RU2680288C1 - Lip cheiloplasty method - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to plastic surgery. Perform incision, de-epidermization of the flap. As a guide, use the red border of the lips. Then, the wound is closed. In this case, a strip of skin under the nose, 4–6 mm wide and 0.2–0.5 mm thick, is de-epidermized. Dermal-subdermal layer is excised, a dermosubdermal flap is cut out, and an autograft is formed from it in the form of an individual form using a cutting tool. Attach seams-handles at each end of the autograft. Along the edges of the upper or lower lip, two vertical cuts are formed, a tunnel is made through them under the red border of the upper or lower lip. Introduce the formed autograft into the tunnel and center it in relation to the line of symmetry of the lips, the seams-holders are removed.EFFECT: method allows to save dermisubdermal flap, increase the volume of the upper lip with excessive height of its dermal part with the achievement of a more aesthetic sustainable result taking into account the individual characteristics of the operated, reduce the time of surgical intervention and rehabilitation.4 cl, 1 ex, 12 dwg

Description

The invention relates to meeting the vital needs of a person, in particular to the field of medicine, namely to plastic surgery, and is intended for modeling lip shapes surgically.

A known method of secondary rhinocheyloplasty with unilateral clefts, including rhinoplasty and correction of the shape of the upper lip, in which on the side of the cleft on the skin above the edge of the nostril at a level symmetrical to the healthy side, an incision is made, excess skin is moved along the upper edge of the nasal cavity into the nasal cavity, and after rhinoplasty, excision of scar-modified tissues of the upper lip and mobilization of stumps of the circular muscle of the mouth, subperitoneally soft tissues exfoliate from the edge of the pear-shaped opening and in the area of the canines the fossa, perform bone grafting of the lower and lateral edges of the pear-shaped opening with a bone graft overlay, fixing it with two microscrews to the upper jaw (Patent No. 2214187RU. Publ. 20.10.2003).

A known method of plastic surgery of the vestibule of the oral cavity, including making an incision from canine to canine along the mucous membrane of the transitional fold, separating the flap of the mucous membrane of the transitional fold with the base on the attached gum of the alveolar process, cutting off the soft tissues of the chin from the periosteum to the required depth and fixing the flap from the alveolar , while the incision is extended along the border of the attached gums and transitional folds to 4-6 teeth, lateral connective tissue strands, muscle the tissues are stupidly squeezed down and the flap is fixed and the wound surface of the transitional fold is closed by applying a wound cover (Patent No. 2216285RU. Publish. November 20, 2003).

However, the known method is not intended to increase the volume of the upper lip.

A known method of plastic surgery of the vestibule of the oral cavity in the anterior section, including an incision along the mucous-gingival border of the upper jaw to the periosteum, separating the mucous membrane in the transitional fold with moving it to the deeper arch of the vestibule of the oral cavity and suturing to the periosteum, closing the wound surface, this wound surface is closed with a non-free flap from the cheek area behind the commissure of the lip, for the formation of the flap, the first incision is made in the transition junction of the upper jaw along the the section behind the commissure of the lip, continue the incision down the cheek, 2-3 mm from the commissure, to the transitional fold of the lower jaw, make a second incision in the transitional fold of the upper jaw distal to the previous one 1 cm, continue the incision along the cheek down and connect to the end of the first incision, the mucous-submucosal flap is separated, starting from the lower end, while the width of the formed flap in the central section should be 1 cm, then the flap on the feeding leg is rotated at an angle of 90 °, placed on the wound surface of the vestibular side of the alveolar process of the upper jaw and fix the sutures to the edges of the mucosa (Patent No. 2264793RU. Publ. November 27, 2005).

However, the known method relates to maxillofacial surgery, and may be applicable for plastic surgery of the vestibule of the oral cavity in the anterior part, it is not intended to increase the shape of the upper lip due to the use of a non-free flap from the cheek area behind the lip commissure.

A known method of plastic surgery of an extensive through defect of the soft tissues of the cheek, the angle of the mouth, fragments of the upper and lower lips, in which the circular muscle of the mouth and the remaining parts of the upper and lower lips are mobilized. A skin-fatty flap is formed from neighboring anatomical regions, corresponding in area to the defect. Chewing muscle is isolated from the attachment point to the corner of the lower jaw to the zygomatic bone, and it is separated from the attachment point to the lower jaw. Two equal legs are formed, carried out to the corner of the mouth. Fix to the remnants of the circular muscles of the mouth and muscles of the upper and lower lips. In the temporal region, a fascial temporal flap is cut out. They are screwed through the tunnel into the oral cavity and fixed to the defect of the mucous membrane of the cheeks, lips and legs of the muscle flap. A skin-fat flap is placed on the defect and layer-by-layer fixed to the edges. The top of the temporal flap is turned outward, fixed to the skin of the skin-fat flap in the region of the corner of the mouth (Patent No. 2489096RU. Publish. 08/10/2013).

