RU2848401C1 - Method for narrowing the nasal arch without lowering a projection with preserving rhinoplasty - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely plastic, maxillofacial and ENT surgery. After a subperiosteal and subperiosteal separation of the mucous membrane of the nasal septum and a nasal crest is separated from the mucous membrane, portions of the nasal crest are cut out with using a piezoelectric apparatus. Two bone blocks 6 mm long, 3 mm wide, 3 mm thick are formed. That is followed by subperiosteal and subperiosteal separation of soft tissues from lower and upper lateral cartilages and nasal bones to a nasal root. Piezoelectric apparatus is used to perform low lateral and partial transverse osteotomies of the nasal bones. Nasal arch is mobilized by green twig fracture. Further, in the line of lateral osteotomies on the right and on the left between the bone fragments, the bone blocks are fixed into a spacer. Mucocutaneous flap is laid back and closed. Air-conducting intranasal splints are inserted into the nasal cavity and fixed with one interrupted suture. Nose is covered with a plaster bandage consisting of strips. External thermoplastic nasal splint is fixed.

EFFECT: method enables narrowing the nasal arch without reducing a projection with preserving rhinoplasty.

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Description

The invention relates to the field of medicine, to plastic, maxillofacial and ENT surgery, and can be used in the treatment of patients with deformities of the osteochondral part of the nose.

A method for stabilizing and narrowing the osteochondral portion of the nasal dorsum during structural rhinoplasty is known (Glushko A.V., Gammadaeva S.Sh., Lebedeva Yu.V., Manturova N.E. Narrowing the bony pyramid of the nose during structural rhinoplasty. Plastic surgery and aesthetic medicine. 2024; (1): 5-12). This technique is applicable when it is necessary to excise a pronounced osteochondral hump and narrow the nasal dorsum and involves violating the integrity and destabilizing the dorsum.

The closest analogue is the method of narrowing the upper part of the bony nasal pyramid during preserving rhinoplasty (Patent No. 2828560 C1 RF, IPC A61B 17/24, A61F 5/08. Method of narrowing the upper part of the bony nasal pyramid during preserving rhinoplasty, 14.10.2024 / Glushko A.V., Gammadaeva S.Sh., Lebedeva Yu.V). This method of narrowing the nasal dorsum is applicable when there is a need to lower the projection. When the projection of the dorsum must be preserved, this method is ineffective.

The objective of the present invention is to narrow the nasal dorsum without reducing the projection during preserving rhinoplasty.

The technical result of the task is a developed method for narrowing the nasal dorsum without reducing the projection during preserving rhinoplasty.

Procedure: In the left nasal passage, approximately 1 cm from the edge of the columella, a vertical incision is made using a #15c scalpel through the mucous membrane of the nasal septum, extending from the superior border of the internal valve to the projection of the inferior nasal spine. Subperichondrial and subperiosteal detachment of the mucous membrane of the nasal septum is performed on both sides, in the cartilaginous and bony portions, respectively. The nasal ridge is then freed from the mucous membrane. Using a piezoelectric device, expanding sections of the nasal ridge are cut out, from which two bone blocks are formed: 6 mm long, 3 mm wide, and 3 mm thick (Fig. 2A, B). Prechondral incisions are then made in the left and right nasal passages using a #15c scalpel, transitioning from the lateral to the medial crus of the lower lateral cartilages. Using a raspatory, subperichondrial soft tissue is removed from the inferior and superior lateral cartilages of the nose. Next, access is created to the bony portion of the lateral clivuses and nasal dorsum. Subperiosteal soft tissue removal is performed up to the root of the nose and just before the medial angles of the eyes. After subperichondrial and subperiosteal soft tissue removal from the inferior and superior lateral cartilages and nasal bones to the root of the nose and dissection of all structures, low lateral and partial transverse osteotomies of the nasal bones are performed using a piezoelectric device (Fig. 1A). The nasal dorsum is mobilized in a greenstick fashion. Bone blocks are fixed in the line of lateral osteotomies on the right and left between the bone fragments as a spacer, which will displace the lateral clivuses medially, thereby narrowing the nasal dorsum (Fig. 1B). After all structures of the nasal dorsum and apex have been addressed, the mucocutaneous flap is repositioned and, after visual assessment of the aesthetics of the result, is sutured with simple interrupted sutures using absorbable synthetic monofilament PDS 6/0 suture. Air-conducting intranasal splints are inserted into the nasal cavity and secured with a single interrupted suture. These are removed in the outpatient setting on the third day. A strip dressing is applied to the nose, and an external thermoplastic nasal splint is secured in place. This is removed in the outpatient setting on the 14th day.

Clinical studies and practical use of the proposed method of narrowing the nasal dorsum without reducing the projection during preserving rhinoplasty were conducted on patients at the Lancet Clinic in Moscow and demonstrated its high effectiveness.

The stated narrowing of the nasal bridge without reducing the projection during preserving rhinoplasty ensured the elimination of the pronounced width of the nasal bridge without its destabilization, destruction of anatomy and with preservation of projection.

The proposed method is available to plastic, maxillofacial, and ENT surgeons. It allows for atraumatically narrowing the nasal dorsum during nose-preserving rhinoplasty, minimizing surgical time, and preventing postoperative complications.

