RU2763823C2 - Nasal dorsum reconstruction method for rhinoplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to otorhinolaryngology and plastic surgery. The nasal dorsum is reconstructed with an open access on the bone and cartilaginous elements of the nasal dorsum. In this case, the skin incision is made along the inner surface of the wings along the caudal edge of the lower lateral cartilage with the transition to the collumela skin. The skin flap is taken upward. The medial legs of the lower lateral cartilage are bred to the side. The anterior edge of the quadrangular cartilage is isolated. A fragment of a quadrangular cartilage with a size of 30 mm by 13 mm is taken. A fragment of a quadrangular cartilage is broken in a crusher, forming a cartilage graft. Then the graft is placed on the bone and cartilaginous elements of the nasal dorsum in the area of ​​the postoperative defect, overlapping it over the entire area by 1.5 mm.

EFFECT: method allows to improve the cosmetic effect after rhinoplasty, to reduce the risk of side effects and complications, to achieve a lasting result.

1 cl, 2 dwg, 2 ex

Description

SUBSTANCE: invention relates to medicine, namely to otorhinolaryngology and plastic, reconstructive rhinoplasty, and can be used for nasal bridge reconstruction. The method provides a good cosmetic and aesthetic result.

A known method of implantation in the tunnel of the soft tissues of the back of the external nose (Application for Invention No. 2398534 C1) canned in various ways. In reconstructive ENT surgery, there are reports of implantation of cartilage preserved in a formalin solution into the soft tissue tunnel of the nasal dorsum.

After the skin incision, along the lateral edge of the wing of the nose on the right with its continuation along the medial edge, along its entire length to the nasolabial fold with the transition to the left side, similarly to the incision on the right, the skin was lifted with a hook, a narrow channel was created from the tip of the nose to the nasal bones. Cartilage grafts taken from the bank of cartilage of the nasal septum preserved in 0.25% formalin solution were introduced into the resulting tunnel. Cartilage was washed in physiological saline before introduction into tissues. In this case, three plates of preserved cartilage of increasing length were used, due to which the shape of the nose was restored.

The disadvantages of analog are:

1. Formalin denatures up to 80% of water-soluble proteins.

2. Inactivates the action of proteolytic enzymes.

3. Violation of the osteoinductive properties of the graft.

4. Changes the color of the graft.

5. Adversely affects the tissues of the maternal bed.

6. Formalized bone grafts do not undergo significant changes within 6 months, and there is no pronounced tendency towards their restructuring into new bone.

7. At present, the carcinogenicity of formaldehyde in relation to the mucous membrane of the nose and upper respiratory tract has been established, it contributes to the manifestation of the carcinogenic properties of other mutagens, it has a harmful effect on the DNA of the cells of the mucous membrane of the upper respiratory tract, while the severity of dysplasia does not depend on the timing of exposure to the graft and concentration formaldehyde in it.

8. Probability of the patient's infection with HIV infection, hepatitis C.9. Possibility of suppuration with subsequent rejection and deformation of the external nose.

A known method of surgical treatment of saddle nose deformity using a fascial-cartilaginous graft, a feature of which is the preparation of a combined graft consisting of a crushed cartilage component placed in a fascial sac of the required size.

The closest technical solution is a method for correcting a saddle nose deformity using the so-called "Turkish delicacy", which is fragments of autocartilage, crushed to a size of 0.5-1.2 mm ³ , mixed with 1 ml of the patient's whole blood.

The resulting mixture of blood and cartilage fragments is wrapped in Surgicel (an absorbable hemostatic agent made from oxidized regenerated cellulose) and, after shaping the implant into a cylindrical shape, is inserted under the skin of the back of the nose.

The disadvantages of the known method are the presence of contraindications and complications when using the Surgicel preparation (SURGICEL tissue cannot be implanted into bone defects and in the immediate vicinity of bone holes and cavities, when using SURGICEL tissue, a burning sensation may be felt and reactions to a foreign body are described), the absence of a binding effect of whole blood on a cartilage autograft, the possibility of resorption of cartilage grafts under the action of lysosomal enzymes during the breakdown of whole blood erythrocytes.

As a prototype, a method of implanting a tubular, flat allobrefobone or cartilage in combination with the dura mater of a human fetus preserved by freezing in an antioxidant and antibiotic solution was taken (Application for an invention and a positive decision of the formal examination N 98111450/14 (012382) dated 24.06.98 .).

Allograft from DM for surgical removal and prevention of nasal dorsum irregularities, including the use of DM preserved in 0.2% alcohol solution of thymol obtained under prosecture conditions, the dimensions of which are selected taking into account the anthropometric data of the patient. The DM is introduced intraoperatively through an endonasal incision and placed in the area of plastic surgery using special tweezers, fixing the bioimplant with a percutaneous injection needle to the bone part of the back of the nose, which is then removed. Additionally, the DM is not fixed, strip stickers and a forming plaster bandage are applied. This method is taken by us as a prototype.

The disadvantages of the prototype are:

1. Insufficient biological inertness of the allograft after conservation.

2. To model a bioimplant, it is necessary to take anthropometric data, which makes the reconstruction process laborious.

3. An allograft requires a determination of the method of conservation, and the optimal timing of transplantation.

4. The collection of material requires the involvement of doctors of other specialties or financial costs for its acquisition.

5. The appearance of edema (after the introduction of tubular, flat allobrefokost or cartilage in combination with the dura mater of the human fetus).

6. The possibility of an aseptic inflammatory reaction, transplant rejection with suppuration of the p/o wound.

7. The bone-soft tissue complex to be transplanted is not a single whole, and therefore, the individual fragments included in its composition may be displaced, which negatively affects the cosmetic and aesthetic results of the operation.

