RU2822701C1 - Method for surgical management of frontal bone osteoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maxillofacial surgery. Skin is incised within a superior orbitopalpebral fold from a medial to lateral angle of the eye. After skin incision, a palpebral portion of a circular muscle of the eye is dissected under an upper edge of an orbit from a medial edge towards a lateral edge. Dissection is performed to orbital septum and orbital part of frontal bone. Supraorbital, supratrochlear and infratrochlear neurovascular bundles are visualized. Periosteum of the orbital part of the frontal bone is dissected horizontally along the entire length of the surgical approach. Periosteum is dissected cephalad. Osteoma is visualized. Main mass of the neoplasm is resected by means of a piezotome. Neoplasm edges are polished with a drill. Orbit contour is formed. Haemostasis is performed. Circular muscle of the eye is closed with interrupted sutures, and the skin of the eyelids is closed with an intradermal suture.

EFFECT: method enables to provide a non-projection access to an aesthetically significant portion of the frontal region during surgical treatment of osteomas of the frontal region, solve the problem of aesthetics and functional state of integumentary tissues of the face and facial muscles.

1 cl, 1 ex

Description

The present invention relates to medicine, namely to maxillofacial surgery, and can be used in the surgical treatment of osteomas of the frontal bone.

It is known that during the treatment of osteomas of the frontal bone, a skin incision is made in the projection of the neoplasm, which leads to the formation of a skin defect [1], or bicoronally [2], which leads to significant tissue trauma and postoperative complications. The problem of creating optimal access from both technical and aesthetic points of view is one of the primary ones, especially in facial surgery. A knowledge-intensive approach based on an understanding of functional anatomy is especially important to improve the quality of life of patients.

Analog. Bicoronary access. The coronal scalp incision is marked with diamond green 5 cm posterior to the hairline. After hydropreparation of the tissues in the projection of the intended incision, it begins from the apex of the ear on one side and continues to the apex of the tragus along the preauricular fold on the other side. The incision includes the skin and aponeurosis. Above the temporal muscles, the tissue is dissected to the deep temporal fascia. Carefully coagulate the dissected vessels using a coagulator. The anterior scalp flap is separated from the periosteum and mobilized towards the superior orbital margins and the neoplasm. In the area of the neoplasm, the periosteum is dissected. Resection of the main mass of the neoplasm is performed using a piezotome, grinding of the edges of the neoplasm using a drill, formation of the orbital contour, and hemostasis is performed. The muscles and fascia are sutured in layers, the skin is sutured with an intradermal suture [3].

The disadvantages of the bicoronary approach are significant tissue trauma, a high risk of damage to the supraorbital neurovascular bundle, changes in the configuration of the upper third of the face, and disruption of the trophism of the periosteum.

Access to the projection of the tumor is known. Markings are made horizontally in the projection of the neoplasm. The skin, subcutaneous fatty tissue, and the frontal belly of the occipitofrontal muscle are dissected and hemostasis is performed. The periosteum is dissected in the projection of the neoplasm. Resection of the main mass of the tumor is performed using a piezotome, grinding of the edges of the tumor using a drill, and formation of the orbital contour. The subcutaneous fatty tissue is sutured with interrupted sutures, the skin is sutured with an intradermal suture [4].

The disadvantage is the formation of an unaesthetic postoperative scar in the area of the supraorbital margin, as well as disruption of trophism.

The closest analogue. Bicoronary access. The coronal scalp incision is marked with diamond green 5 cm posterior to the hairline. After hydropreparation of the tissues in the projection of the intended incision, it begins from the apex of the ear on one side and continues to the apex of the tragus along the preauricular fold on the other side. The incision includes the skin and aponeurosis. Above the temporal muscles, the tissue is dissected to the deep temporal fascia. Carefully coagulate the dissected vessels using a coagulator. The anterior scalp flap is separated from the periosteum and mobilized towards the superior orbital margins and the neoplasm. In the area of the neoplasm, the periosteum is dissected. Resection of the main mass of the tumor is performed using a piezotome, the edges of the tumor are polished using a drill, the contour of the orbit is formed, and hemostasis is performed. The muscles and fascia are sutured in layers, the skin is sutured with an intradermal suture [3].

The disadvantages of the bicoronary approach are significant tissue trauma, a high risk of damage to the supraorbital neurovascular bundle, changes in the configuration of the upper third of the face, and disruption of the trophism of the periosteum.

Tasks. Providing access to the osteoma of the frontal bone during its removal, solving the problem of postoperative aesthetics, trophism and functional state of the integumentary tissues and facial muscles of the upper third of the face.

The essence of the invention is: making a skin incision in the area of the upper orbitopalpebral fold from the medial to lateral corners of the eye, after dissecting the skin, dissecting the palpebral part of the orbicularis oculi muscle under the upper edge of the orbit from the medial edge towards the lateral edge, performing dissection to the orbital septum and the orbital part of the frontal bone . orbital contour, hemostasis, suturing the orbicularis oculi muscle with interrupted sutures, and the skin with an intradermal suture.