List of drawings:

Fig. 1. Illustration of the implementation of narrowing the nasal dorsum without reducing the projection during preserving rhinoplasty: A - low lateral and incomplete transverse osteotomies were performed; B - bone blocks were placed in the spacer between the bone fragments on the right and left in the line of lateral osteotomies.

Fig. 2. Formed bone blocks (A - right, B - left).

Fig. 3. Intraoperative photographs of the patient before (A - side view, C - bottom view, E - top view) and after (B - side view, D - bottom view, F - top view) surgical treatment.

Narrowing of the nasal bridge without reducing the projection during preserving rhinoplasty is performed as follows: Illustration Fig. 1A-B.

The implementation of the proposed method of narrowing the nasal dorsum without reducing the projection during preserving rhinoplasty is illustrated by the following clinical example.

Clinical example 1

Patient K., 29, was admitted to the clinic with a diagnosis of "Congenital deformity of the osteochondral region of the nose." She complained of an unattractive nose with a wide bridge and facial disharmony. She consulted the Lancet Clinic. Her general condition is satisfactory. A physical examination revealed a wide nasal bridge and a deformed apex (Fig. 3A, C, E). Anterior rhinoscopy revealed the nasal mucosa to be pink, moist, and free of inflammation. CT (computed tomography) revealed a deformity of the osteochondral region of the nose. The diagnosis was "Congenital deformity of the osteochondral region of the nose." Surgical treatment, including rhinoseptoplasty, was recommended. The patient was fully prepared for surgery in accordance with medical care standards. After the patient was placed in ETN under controlled hypotension, the nasal cavity was prepared with an antiseptic solution. Primary infiltration anesthesia was administered with Sol. Ropivacaini 5 mg/ml (6 ml) from the nasal cavity in the area of the septum, alae and lateral slopes of the nose. The surgical field was completely prepared. Repeated infiltration anesthesia with Sol. Ropivacaini 5 mg/ml was administered from the nasal cavity in the area of the septum, alae and lateral slopes of the nose. The nasal cavity was sanitized. In the left nasal meatus, approximately 1 cm from the edge of the columella, a vertical incision was made with a #15c scalpel in the mucous membrane of the nasal septum from the superior border of the internal valve to the projection of the inferior nasal spine. Subperichondrium and subperiosteal detachment of the mucous membrane of the nasal septum was performed on both sides in the cartilaginous and bony parts, respectively. The nasal ridge was then freed from the mucous membrane. Using a piezoelectric device, expanding sections of the nasal ridge were cut out, which were then used to form two bone blocks 6 mm long, 3 mm wide, and 3 mm thick. Prechondral incisions were then made in the left and right nasal passages with a #15c scalpel, extending from the lateral to the medial crus of the lower lateral cartilages. Using a raspatory, subperichondrial soft tissue was removed from the lower and upper lateral cartilages of the nose. Next, access was created to the bony portion of the lateral clivus and nasal dorsum. Subperiosteal soft tissue removal was performed up to the root of the nose and just before the medial canthus. Following subperichondral and subperiosteal soft tissue dissection from the inferior and superior lateral cartilages and nasal bones to the nasal root and dissection of all structures, low lateral and partial transverse osteotomies of the nasal bones were performed using a piezoelectric device. The nasal dorsum was mobilized using a greenstick technique. Bone blocks were fixed as spacers between the bone fragments along the lateral osteotomies on the right and left sides. After treatment of all structures of the dorsum and apex of the nose, the mucocutaneous flap was repositioned and, after visual assessment of the aesthetics of the resulting result, closed with simple interrupted sutures using absorbable synthetic monofilament PDS 6/0 suture. Air-conducting intranasal splints were inserted into the nasal cavity and secured with a single interrupted suture. A strip bandage is applied to the nose, and an external thermoplastic nasal splint is fixed in place.

No signs of nosebleeds were detected. The patient was awakened from anesthesia and transferred to the intensive care unit for follow-up. The patient underwent rhinoseptoplasty to correct the pronounced width of the nasal dorsum without loss of projection. Intraoperatively, the desired narrowing of the nasal dorsum without loss of projection was achieved (Fig. 3B, D, F) by medial displacement of the lateral slopes using bone blocks. The intranasal splints were removed after 3 days, and the external splint and sutures were removed after 14 days. The patient was followed up at 1, 3, 6 months, and 1 year postoperatively. No complications were identified in the early or late postoperative periods. Stable anatomy and aesthetics of the nasal dorsum were achieved.

Claims (1)

A method for narrowing the nasal bridge without lowering the projection during preserving rhinoplasty, characterized by the fact that after subperichondrium and subperiosteal detachment of the mucous membrane of the nasal septum and release of the nasal crest from the mucous membrane, using a piezoelectric device, sections of the nasal crest are sawed out, from which two bone blocks 6 mm long, 3 mm wide, 3 mm thick are then formed, then subperichondrium and subperiosteal detachment of soft tissues is carried out from the lower and upper lateral cartilages and nasal bones to the root of the nose, then using a piezoelectric device, low lateral and incomplete transverse osteotomies of the nasal bones are performed, mobilization of the nasal bridge is carried out by breaking the bones according to the greenstick type, then in the line of lateral osteotomies on the right and left between the bone fragments, bone blocks are fixed in a spacer, the cutaneous-mucous flap is placed in place and They are sutured, air-conducting intranasal splints are installed in the nasal cavity and fixed with one interrupted suture, a plaster bandage made of strips is applied to the nose, and an external thermoplastic nasal splint is fixed.