METHOD TO ELIMINATE FACIAL MUSCLES PARALYSIS Russian patent published in 2021 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maxillofacial surgery. Preauricular incision is made on an affected side, and a skin flap is mobilized. In the temporal region, superficial temporal arteries and vein are visualized, pass into the area of nasolabial fold, a bed for the autograft is formed. In the area of mandibular incision, masticatory branch of trigeminal nerve is isolated. On the healthy side, a preauricular incision is made, a skin-fat flap is mobilized, a buccal branch of the facial nerve is separated. That is followed by sampling of autograft nerve. Further, the sural nerve autograft is pierced by a neuroconductor from the vestibular surface of the upper lip from the affected side to a healthy one. With the use of microsurgical technique, 0.5 diameter of the buccal branch of the facial nerve of the healthy side is dissected; the previous autograft of the gastrocnemius nerve is anchored to the buccal branch of the facial nerve of the healthy side. On the side of the lesion, the skin is incised along a front axillary crease 7 cm long. Lateral edge of the greater pectoral muscle is visualized. Greater pectoral muscle is lifted and discharged in the medial direction; a neurovascular bundle of the small pectoral muscle is visualized. Then, the pectoral muscle is stripped from the chest in a direction towards the scapular process of the blade and cut off from it. Then point of thoracic artery exit from axillary artery is marked. Thoracic artery is separated distally, a place of its entering into a small pectoral muscle is visualized. Similarly, a vein of a small pectoral muscle is followed. Then medial and lateral thoracic nerves are separated in distal direction; the mediastinal nerve is used as the autograft; it innervates a large portion of muscle. Medial thoracic nerve is dissected away from the thoracic loop. Then, small pectoral muscle is dissected away from 3-5 ribs. Lower edge of small pectoral muscle is sutured with U-sutures. Vascular bundle ligation is performed in the proximal segment. Flap is cut off and transferred into the recipient's area on the face. Edges of the donor's wound are compared and closed in layers. Further, the small pectoral muscle autograft is inserted into the prepared bed in the recipient's area, then the tendon portion of the small pectoral muscle is fixed in the temporal region, and the costal rib of the small pectoral muscle is fixed in the commissure of the mouth. Using the microsurgical technique, the small pectoral muscle autograft is revascularized by applying vascular anastomoses between the superficial temporal artery and the end-to-end thoracic artery and the superficial temporal vein and the end-to-end thoracic vein. Reinnervation of sternum-hyoid muscle is performed by superimposition of nerve anastomosis: end of nerve of autograft is sutured together with masticatory branch of trigeminal nerve and second end of sural nerve autograft. Edges of the wound are compared and closed in layers.

EFFECT: method enables surgical intervention in one stage, considerable reduction of rehabilitation time of patients, improved aesthetic and functional results, achieving a satisfactory range of motions on the affected side, which are friendly to the healthy side.

1 cl, 1 ex, 2 dwg