METHOD FOR SURGICAL APPROACH TO NASAL BONES WITH OSTEOTOMY IN SIMULTANEOUS OPERATIONS WITH ORTHOGNATHOUS INTERVENTION AND RHINOPLASTY Russian patent published in 2022 - IPC A61B17/00 A61B17/24 A61B6/14 

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely, to dental surgery and maxillofacial surgery. The mucous membrane is incised with subsequent approach to the maxillary bone of the patient. Herewith, in the preoperative period, prior to orthognathous intervention, the volume and size of the maxillary bone deformities of the patient subject to surgical treatment are determined by spiral computed tomography. Using an overview scanogram, multiplanar reconstructions of the image of the patient's maxilla are built in three planes: coronary, frontal, and sagittal. Then, after endotracheal anaesthesia and antiseptic treatment of the surgical area, nerve block and infiltration anaesthesia are performed in the maxillary region. The upper lip of the patient is elevated with tension. A V-shaped incision of the mucous membrane is performed from the mesial surface of the first premolar to the upper frenulum with a margin of 4 to 5 mm above the attached gum to the midpoint between the vermilion border of the upper lip and the point of attachment of the upper frenulum of the patient. The mucous membrane, the depressor muscle of the nose septum, the alar and transverse parts of the nasal muscle, the orbicular muscle of the mouth, and the periosteum are herein dissected in a single movement. After the incision, the musculomucosal flap is retained and pulled down. The maxillary bone of the patient is exposed, and the orbicular muscle of the mouth, the depressor muscle of the nose septum, the alar and transverse parts of the nasal muscle, the buccinator muscle, and the nasal muscle are separated from the maxillary bone by means of a raspatory, providing approach to the maxillary bone of the patient and visualisation thereof prior to orthognathous intervention. The nasal septum is separated from the maxillary bone of the patient using a raspatory or a reciprocating saw. Osteotomy of the patient's maxilla is performed with a margin of 3 to 3.5 mm from the tooth root apexes using reciprocal saws or a piezoelectric knife, starting from the distal maxilla — the zygomatic alveolar crest, in the direction of the pyriform aperture on one side of the maxilla, and then osteotomy is performed on the other side of the maxilla. The maxilla is mobilised by separation using a bent gouge and a hammer. The patient's maxilla is positioned according to a premade splint and fixed in the set position using mini screws and mini plates. The same approach is then used to skeletonise the bones of the nasal "pyramid" using a raspatory and perform lateral osteotomy of the nasal bones using a reciprocating saw or a piezoelectric knife. Herewith, a micro osteotome is passed to the edge of the pyriform aperture, starting osteotomy in the area of the ascending maxillary process at the point of attachment of the lower nasal concha. Then, in order to correct the width of the base of the nose alae, an approximating "Cinch suture" is applied to the nose alae, and the nasal septum is fixed by passing a seam through the septum and the aperture in the area of the base of the anterior nasal spine consecutively on both sides, forming an "eight"-shaped suture configuration. Herewith, in order to apply an approximation suture to the nose alae, the upper lip is turned outwards by the thumbs, placing the index finger outside in the area of attachment of the nose ala, and with the lip turned outward, capturing the lateral portion of soft tissues in the area of the nose ala, located under the index finger, using surgical forceps. Then the patient's upper lip is released, and the soft tissues are pulled inward, controlling the degree of displacement of the nose ala. A suture is applied to the tissues secured with the forceps using a resorbable suture material. The suture is tightened to approximate the nose alae with planned hypercorrection by 3 mm, with account to the predicted postoperative expansion of the base of the nose. The incision in the soft tissues is sutured in layers. The mucosa is sutured together with the resorbable suture material using the "V-Y" technique with mandatory central alignment.

EFFECT: possibility of sufficient and necessary visualisation of the maxillary bone of the patient during orthognathous intervention, of minimising the circulatory disorders in the area of soft tissues of the perioral, subglacial and buccal regions, lowering the risk of necrosis of the osteotomised fragment of the maxilla, preventing the occurrence of a torn wound of muscle fibres, and shortening the rehabilitation period of the patient.

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