the lateral corner of the eye.

Then the second thread is carried out from the incision in the region of the lateral angle of the eye in the subperiosteal layer, the puncture site of the second thread is located at a distance of 0.8-1.0 cm from the puncture site of the first thread, in the projection of the created nasolabial groove, then the end of the thread is charged into a curved surgical needle and perform an injection into the same hole in the skin through which this thread comes out. The thread is carried out subcutaneously along the line of the formed nasolabial fold (6), after 0.8-1.0 cm, a puncture is performed. The end of the second thread is loaded into a long sharp needle (ski model) and through the place of its puncturing is carried out back in the subperiosteal layer to the incision (2) in the lateral corner of the eye. The ends of the threads using a neuroconductor are carried out in the subcutaneous layer of the temporal region and removed from the incision (1) in the temporal region. The threads are pulled to create the desired depth of the nasolabial folds and the wing of the nose is set to the symmetry position. The arrangement of the threads corresponds to the projection of the location of the large (7) and small zygomatic muscles (8). Both threads are fixed with knots to the deep leaf of the temporal fascia (9) with interrupted sutures.

Thus, reposition and lifting of soft tissues of the middle zone of the face are carried out.

You can create a nasolabial fold of any depth and length. If necessary, skin is excised in the lateral angle of the eye.

The wound is drained, sutured in layers. Impose a pressing aseptic dressing.

In the postoperative period, antibacterial, anti-inflammatory, analgesic therapy, dressings are performed.

Example

Patient Z., was in the Department of Oral and Maxillofacial Surgery, FSBI Central Research Institute for Nuclear Medicine and ChLH with a diagnosis of paralysis of facial muscles on the right. Condition after a series of reconstructive operations.

From the anamnesis: paralysis of facial muscles on the right arose as a result of previous surgical treatment for the formation of a cerebellar angle on the right. Then a number of neuroplastic operations were performed without significant functional and aesthetic results.

During external examination in a patient: asymmetry of the face due to atrophy of facial muscles on the right and hypertonicity on the left; the central axis of the face is shifted to the healthy side; ptosis of soft tissues of the middle and lower zones of the face; pronounced ptosis of the angle of the mouth on the right; expression tests not in full; the turgor and elasticity of the soft tissues of the face on the right are reduced.

In the clinic, after a complete clinical and laboratory examination in the operating room under endotracheal anesthesia, the operation was performed by the proposed method.

Before the operation, markings were made in the patient's sitting position, the future nasolabial fold was outlined, symmetrically to the healthy side.

After processing the surgical field with an antiseptic solution, the surgical areas were hydrotreated with a 0.25% lidocaine solution with adrenaline (1: 1000 ratio) in the temporal, infraorbital, and zygomatic regions. Next, 1.5 cm skin incisions were made in the scalp in the upper temporal region at the border with the parietal region and in the lateral angle of the eye along a natural fold 1.0 cm long.

In the area of the lateral angle of the eye, soft tissues were distributed to the periosteum, the periosteum was dissected with a scalpel, and passed periosteally. The subperiosteal dissection was performed by the Molt raspator to mobilize soft tissues in the zygomatic and infraorbital regions to the upper arch of the vestibule of the oral cavity with the release of the nose wing while preserving the neurovascular infraorbital bundle. Then, from the incision in the lateral corner of the eye, under the previously mobilized soft tissues with a long sharp needle (ski model), the Lavsan 2-0 thread was drawn. A needle with a thread was brought out in the area of the base of the nasolabial fold, at the point of attachment of the muscle that lifts the nose wing and upper lip, while one end of the thread remained in the wound in the lateral corner of the eye. The end of the thread, brought out in the area of the wing of the nose, was charged into a curved surgical needle and an injection was made into the same hole in the skin through which this thread was brought out. The thread was carried out subcutaneously along the line of the nasolabial fold formed, after 1.0 cm a puncture was performed. Then the thread was loaded into a long sharp needle (ski model) and passed through the place of the last puncture back to the incision in the lateral corner of the eye.