However, the known method is intended for the reconstruction of fragments of the upper and lower lips in cancer of the soft tissues of the face and is not intended to change the shape of the upper lip.

A known method of plastics bullhorn lips, in which under the base of the nose make a neat incision and remove a strip of skin in the form of bull horns. Then sutures.

Thus, the upper lip is shortened, and its red border is turned out. In this case, only that part of the upper lip that is located under the base of the nose is lifted - this improves the shape of the lips (Electronic resource: https://platinental.ru/services/medical/plastic_surgery/hejloplastika/bulhorn/).

However, the well-known plastic lips bullhorn does not allow to achieve the proper aesthetic result due to the lack of volume of tissue in the upper lip.

A known method of plasty of the lower lip through a cheek flap in which the angle of the mouth is formed using a triangular flap cut from the red border of the lower lip with the base adjacent to the corner of the mouth (Patent No. 2143856 RU. Publ. 10.01.2000).

However, the known method is not intended for plastics of the upper lip.

The publication “Upper Lip Aging: A New Treatment Method” is known, which describes a method that includes dissecting the skin from a circular muscle, inserting a temporary trapezoidal flap pretemporal, a nasolabial joint, fixing the Vikril graft with sutures at the level of the nasolabial folds, and the graft was made of silicone (Hinderer UT : Aging of the Upper Lip: A New Treatment Technique. Madrid, Spain Aesth. Plast. Surg. 19: 519-526, 1995).

However, despite the fact that eversion of vermilion, increase in the bulge of the lip, and acceptance of the concave youthful lip by the lip are achieved, the foreign method uses a foreign, synthetic material, often leading to undesirable deformations for patients.

A known method of upper lip plasty by dissecting the central part of the upper lip, including the formation on the lower lip of a full-layer flap on the arterialized feeding leg and stitching it into the defect of the upper lip, in which the cut on the upper lip is made from the mucous membrane to the skin, de-epidermize the cut flap and make up for it lip defect (A.S. No. 1289470 of the USSR. Publish. 02.15.1987).

However, the known method is traumatic, leaving more scars, requiring sufficiently large incisions and damage to the upper lip and a longer rehabilitation period. In addition, it is not intended to increase the volume of the upper lip due to the dermosubdermal flap from under the nasal region.

The objective of the present invention is the ability to save a dermosubdermal flap and use it to augment (fill) the upper or lower lip.

The result is manifested in the possibility of increasing the volume of the lips with excess height of the skin of the upper lip with the achievement of a more aesthetic sustainable result, taking into account the individual characteristics of the operated person, reducing the time of surgery and rehabilitation.

The problem is solved in that in the method of cheiloplasty of the lips, including performing an incision, de-epidermization of the flap, use of the red border of the lips as a guideline, suturing of wounds, the skin strip under the nose is pre-epidermized 4-6 mm wide and 0.2-0.5 mm thick the dermal-subdermal layer is excised, the dermosubdermal flap is cut out, an autograft is formed in it in the form of an individual shape using a cutting tool, suture-holders are fixed at each end of the autograft, along the edges of the upper or lower two vertical incisions are made to her lips, a tunnel is made through them under the red border of the upper or lower lip, the formed autograft is introduced into the tunnel and centered with respect to the line of symmetry of the lips, the stitch-seams are removed.

It is advisable to use scissors as a cutting tool to obtain a more accurate individual shape of the autograft.

To simplify the introduction of the autograft into the tunnel and reduce the morbidity, each of the fixation elements should be made of Prolene 3.0 threads, and vertical incisions should be sutured with Prolene 5.0 threads.

The present invention is illustrated in the detailed description, diagrams, and exemplary embodiments that illustrate:

Schematic modeling of surgical intervention:

FIG. 1 shows diagrams of the marking of epidermisation of a strip of skin under the nose and excision of the dermal-subdermal layer in the form of its individual form;

FIG. 2 - is a diagram of the excision of the individual form of the dermal-subdermal layer, autograft and their individual form;

FIG. 3 - shows a seam diagram after removing a strip of skin under the nose, an incision under the red border of the lips, an autograft, with fixed elements of fixation at its ends, made in the form of threads;

FIG. 4 shows a diagram of introducing an autograft into a tunnel formed under the red border of the upper lip;

