Method for eliminating cicatricial deformation of soft tissues of midface

Abstract

FIELD: plastic surgery.SUBSTANCE: used to eliminate cicatricial deformation of the midface. Subciliary and pericanthal incisions are made on the lower eyelids, and subcutaneous dissection is performed to eliminate cicatricial contractions. On the upper eyelids, excess skin, orbicularis muscle and medial hernias are excised. The frontotemporal stage includes: in the hairy part of the frontal and parietal regions, subperiosteal flap detachment is performed with dissection of the orbital ligaments. In the temporal zone, suprafascial dissection is performed. The supraorbital and supratrochlear vascular-nerve bundles are strictly preserved. The middle zone and oral cavity include peeling away the tissue in the parotid areas under the SMAS layer up to the zygomatic arch, dissecting the temporal septa and orbital thickenings. Through an incision in the oral mucosa, subperiosteal dissection of the maxilla and zygomatic bones is performed with dissection of the retaining ligaments. The branches of the facial and infraorbital nerves are preserved. After which, under the control of an endoscope, the oral cavity and temple are connected by dissecting the periosteum of the zygomatic arch. Polyethylene zygomatic implants are fixed to the upper jaw with screws. The tissues of the malar body are moved upward and medially, and those of the modiolus are moved upward and laterally. The flaps are fixed to the deep temporal fascia. The forehead flap is pulled upward and secured to the skull with removable screws. In the final stage, the fascia, scalp, eyelids and oral mucosa are sutured layer by layer.EFFECT: method allows for the effective elimination of cicatricial deformation of soft tissues and the restoration of the natural anatomical contours of the midface through combined endoscopically assisted subperiosteal and sub-SMAS redistribution of tissue complexes in the vertical-medial and vertical-lateral directions, supplemented by frame volumetric reconstruction with zygomatic implants made of porous polyethylene and total mobilization of the retaining ligamentous apparatus of the periorbital and maxillofacial regions.1 cl, 1 ex

Description

[0001] The proposed invention relates to medicine, namely to aesthetic plastic surgery, and can be used to eliminate cicatricial deformation of the soft tissues of the midface.

[0002] It is known that during the correction of cicatricial deformities of the face [1], lipofilling of this area is performed, which leads to the formation of "fat lakes," which is a consequence of rigotomy and non-compliance with the technique of facial lipofilling. It is also known [2] that facial lipofilling often leads to unsatisfactory results in terms of maintaining the gravitational relationships of the midface – ptosis.

[0003] The problem of achieving the most outstanding treatment results that meet the needs of consumers of medical services in plastic surgery is relevant.

[0004] Analog. Soft tissue lipofilling of the midface. Using a specialized cannula, finely dispersed fat, previously harvested from the patient, is injected into the postoperative scar area. Scar smoothing is observed postoperatively.

[0005] The disadvantage is the formation of "fat lakes", which is a consequence of rigototomy and non-compliance with the technique of facial lipofilling, unsatisfactory results in terms of maintaining the gravitational relationships of the midface - ptosis.

[0006] Closest analogue. Soft tissue lipofilling of the midface. Using a specialized cannula, finely dispersed fat, previously harvested from the patient, is injected into the postoperative scar area. Scar smoothing is observed postoperatively.

[0007] The disadvantage is the formation of "fat lakes", which is a consequence of rigototomy and non-compliance with the technique of facial lipofilling, unsatisfactory results in terms of maintaining the gravitational relationships of the midface - ptosis.

[0008] Objectives: To develop a method for eliminating cicatricial deformities of the soft tissues of the midface, addressing the problem of postoperative complications and insufficient effectiveness of the intervention.