Technical result. The advantages are the provision of non-projection access to an aesthetically significant area of the frontal region for tumor removal. This approach involves creating an incision in the area of the orbitopalpebral fold of the upper eyelid, which in the long-term postoperative period solves the problem of aesthetics and functional state of the integumentary tissues of the face and facial muscles.

The problem of postoperative aesthetics, trophism and functional state of the integumentary tissues and facial muscles of the upper third of the face is solved by making a skin incision in the area of the upper orbitopalpebral fold from the medial to lateral corners of the eye, after dissecting the skin, dissecting the palpebral part of the orbicularis oculi muscle under the upper edge of the orbit from the medial edge towards the lateral edge, dissection to the orbital septum and the orbital part of the frontal bone, visualization of the supraorbital, supratrochlear and subtrochlear neurovascular bundles, dissection of the periosteum of the orbital part of the frontal bone in the horizontal direction throughout the surgical approach, peeling of the periosteum cranially, visualization of osteoma, resection using a piezotome of the main mass of the neoplasm, grinding the edges of the neoplasm using a drill, forming the orbital contour, performing hemostasis, suturing the orbicularis oculi muscle with interrupted sutures, and the skin with an intradermal suture.

The method was tested on ten patients during 2023.

The method is carried out as follows: a skin incision is made in the area of the upper orbitopalpebral fold from the medial to the lateral corners of the eye, after dissecting the skin, the palpebral part of the orbicularis oculi muscle is dissected under the upper edge of the orbit from the medial edge towards the lateral edge, dissection is performed to the orbital septum and the orbital part frontal bone, visualize the supraorbital, supratrochlear and subtrochlear neurovascular bundles, dissect the periosteum of the orbital part of the frontal bone in a horizontal direction throughout the entire surgical approach, peel off the periosteum cranially, visualize the osteoma, resect the main mass of the neoplasm using a piezotome, grind the edges of the neoplasm using a drill , form the contour of the orbit, perform hemostasis, suture the orbicularis oculi muscle with interrupted sutures, and the skin of the eyelids with an intradermal suture. Example:

1. The patient was admitted with a diagnosis of Osteoma of the right frontal region. Local status: The configuration of the face is changed due to the presence of a tumor in the right frontal region. Mouth opening was preserved and painless.

CT conclusion: Bone tumor in the right frontal region.

It was decided to remove the tumor through the orbitopalpebral fold approach.

Preoperatively, markings were applied in the area of the superior orbitopalpebral fold of the upper eyelid. Intraoperatively, a skin incision was made in the area of the orbitopalpebral fold from the medial to lateral corners of the eye, after dissecting the skin, the palpebral part of the orbicularis oculi muscle was dissected under the upper edge of the orbit from the medial edge towards the lateral edge, dissection was performed to the orbital septum and the orbital part of the frontal bone , the supraorbital, supratrochlear and subtrochlear neurovascular bundles were visualized, the periosteum of the orbital part of the frontal bone was dissected in the horizontal direction throughout the entire surgical approach, the periosteum was detached, osteoma was visualized, the main mass of the neoplasm was resected using a piezotome, they were polished using The edges of the neoplasm were drilled, the orbital contour was formed, hemostasis was performed, the orbicularis oculi muscle was sutured with interrupted sutures, and the skin of the eyelids was sutured with an intradermal suture.

CT examination of the facial skeleton: the contours of the supraorbital edge are smoothed, the neoplasm is resected.

Local status: the functional state of the facial muscles is fully preserved. The configuration of the face and soft tissues has been restored. No soft tissue swelling is observed. The postoperative scar is visualized after straightening the fold of the upper eyelid in the form of a thin strip.

Bibliography:

1. Plastic surgery course: A guide for doctors. In 2 volumes / Ed. K.P. Pshenisnova;

2. Maxillofacial surgery. National leadership / Ed. Academician of the Russian Academy of Sciences A.A. Kulakova;

3. Maxillofacial surgery. Training manual / Ed. A.Yu. Drobysheva;

4. Facial plastic surgery. Guide for doctors / Ed. K.P. Pshenisnova;

5. Oral and Maxillofacial surgery for the clinician / Krishnamurthy Bonanthaya.

Claims (1)

A method of surgical treatment of frontal bone osteoma, including marking, skin dissection, electrocoagulation, dissection and peeling of the periosteum, visualization of the osteoma, resection of the main mass of the tumor using a piezotome, grinding the edges of the tumor using a drill, shaping the orbital contour, hemostasis, characterized in that the incision of the skin is performed in the area of the upper orbitopalpebral fold from the medial to lateral corners of the eye, after dissecting the skin, the palpebral part of the orbicularis oculi muscle is dissected under the upper edge of the orbit from the medial edge towards the lateral edge, dissection is performed to the orbital septum and the orbital part of the frontal bone, the supraorbital, supratrochlear bones are visualized and subtrochlear neurovascular bundles, dissect the periosteum of the orbital part of the frontal bone in a horizontal direction throughout the entire surgical approach, exfoliate the periosteum cranially and, after removing the tumor, suture the orbicularis oculi muscle with interrupted sutures, and the skin of the eyelids with an intradermal suture.