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

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to maxillofacial, reconstructive, plastic surgery, and can be used for reinnervation of facial muscles. Skin and subcutaneous fat is incised on the affected side by pre-bovine access. Further, along the hair growth line, the skin flap is peeled to the front edge of the parotid gland with subsequent release of the muscular-aponeurotic layer. Posterior edge of parotid gland is separated and mobilized from cartilaginous part of external ear-tragus, antitragus and intertragic notch. Further, the trunk of the facial nerve is separated and cut off within the exit from the thraleses-like opening. Fascia-shaped case of a masseter is dissected; its fibers are expanded to reach a semilunar incision. Masticatory branch of the trigeminal nerve is cut off and sutured together with the trunk of the facial nerve. Additionally, parotid parenchyma is excised on affected side. Branches of the facial nerve are recovered from the parotid gland and the facial nerve is divided into an upper part consisting of the temporal, bilge and cheek branches, and a lower part consisting of the marginal and cervical branches, which is rotated in the region of the carotid triangle. Further, in the area of the apical part of the digastric muscle, a sublingual nerve is separated, 30–40 % of its fascicles are incised and sutured with the lower part of the facial nerve. On the healthy side, the skin and subcutaneous fat are dissected in the same way, the skin-fat flap is delaminated, the musculo-aponeurotic layer is separated, the posterior edge of the parotid gland separated and mobilized from the cartilaginous part of the external tragola, the anticolum and the intercostal incision. Additionally, on the healthy side near the anterior edge of the parotid, a buccal branch of the facial nerve is separated, followed by dissection of 0,5–0,75 of its diameter. That is followed by sampling of an autograft sural nerve that is delivered from an affected side to a healthy one under an earlier subcutaneous fat flap through an oral cavity under the mucous membrane. It is sutured together with the buccal branch of the facial nerve. Upper part of the facial nerve trunk is sutured on the affected side with the masticatory branch of the trigeminal nerve and with the autograft sural nerve. Soft tissues are closed in layers.

EFFECT: method enables improving functional and aesthetic results in re-innervation of facial muscles by excising parotid parenchyma on the affected side, separating branches of the facial nerve from the parotid, extraction of sublingual nerve and dissection of 30–40 % of its fascicles, extraction of buccal branch of facial nerve on healthy side with subsequent dissection of 0,5–0,75 of its diameter, use of autograft sural nerve.

1 cl, 1 dwg, 1 ex