METHOD FOR DYNAMIC CORRECTION OF PARALYSIS OF THE MUSCLE THAT LOWERS THE LOWER LIP Russian patent published in 2022 - IPC A61B17/24 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to maxillofacial surgery. Submandibular access is performed on the side of paralysis, the anterior belly of the digastric muscle is cut off from the digastric fossa of the lower jaw. The tendon of the digastric muscle is cut off from the hyoid bone, the posterior belly of the digastric muscle is cut at the border of the anterior and middle thirds. The perforating neurovascular bundle of the anterior belly of the digastric muscle is isolated and preserved. Complete mobilization of the muscle flap is achieved, which includes the anterior belly, tendon and the anterior third of the posterior belly of the digastric muscle. After that, an incision is made along the border of the red border of the lower lip from the corner of the mouth to the middle of the lower lip. Next, a subcutaneous tunnel is formed from the previously performed submandibular access to the lower lip, the anterior end of the anterior belly of the digastric muscle is fixed with sutures to the hyoid bone. Longitudinal incisions are made in the anterior third of the posterior abdomen and divided into 3 equal parts, the anterior third of the posterior abdomen, the tendon and part of the anterior abdomen of the digastric muscle are passed into the formed subcutaneous tunnel. Then 3 parts of the anterior third of the posterior abdomen are fixed with sutures to the circular muscle of the mouth and the red border in the area of ​​the corner, middle and lateral third of the lower lip. After that, the hypoglossal and large auricular nerves are isolated, the large auricular nerve is crossed proximally at the level of the anterior edge of the sternocleidomastoid muscle and distally after the branching of the large auricular nerve into the anterior and posterior branches. Then, using microsurgical techniques, 40% of the fasciculi of the hypoglossal nerve, as well as 40% of the fascicles of the perforant nerve of the anterior belly of the digastric muscle, are isolated and transected, after which microsurgical anastomoses are performed between 40% of the fasciculi of the hypoglossal nerve and the proximal part of the greater auricular nerve, between the posterior branch of the greater auricular nerve and 40% of the fasciculi of the perforant nerve of the anterior belly of the digastric muscle, between the anterior branch of the greater auricular nerve and the anterior belly of the digastric muscle, according to the type of neurotization.

EFFECT: method allows to improve the functional and aesthetic results of treatment of patients with facial paralysis due to the use of nearby donor anatomical structures, taking into account the anatomical features of the patient with a minimal risk of damage to the perforating neurovascular bundle of the anterior belly of the digastric muscle and minimal donor damage to the chewing function, as well as to achieve a correct vector traction of the lower lip, identical to the muscle that lowers the lower lip, is normal.

1 cl, 11 dwg, 1 ex