[0009] The essence of the invention is: making subciliary and pericanthal incisions in the lower eyelid area, performing subcutaneous dissection of the lower eyelids, making incisions in the natural folds of the upper eyelids, dissecting the skin, orbicularis oculi muscles in the upper eyelid area, resecting the skin and orbicularis oculi muscles in the upper eyelid area, accessing the medial parts of the periorbital fat tissue, resecting the medial parts of the periorbital fat tissue, dissecting the tissues in the hairy part of the frontal regions in layers, accessing the subperiosteal layer, performing dissection in the subperiosteal layer of the frontal, parietal regions with dissection of the ligaments supporting the orbit and preserving the integrity of the supraorbital, supratrochlear vascular-nerve bundles, dissecting the tissues in the hairy part of the temporal regions in layers, accessing the layer above the superficial leaflet of the deep temporal fascia, performing suprafascial dissection of the temporal regions,access under the superficial muscular-apenorrhea layer in the parotid regions, dissection under the superficial muscular-apenorrhea layer in the parotid regions to the lower edge of the zygomatic arch with dissection of the superior and inferior temporal septa, ligaments supporting the orbit, lateral orbital thickenings while preserving the integrity of the temporal and zygomatic branches of the facial nerves, making an incision in the mucous membrane of the vestibule of the oral cavity, access to the subperiosteal layer, dissection in the subperiosteal layer of the maxillae, anterior surfaces of the zygomatic bones with dissection of the tarsal supporting ligaments, ligaments supporting the orbit, zygomatic retaining ligaments while preserving the integrity of the infraorbital nerve bundles,unification of the formed cavities between dissections in the temporal regions and the upper jaw region by dissecting the periosteum of the upper edges of the anterior 2 / 3 of the zygomatic arches under endoscopic control while preserving the integrity of the temporal branches of the facial nerves, installation of zygomatic implants made of polyethylene, fixation with screws to the upper jaw, suturing the areas of the malar body, moving the midface flaps in the upper-medial direction, suturing the areas of the modiolus, moving the midface flaps in the upper-lateral direction, fixing the midface flaps to the superficial layers of the deep temporal fascia in the upper-medial and upper-lateral directions, moving the flap of the upper face in the superior direction, fixing the flap of the upper face with intraosseous removable screws to the cranial vault in the frontal region, suturing the layers of the temporoparietal fascia, suturing the skin of the scalp, suturing the skin of the upper and lower century,suturing of the mucous membrane of the vestibule of the oral cavity,

[0010] Technical result. The advantage is complete aesthetic rehabilitation and the absence of postoperative complications.

[0011] The problem of postoperative complications and insufficient effect from the intervention is solved by performing subciliary and pericanthal incisions in the lower eyelid area, performing subcutaneous dissection of the lower eyelids, making incisions in the natural folds of the upper eyelids, dissecting the skin, orbicularis oculi muscles in the upper eyelid area, resecting the skin and orbicularis oculi muscles in the upper eyelid area, accessing the medial parts of the periorbital fat tissue, resection of the medial parts of the periorbital fat tissue, layer-by-layer dissection of tissues in the hairy part of the frontal regions, accessing the subperiosteal layer, performing dissection in the subperiosteal layer of the frontal, parietal regions with dissection of the ligaments supporting the orbit and preserving the integrity of the supraorbital, supratrochlear vascular-nerve bundles, layer-by-layer dissection of tissues in the hairy part of the temporal regions, accessing the layer above the superficial leaflet of the deep temporal fascia,performing suprafascial dissection of the temporal regions, gaining access under the superficial muscular-apenorrhea layer in the parotid regions, dissection under the superficial muscular-apenorrhea layer in the parotid regions to the lower edge of the zygomatic arch with dissection of the superior and inferior temporal septa, ligaments supporting the orbit, lateral orbital thickenings while preserving the integrity of the temporal and zygomatic branches of the facial nerves, performing an incision of the mucous membrane of the vestibule of the oral cavity, gaining access to the subperiosteal layer, dissection in the subperiosteal layer of the maxillae, anterior surfaces of the zygomatic bones with dissection of the tarsal supporting ligaments, ligaments supporting the orbit, zygomatic retaining ligaments while preserving the integrity of the infraorbital nerve bundles,unification of the formed cavities between dissections in the temporal regions and the upper jaw region by dissecting the periosteum of the upper edges of the anterior 2 / 3 of the zygomatic arches under endoscopic control while preserving the integrity of the temporal branches of the facial nerves, installation of zygomatic implants made of polyethylene, fixation with screws to the upper jaw, suturing the areas of the malar body, moving the midface flaps in the upper-medial direction, suturing the areas of the modiolus, moving the midface flaps in the upper-lateral direction, fixing the midface flaps to the superficial layers of the deep temporal fascia in the upper-medial and upper-lateral directions, moving the flap of the upper face in the superior direction, fixing the flap of the upper face with intraosseous removable screws to the cranial vault in the frontal region, suturing the layers of the temporoparietal fascia, suturing the skin of the scalp, suturing the skin of the upper and lower century,suturing of the mucous membrane of the vestibule of the oral cavity,

[0012] The method was tested on ten patients during 2023-2025.