8. Lack of conditions for rapid revascularization of the bioimplant and fixation of the dura mater in the plasty area.

The objective of the claimed invention is to eliminate these shortcomings and reconstruct the back of the nose, i.e. in creating a simple, reliable way to improve the cosmetic, aesthetic function of the external nose, after rhinoplasty on the cartilaginous and bone structures of the back of the nose.

To eliminate the shortcomings of the previously proposed prototype, we propose a method of prevention developed by us to obtain a smooth back of the nose after rhinoplasty.

The purpose of this invention is the reconstruction of the back of the nose. This goal is achieved by the fact that after the skin incision, which is made along the inner surface of the wings along the caudal edge of the lower lateral cartilages with the transition to the skin of the collumela, including open access to the cartilage and bones of the nose, the skin flap is retracted upward. The medial pedicles of the lower lateral cartilage are bred to the side. Allocate the front edge of the quadrangular cartilage, from which the mucous membrane is separated. A fragment of a quadrangular cartilage measuring 30 mm by 13 mm is taken. A fragment of quadrangular cartilage is broken in a crusher (Fig. 1). Upon completion of open rhinoplasty, the cartilage graft is placed on the bone and cartilage elements of the back of the nose in the area of the postoperative defect, overlapping it over the entire area by 1.5 mm (Fig. 2). The skin flap is returned to its place, the imposition of cosmetic sutures on the skin. A splint is placed on the external nose and fixed with a paper adhesive plaster.

Examples of the invention:

Example 1

Patient T., aged 24, was admitted with a diagnosis of post-traumatic scoliosis of the external nose of the 2nd degree. After the examination, the patient underwent surgery - reconstructive rhinoplasty of the back of the external nose.

After a skin incision, including open access to the cartilage and bones of the nose, the skin flap is retracted upward. The patient underwent three osteotomies, the external nose became mobile, set exactly along the midline. The triangular cartilages are sewn together, and irregularities have formed on the back of the nose. In order to eliminate them, a fragment was previously taken from the quadrangular cartilage of the nasal septum. In the area of the movable part of the nasal septum, the mucous membrane is bluntly separated with a raspator, and a quadrangular cartilage is isolated. A fragment of a quadrangular cartilage measuring 30 mm by 13 mm is taken. A fragment of a quadrangular cartilage is broken in a crusher, a graft is formed to eliminate irregularities on the backs of the external nose.

The resulting cartilage graft is placed on the bone and cartilage of the back of the nose. The skin flap is returned to its place, the imposition of cosmetic sutures on the skin. Swabs are inserted into the nasal cavity. A splint is placed on the external nose, which is fixed with a paper adhesive plaster.

In the postoperative period, the patient received a/b therapy, local, anesthetic, the sutures were removed on the 7th day, the splint was removed on the 12th day after the operation. The bridge of the nose is even, located along the midline, the lateral slopes are symmetrical. Control examinations were performed within one month after the operation, three, six months.

The obtained functional and aesthetic result of the nasal bridge reconstruction performed was rated by the patient as excellent.

Example #2

Patient D., 44 years old, complained of crooked nose after an injury.

On examination, the external nose is deformed, due to the S-shaped curvature of both the bone and cartilage sections of the back of the nose. At endoscopic examination, S-shaped curvature of the cartilaginous part of the nasal septum to the left. After carrying out all the methods of research, the diagnosis was made: Scoliosis of the external nose of the 2nd degree. Deviated septum of the nose.

After drug preparation and treatment of the surgical field three times with an antiseptic solution. An operation was performed to reconstruct the back of the nose and septoplasty according to the above method.

The tampons were removed from the nasal cavity on the fourth day, the sutures were removed on the seventh day. Langeta removed on the 11th day. The shape of the nose is correct, symmetrical. The back of the nose in the midline. The patient was examined at intervals of one, three and six months after the operation. The result was rated by the patient as excellent. All patients had a good functional and cosmetic result.

Sources of information

1. Evaluation of a new procedure for nasal alar rim and valve collapse: Nasal alar rim reconstruction / Robert J. Troell, Nelson B. Powell, Robert W. Riley and Kasey K. Li // Otolaryngology. - Head and Neck Surgery. - 2000. - Vol.122. - P. 204-211 (prototype).

2. Source: http://kursak.net/klinicheskaya-anatomiya-nosa-i-okolonosovyx-pazux/©kursak.net.

3. Patent CN 202355483 U, 2012.

4. Patent EP 1857078 (A2), 2006.

5. Patent EP 2700385, 2014.

6. Patent EP 2720654 (A2), 2014.

7. Patent FR 2965474 A1, 2012.

8. Patent RU 2004113573 A, 2004.

9. Patent RU 2012106537 A, 2012.

10. Patent RU 2398534 C1, 2009.

11. Patent RU 2420242 C1, 2010.

12. Patent RU 2638424 C1, 2016.

Claims (1)

A method for surgical reconstruction of the back of the nose in the bone and cartilage section, including open access to the bone and cartilage elements of the back of the nose, characterized in that the skin incision is made along the inner surface of the wings along the caudal edge of the lower lateral cartilages with the transition to the skin of the collumela, the skin flap is retracted upward, the medial pedicles of the lower lateral cartilage are bred to the side, the anterior edge of the quadrangular cartilage is isolated, a fragment of the quadrangular cartilage measuring 30 mm by 13 mm is taken, the fragment of the quadrangular cartilage is broken in a crusher, forming a cartilage graft, then the graft is placed on the bone and cartilaginous elements of the back of the nose in the area postoperative defect, covering it over the entire area by 1.5 mm.

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