Then the second thread was drawn from the incision in the area of the lateral angle of the eye in the subperiosteal layer, the puncture site of the second thread was placed at a distance of 1.0 cm from the puncture site of the first thread in the projection of the created nasolabial groove, then the end of the thread was loaded into a curved surgical needle and the injection was performed at that the same hole in the skin through which this thread came out. The thread was carried out subcutaneously along the line of the nasolabial fold formed, after 1.0 cm a puncture was performed. The end of the second thread was loaded into a long sharp needle (ski model) and through the place of its puncturing was carried back into the subperiosteal layer to the incision in the lateral corner of the eye. The ends of the threads using a neuroconductor held in the subcutaneous layer of the temporal region and brought out of the incision in the temporal region. The threads were pulled up to create the desired depth of the nasolabial folds and the nose wing was set to the symmetry position. The arrangement of the threads corresponded to the projection of the location of the major and minor zygomatic muscles. Both threads were fixed with knots to the deep leaf of the temporal fascia with interrupted sutures. The ends of the threads using a neuroconductor were held in the subcutaneous layer and brought out of the incision in the temporal region. The thread was pulled up to create the desired depth of the nasolabial folds and the nose wing was set to the symmetry position. Then the thread was fixed with knots to the deep leaf of the temporal fascia with interrupted sutures.

Thus, we repositioned and lifted the soft tissues of the middle zone of the face and the circular muscles of the eye. Excess skin was excised in the lateral angle of the eye. The wound was drained, sutured in layers. Imposed a pressure aseptic dressing. In the postoperative period, antibacterial, anti-inflammatory, analgesic therapy, dressings were performed.

As a result of surgical treatment in a patient with facial paralysis of facial muscles, ptosis of soft tissues of the middle zone of the face was eliminated, a nasolabial fold was formed, and a stable aesthetically satisfactory result was achieved.

Observation of the patient for 1 year showed the absence of relapse of ptosis of soft tissues of the face and a more lasting result compared to previously used surgical techniques.

Thus, the proposed method can be used to eliminate ptosis of soft tissues of the face and the formation of the nasolabial fold in paralysis of the facial muscles of various etiologies.

The proposed method has several advantages, such as:

- ease of execution;

- low injuries;

- the absence of incisions in the nasolabial fold;

- the ability to create a nasolabial fold of any depth and length;

- elimination of the valve effect during nasal breathing by establishing the nose wing in a position of symmetry;

- the risk of aggravation of lagophthalmus due to the absence of dissection in the region of the circular muscle of the eye is excluded;

- the creation of support for the lower eyelid and lateral angle of the eye due to the reposition of soft tissues of the middle zone of the face and fixation of threads in the lateral angle of the eye;

- a persistent result of fixation of the soft tissues of the face due to the fixation of filaments to motionless tissues, namely to the deep temporal fascia.

Claims (1)

A method for eliminating ptosis of soft tissues of the middle zone of the face and forming a nasolabial fold with paralysis of the facial muscles by cutting in the temporal region, pulling and fixing soft tissues using a non-absorbable suture thread, characterized in that the incision is made in the scalp of the upper part of the temporal region of the head with a length of 1, 5-2.0 cm, then an additional incision is made along the natural fold in the area of the lateral angle of the eye, 0.8-1.0 cm long, soft tissues in the area of the lateral angle of the eye are uncovered to the periosteum The sciatica, periosteum are dissected, pass subperiosteally, mobilize soft tissues of the middle zone of the face by subperiosteal dissection of the zygomatic and infraorbital regions to the upper arch of the vestibule of the oral cavity, freeing the nose wing, then from the incision in the lateral corner of the eye, an unabsorbable, non-absorbable suture is carried out under the mobilized soft tissues. in the area of the base of the nasolabial fold at the attachment point of the muscle that lifts the wing of the nose and upper lip, leaving one end of the thread in the wound in the lateral angle of the eye, etc. the end of the thread brought out in the area of the base of the nasolabial fold is punctured at the exit of the thread, which is then subcutaneously drawn along the line of the formed nasolabial fold, the thread is punctured after 0.8-1.0 cm, then the thread through the last puncture is carried out under previously mobilized soft tissues before the incision in the lateral corner of the eye, then the second non-absorbable suture is carried out from the incision in the lateral angle of the eye under previously mobilized soft tissues in the subperiosteal layer, which is punctured at a distance of 0.8-1.0 cm from a hundred punctures of the first suture thread in the projection of the created nasolabial furrow, one end of the second thread is pierced into the same hole through which this thread comes out, then the thread is sutured subcutaneously along the line of the formed nasolabial fold and made a puncture through 0.8-1.0 cm, end the second thread through the place of its puncture is carried out under previously mobilized soft tissues in the subperiosteal layer to the incision in the lateral corner of the eye, the ends of both threads are carried out in the subcutaneous layer of the temporal region and removed from the incision in the temporal region, create the desired depth osogubnoy folds and mounted wing of a nose in the symmetry position by pulling the two suture strands with subsequent fixing to the leaf of the deep temporal fascia.

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