[0013] The method is carried out as follows: making subciliary and pericanthal incisions in the lower eyelid area, performing subcutaneous dissection of the lower eyelids, making incisions in the natural folds of the upper eyelids, dissecting the skin, orbicularis oculi muscles in the upper eyelid area, resecting the skin and orbicularis oculi muscles in the upper eyelid area, accessing the medial parts of the periorbital fat tissue, resecting the medial parts of the periorbital fat tissue, layer-by-layer dissection of tissues in the hairy part of the frontal regions, accessing the subperiosteal layer, dissecting in the subperiosteal layer of the frontal, parietal regions with dissection of the ligaments supporting the orbit and preserving the integrity of the supraorbital, supratrochlear vascular-nerve bundles, layer-by-layer dissection of tissues in the hairy part of the temporal regions, accessing the layer above the superficial leaflet of the deep temporal fascia, performing suprafascial dissection of the temporal regions,access under the superficial muscular-apenorrhea layer in the parotid regions, dissection under the superficial muscular-apenorrhea layer in the parotid regions to the lower edge of the zygomatic arch with dissection of the superior and inferior temporal septa, ligaments supporting the orbit, lateral orbital thickenings while preserving the integrity of the temporal and zygomatic branches of the facial nerves, making an incision in the mucous membrane of the vestibule of the oral cavity, access to the subperiosteal layer, dissection in the subperiosteal layer of the maxillae, anterior surfaces of the zygomatic bones with dissection of the tarsal supporting ligaments, ligaments supporting the orbit, zygomatic retaining ligaments while preserving the integrity of the infraorbital nerve bundles,unification of the formed cavities between dissections in the temporal regions and the upper jaw region by dissecting the periosteum of the upper edges of the anterior 2 / 3 of the zygomatic arches under endoscopic control while preserving the integrity of the temporal branches of the facial nerves, installation of zygomatic implants made of polyethylene, fixation with screws to the upper jaw, suturing the areas of the malar body, moving the midface flaps in the upper-medial direction, suturing the areas of the modiolus, moving the midface flaps in the upper-lateral direction, fixing the midface flaps to the superficial layers of the deep temporal fascia in the upper-medial and upper-lateral directions, moving the flap of the upper face in the superior direction, fixing the flap of the upper face with intraosseous removable screws to the cranial vault in the frontal region, suturing the layers of the temporoparietal fascia, suturing the skin of the scalp, suturing the skin of the upper and lower century,suturing of the mucous membrane of the vestibule of the oral cavity,

[0014] Example

[0015] 1. Patient A. was admitted with a diagnosis of cicatricial deformation and atrophic changes in the soft tissues of the midface region.

[0016] The face is asymmetrical, the skin has a physiological color, facial expression tests are positive, the true position of the eyebrow is difficult due to the presence of a tattoo, along the hairline, the true position of the head of the eyebrow is at the level of the upper edge of the orbit, the arch and tail of the eyebrow are located below the upper edge of the orbit, the eyes close completely, dermatochalasis of the upper eyelids, the nasal part of the periorbital fat is visualized, canthal tilt is negative, minimal deepening along the entire nasolacrimal groove, dermatochalasis of the lower eyelids, the contour of the lower eyelid is smooth without signs of hernial protrusions, the nasolabial fold is visualized only when smiling, the malar body is located on the lower part of the zygomatic arch, the facial vector is negative, a linear scar is visualized in the cheek area on the right, atrophic, without signs of inflammation, painless on palpation, soft tissues around the scar are slightly mobile, a linear scar is visualized in the border zone between the parotid and buccal region on the left,atrophic, painless on palpation, soft tissues around the scar are slightly mobile, regional lymph nodes are not enlarged, mouth opening is full, the oral cavity is sanitized,

[0017] A decision was made to perform correction of cicatricial changes in the midface.

