METHOD FOR ELIMINATING DEFECT AND DEFORMATION OF THE PAROTIDEOMASSETERIC REGION WITH A SUPERFICIAL MUSCULO-APONEUROTIC SYSTEM (SMAS) Russian patent published in 2022 - IPC A61B17/00 A61B17/322 A61N1/18 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to maxillofacial, reconstructive, and plastic surgery. Marking is applied with a solution of brilliant green in the preauricular-postauricular region. Hydrotreatment of the soft tissues is performed at the level of subcutaneous fat. A horizontal linear incision is made in the temporal region in the scalp area with a length of up to 35 mm until the projection of the tragus. Then the incision is continued preauricularly along the top of the tragus to the lobe of the auricle, bordering the latter. The incision is continued to the mastoid region along the hairline in the view of the sternocleidomastoid muscle. The adipocutaneous flap is mobilised by the method for sharp and blunt dissection to the vertical border drawn from the lateral corner of the eye, corner of the mouth, anterior edge of the masseter muscle with a total incision length of 15 cm. Hydrotreatment of the flap of the superficial muscular-aponeurotic system (SMAS) is then performed. A horizontal incision of the SMAS flap is then made above the projection of the upper edge of the zygomatic arch with a length of up to 35 mm by means of monopolar electrocoagulation in the cutting mode. The incision is then continued vertically to the projection of the anterior edge of the sternocleidomastoid muscle with a length of 60 to 70 mm. The SMAS flap is mobilised by the method for blunt dissection to the vertical border drawn from the lateral corner of the eye, corner of the mouth, anterior edge of the masseter muscle. The posterior edge of the parotid gland is isolated and mobilised from the cartilaginous outer ear: the tragus and the intertragic notch. The trunk of the facial nerve is isolated in the area of the exit from the stylomastoid foramen. The parenchyma of the parotid gland is excised above the trunk and the branches of the facial nerve: temporal, zygomatic, buccal, marginal, and cervical, followed by resecting the parotid gland and the tumour depending on the localisation thereof in the superficial lobe of the parotid salivary gland. The SMAS flap is rotated into place, distributed along the perimeter of the wound over the trunk and branches of the facial nerve, and secured with interrupted and continuous sutures. The adipocutaneous flap is returned into place and secured along the perimeter of the wound with interrupted and continuous sutures. 2 to 3 drains made of silicone tubes are passed into the wound and removed on day 3–4.

EFFECT: possibility of eliminating a soft tissue defect of the parotideomasseteric region and isolating the trunk and branches of the facial and trifacial nerves without free tissue transfer and use of microsurgical equipment, visualising the invasion volume of the tumour, preventing the occurrence of early and long-term postoperative complications, achieving a high aesthetic result, and avoiding future corrective operations.

1 cl, 6 dwg, 2 ex