FIG. 5 is a diagram of suturing in the corners of the upper lip and the outgoing fixation elements of the autograft to center it relative to the axis of symmetry of the upper lip;

FIG. 6 - characterizes the treatment result scheme with a visible increase in the volume of the upper lip of an individual form;

Photo of a clinical example:

FIG. 7 - marking of epidermisation of the strip of skin under the nose with a thickness of not more than 0.5 mm and a width of not more than 6 mm and its removal;

FIG. 8 - excised dermal-subdermal layer for the formation of an individual form of autograft;

FIG. 9-formed individual autograft form;

FIG. 10 - introduction of the formed autograft into the tunnel, made under the red border of the upper lip;

FIG. 11 - centering of the introduced autograft relative to the axis of symmetry of the upper lip;

FIG. 12 is the result of the method. Comparison of the shape of the lips before plastic surgery (photo on the left) and after plastic surgery (photo on the right).

The way cheiloplasty of the lips is as follows. Pre-simulate the course of surgery using

circuits.

On the face under the nose, a strip of skin is outlined (Fig. 1-7). The width of the strip is from 4-6 mm and the thickness is from 0.2 to 0.5 mm. Dimensions depend on the individual skin structure. Then, along the planned line, they plan to perform epidermalization of the flap and excise the dermal-subdermal layer. In addition, from the cut out dermosubdermal flap, an autograft is formed in the form of an individual shape using a cutting tool. At each end of the autograft, a fixation element must be fixed. At the edges of the upper or lower lip, two vertical incisions are formed. Then a tunnel is made under the red border of the lips, the formed autograft is introduced into the tunnel and centered with respect to the line of symmetry of the lips. The elements of the fix field are deleted. Sutures are sutured. It is possible to use scissors as a cutting tool, and 3-0 prolene as fixing elements of the thread and 5-0 for suturing vertical incisions of the prolene thread.

An example of the method.

Patient A. (72 years old) (hereinafter referred to as the patient) went to the clinic with complaints of age-related changes in the upper lip, a decrease in volume and an increase in the skin part of the lip. The patient was offered a method of cheiloplasty of the upper lip. (Fig. 7-11).

A contour line of skin strips was removed on the face under the nose for removal. The intended strip of skin was six 6 mm wide. Surgery was performed in the operating room under local infiltration anesthesia, a solution of 0.5% lidocaine. Then, according to preliminary marking, a shallow cut of the skin under the nose was made. Further, with a scalpel No. 15, the epidermization of the skin flap was performed. After that, with the same scalpel, a dermo-subdermal flap with a thickness of not more than 5 mm was excised, which will subsequently be used as an autograft. A skin defect under the nose was sutured in layers. On the edges of the upper lip, after additional infiltration anesthesia, two vertical incisions were made along the Zmm. Through these incisions, a tunnel was formed under the red border of the upper lip. With the help of scissors, the dermo-subdermal flap was given the necessary shape, removing all the pointed edges. On both ends of this flap suture-holders were laid with 3-0 prolene thread. Further, this autograft was installed in a tunnel in the upper lip. With the help of stitches-holders, the graft was placed symmetrically in the lip. The stitching stitches are removed. One suture from prolene 5-0 was applied to the wounds.

The result of the surgical intervention is presented in figure 12, namely, the shape of the upper lip before treatment (photo on the left) has a smaller volume, relative to the shape of the upper lip, which has a larger volume, after cheiloplasty (photo on the right).

The proposed method allows to increase the volume of the upper lip without various additional means: fillers, own fat, synthetic materials.

In addition, it allows the use of a dermosubdermal flap as an autograft.

The proposed method allows to increase the volume of the upper lip, to achieve a stable aesthetic result, taking into account the individual characteristics of the patient.

Claims (4)

1. The method of cheiloplasty of the lips, including performing an incision, de-epidermization of the flap, using the red border of the lips as a guideline, suturing of wounds, characterized in that the epidermis is pre-epidermized strip of skin under the nose with a width of 4-6 mm and a thickness of 0.2-0.5 mm, The dermal-subdermal layer is excised, the dermosubdermal flap is cut out, an autograft is formed from it in the form of an individual shape using a cutting tool, sutures are held on each end of the autograft, along the edges of the upper or lower lip I form two vertical incision through the tunnel they operate under red border the upper or lower lips is introduced into the tunnel formed autograft and center it with respect to the line of symmetry of the lips, the sutures taped-removed. 2. The method according to p. 1, characterized in that scissors are used as a cutting tool. 3. The method according to p. 1, characterized in that each of the fixation elements is made of 3-0 prolene threads. 4. The method according to p. 1, characterized in that the vertical incisions are sutured with 5-0 prolene threads.

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