RU2461359C1 - Method for relieving glossoplegia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly maxillofacial surgery. A hypoglossus is separated, and an end-to-end nerve graft is anchored thereto. The nerve graft is presented by a sural nerve delivered through a pre-formed tunnel extending from a proglossis through a root of the tongue into a digastric triangle.

EFFECT: method enables improving the tongue functions with the minimally damaged donor area.

1 ex

Description

This invention relates to medicine, namely to maxillofacial surgery, and can be used to eliminate paralysis of the muscles of the tongue of an acquired nature, as well as defects of one or both of the hyoid nerves resulting from trauma and burns of the face, cancer and other surgical interventions.

A known method of eliminating paralysis of the tongue by direct stitching (neuroraphy) of the hyoid nerve. [Ostroverkhov G.E. and other Operative surgery and topographic anatomy, M., 1998, S. 357-359].

However, this method is not always possible with damage to the hyoid nerve at the root of the tongue.

Closest to the proposed is a way to eliminate tongue paralysis by cutting the submandibular region, isolating the hyoid nerve to form the side to end neuroanastimosis of the hyoid and facial nerves using the stitching of the large ear nerve [Mark May. Facial paralysis. - New York, - 2003, S.151-163].

The disadvantage of this method is the insufficiently expressed result of the restoration of motor activity of the facial muscles of the lower face zone.

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

The technical result is achieved by the fact that in the method of eliminating tongue paralysis by making an incision in the submandibular region, isolating the hyoid nerve and stitching a nerve transplant to it, a distinctive feature is that the calf nerve is used as a nerve transplant, which is passed through a preformed tunnel passing from the tip of the tongue through the root of the tongue into the submandibular triangle, and hem “end to end” with the hyoid nerve.

The method is as follows.

In ETN conditions, after processing the surgical field, an incision was made in the submandibular region. The skin is mobilized, in the submandibular triangle, the submandibular salivary gland is isolated, the duct and facial artery are untied, the gland is removed. The anterior abdomen of the biceps muscle is taken on a holder and taken up. The skin incision is extended in the carotid triangle, the external jugular vein and the external carotid artery are isolated. Under the lingual artery, the proximal sublingual nerve is isolated, the nerve is traced all the way to the entrance to the muscles of the root of the tongue, where crush and scarred tissues are found.

Donor area: right shin. A 3-5 cm long incision is made in the lateral ankle region. The peripheral section of the calf nerve is isolated and cut off. Using a stripper, the nerve is secreted for 7-24 cm. At the level of the upper third of the leg, the skin is brought out through the skin incision and cut off. Wounds are sutured in layers with Vicryl 3.0, Prolen 3.0, and drainage. Apply an aseptic dressing.

Using a neuroconductor, a tunnel is formed from the root of the tongue to the end section, the gastrocnemius nerve is carried out in the tunnel and displayed in the submandibular region until it is compared with the unchanged sublingual nerve. Under the conditions of microsurgical technique, anastomoses are inserted between the hyoid nerve and the gastrocnemius transplant "end to end" with a thread of 8.0. Vicryl 4.0, Prolen 4.0, drainage, aseptic dressing are stitched in layers.

Example

Patient G. (born 1978), was in the clinic with a diagnosis of

Bilateral paralysis of the tongue (Glossoplegia). Injury resulting from a traffic accident.

At the time of admission, the patient noted a complete absence of tongue movements.

In the clinic, after a complete clinical and laboratory examination under conditions of endotracheal combined anesthesia, a reconstructive operation was performed in the amount of formation of hyoid nerve neuroanastomoses using a transplant from the gastrocnemius nerve using microsurgical technique. Received the result of reinnervation of the muscles of the tongue after 6 months.

Under ETN conditions, after processing the surgical field, an incision was made along the old scar in the submandibular region on the right. The skin is mobilized, the submandibular salivary gland is isolated in the submandibular triangle, the duct and facial artery are untied, the gland is removed. The anterior abdomen of the biceps muscle is taken on a holder and retracted upward. The skin incision is extended in the carotid triangle, the external jugular vein and the external carotid artery are isolated. The proximal sublingual nerve was isolated under the lingual artery, the nerve was traced all the way to the entrance to the muscles of the root of the tongue, where a crush and scar tissue was detected. The incision is extended into the submandibular region on the left. The submandibular salivary gland was removed, the sublingual nerve was isolated and traced to the sublingual nerve 5 mm below the anterior abdomen of the biliary network. Visually defined crushing and scarring of the distal sublingual nerves. When applying electrodes and direct stimulation of nerves (20 mA, 0.5 ms, 5 Hz), muscle contractions of the tongue were not obtained.

Donor area: right shin. A 3 cm long incision was made in the lateral ankle. The peripheral section of the calf nerve was isolated and cut off. Using a stripper, the nerve was isolated for 24 cm. At the level of the upper third of the lower leg, it was brought out and cut off through a skin incision. The wounds were sutured in layers by Vicryl 3.0, Prolen 3.0, and drainage. Apply an aseptic dressing.

Using a neuroconductor, tunnels were formed from the root of the tongue to the end section, the gastrocnemius nerve is divided into two equivalent grafts, which are carried out in the tunnels and brought to the submandibular region from two sides until they are compared with the unchanged sublingual nerves. Using the microsurgical technique, anastomoses were placed between the hyoid nerve and the gastrocnemius end-to-end transplant of suture with thread 8.0 on both sides. Vicryl 4.0 filament seams, Prolen 4.0, drainage, aseptic dressing were stitched in layers.

In the postoperative period, the patient underwent antibacterial and neurostimulating therapy. Within 6 months of the recovery period, electrical stimulation was performed on an individual Enestim apparatus in the “trophic” and “myostim” modes for 40 minutes with a course of 10 procedures with an interval of one month.

As a result of the operation, restoration of the motor function of the tongue was obtained, the follow-up periods were 6 and 12 months.

6 months after the operation, the appearance of muscle movements of the tongue, the possibility of chewing and articulation were observed. After 12 months, the functional motor activity of the muscles of the tongue significantly increased.

The proposed method has several advantages, such as the possibility of reinnervation of the muscles of the tongue with damage to the hyoid nerve in the area of the root of the tongue.

The use of the calf nerve allows to eliminate paralysis of the muscles of the tongue both on one side and on both sides with minimal damage to the donor area.

Claims (1)

A method for eliminating tongue paralysis by performing an incision in the submandibular region, isolating the sublingual nerve and stitching a nerve transplant to it, characterized in that the calf nerve is used as a nerve transplant, which is passed through a preformed tunnel passing from the tip of the tongue through the tongue root into the submandibular triangle , and hem “end to end” with the hyoid nerve.