[0018] Intraoperatively, performing subciliary and pericanthal incisions in the lower eyelid area, performing subcutaneous dissection of the lower eyelids, performing incisions in the natural folds of the upper eyelids, dissecting the skin, orbicularis oculi muscles in the upper eyelid area, resecting the skin and orbicularis oculi muscles in the upper eyelid area, accessing the medial parts of the periorbital fat tissue, resection of the medial parts of the periorbital fat tissue, layer-by-layer dissection of tissues in the hairy part of the frontal regions, accessing the subperiosteal layer, performing dissection in the subperiosteal layer of the frontal, parietal regions with dissection of the ligaments supporting the orbit and preserving the integrity of the supraorbital, supratrochlear vascular-nerve bundles, layer-by-layer dissection of tissues in the hairy part of the temporal regions, accessing the layer above the superficial leaflet of the deep temporal fascia, performing suprafascial dissection of the temporal regions,access under the superficial muscular-apenorrhea layer in the parotid regions, dissection under the superficial muscular-apenorrhea layer in the parotid regions to the lower edge of the zygomatic arch with dissection of the superior and inferior temporal septa, ligaments supporting the orbit, lateral orbital thickenings while preserving the integrity of the temporal and zygomatic branches of the facial nerves, making an incision in the mucous membrane of the vestibule of the oral cavity, access to the subperiosteal layer, dissection in the subperiosteal layer of the maxillae, anterior surfaces of the zygomatic bones with dissection of the tarsal supporting ligaments, ligaments supporting the orbit, zygomatic retaining ligaments while preserving the integrity of the infraorbital nerve bundles,unification of the formed cavities between dissections in the temporal regions and the upper jaw region by dissecting the periosteum of the upper edges of the anterior 2 / 3 of the zygomatic arches under endoscopic control while preserving the integrity of the temporal branches of the facial nerves, installation of zygomatic implants made of polyethylene, fixation with screws to the upper jaw, suturing the areas of the malar body, moving the midface flaps in the upper-medial direction, suturing the areas of the modiolus, moving the midface flaps in the upper-lateral direction, fixing the midface flaps to the superficial layers of the deep temporal fascia in the upper-medial and upper-lateral directions, moving the flap of the upper face in the superior direction, fixing the flap of the upper face with intraosseous removable screws to the cranial vault in the frontal region, suturing the layers of the temporoparietal fascia, suturing the skin of the scalp, suturing the skin of the upper and lower century,suturing of the mucous membrane of the vestibule of the oral cavity,

[0019] Local status after surgery

[0020] The face is asymmetrical, the skin is of physiological color, facial expression tests are positive, the true location of the eyebrow is difficult due to the presence of a tattoo, along the hairline, the true location of the head of the eyebrow is at the level of the upper edge of the orbit, the arch and tail of the eyebrow are located above the upper edge of the orbit, the eyes close completely, the skin of the upper eyelid is smooth, tightly adjacent to the underlying structures, the canthal tilt is positive, the skin in the lower eyelid area is tightly adjacent to the underlying structures, the malar groove is smoothed, a smooth transition from the lower eyelid to the cheek, the contour of the lower eyelid is smooth without signs of hernial protrusions, the nasolabial fold is visualized only when smiling, the malar fat pad is located on the upper part of the zygomatic arch, the facial vector is positive, a linear scar is visualized in the cheek area on the right, atrophic, without signs of inflammation, painless on palpation, soft tissues around the scar are slightly mobile,a linear scar is visualized in the border zone between the parotid and buccal region on the left, atrophic, painless on palpation, soft tissues around the scar are slightly mobile, regional lymph nodes are not enlarged, mouth opening is full, the oral cavity is sanitized,

[0021] Bibliography

[0022] 1. Method for correcting age-related gravitational changes in soft tissues of the periorbital region. Patent. Russian Federation 2784999 C1.

[0023] 2. Method for correcting age-related gravitational changes in the soft tissues of the face and neck. Patent. Russian Federation 2819212 C1.

[0024] 3. Course of plastic surgery: Manual for doctors. In 2 volumes / Edited by K.P. Pshenisnov;

[0025] 4. Plastic surgery of the face. Manual for doctors / Edited by K.P. Pshenisnov.