METHOD OF REINNERVATION OF FACIAL MUSCLES Russian patent published in 2019 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maxillofacial, reconstructive, plastic surgery. Skin and subcutaneous fat are dissected on an affected and healthy sides with preauricular-postaural approach. Further, along the hair growth line, delamination of the skin-fat flap to the front edge of the parotid gland with subsequent release of the muscular-aponeurotic layer, separation and mobilization of the posterior edge of the parotid gland from the cartilaginous part of the external ear – antilobium, antitragus and intertragic notch. On the involved side, the facial nerve is isolated and cut off within the exit of the thymus-like opening and the parenchyma of the parotid glands is excised. Further, the trunk and branches of the facial nerve are separated in the parotid gland and the facial nerve is divided into an upper part with temporal, bilge and cheek branches and a lower portion with marginal and cervical branches. Sublingual nerve is extracted in the area of an apex of the digastric muscle to dissect 30–40 % of its fascicles. Then the fascia-shaped case of chewing muscle is dissected, its fibers are expanded to reach a half-moon incision, the chewing branch of the trigeminal nerve in it is cut off as much as possible to a arcus zygomaticus. On a healthy side, an anterior edge of the parotid gland is separated by a buccal branch of the facial nerve with subsequent dissection of 0.5–0.75 of its diameter. That is followed by sampling of an autograft nerve that is delivered from an affected side to a healthy one under a previously isolated skin-fat flap through an oral cavity under the mucous membrane and sutured together with a buccal branch of the facial nerve, followed by layer-by-layer soft tissue suturing. Recovered autograft of nervus suralis 30–36 cm long is divided into three lengths 20–25 cm, 6.0–6.5 cm and 4.0–4.5 cm. On the healthy side, the cheek branch of the facial nerve is sutured together with the end of segment 20–25 cm long autograft from an affected side to a healthy one under a previously isolated skin-fat flap through an oral cavity under the mucous membrane. On the involved side, the other end of the segment is sutured together with an upper portion of the facial nerve and the end of a segment of the autograft nerve length of 6.0–6.5 cm, other end of a segment of an autograft nerve in length 6.0–6.5 cm is stitched with a sublingual nerve, the end of a segment of an autograft nerve end of length 4.0–4.5 cm is stitched together with a chewing branch of a trigeminal nerve, other end of the given segment is stitched with the lower part of a trunk of facial nerve.

EFFECT: method allows increasing functional and aesthetic results of treatment, as a result, patients have a high degree of facial muscle excursion.

1 cl, 1 dwg, 2 ex