METHOD OF PLASTIC SURGERY OF THE FACIAL NERVE IN CASE OF ITS INTRACANAL LESION Russian patent published in 2023 - IPC A61B17/00 

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: extended antromastoidectomy is performed with removal of the posterior wall of the external auditory canal. The autofascia of the temporal muscle is taken. The external auditory meatus is closed tightly. Translabyrinthine access to the internal auditory canal (IAS) is performed. After identifying the VSP along its entire length, its membrane is opened, and the pathological formation is removed. The VSP nerves are inspected, the facial nerve is identified along its entire length. If a defect in the trunk of the facial nerve in the intracanal segment is detected, a decision is made on its reconstruction. To do this, the facial nerve is skeletonized in the mastoid and tympanic sections, the bone mass is removed above the geniculate ganglion and the greater petrosal nerve (BKN). The distal end of the damaged nerve is decanalized throughout from the labyrinth to the lower third of the mastoid region. With a diamond bur, a bone groove is formed for a new course of the facial nerve from the level of the internal opening of the VSP to the unchanged distal segment of the facial nerve. Excision of the damaged area of the nerve is performed. With a defect of the facial nerve trunk up to 10.0 mm, the distal end of the nerve is compared with the endoneural surface with the same surface of the proximal part of the nerve, end-to-end suturing of the ends of the nerve is performed with the imposition of several interrupted epiperineural sutures. The anastomosis area is covered with a fragment of autofascia and placed in the formed bone groove. If the defect of the facial nerve trunk is more than 10.0 mm, a graft prepared for this purpose, suitable for the content of axons and along the length of the nerve, is placed in the formed bone canal, the endoneural surfaces of the graft are combined with the endoneural surfaces of the distal and proximal ends of the facial nerve. Separate nodal sutures are applied to the junctions. Then they are covered with fascial flaps. The internal auditory meatus is closed with a fascial flap. The antromastoid and trepanation cavity is tamponed with auto-fat.

EFFECT: method allows to create conditions in the area of the internal auditory canal for plastic surgery of the facial nerve in a limited space and create optimal conditions for its recovery in case of intracanal lesions due to tumor processes and injuries at the level of the labyrinth segment with a defect length of less than 10.0 mm, and also more than 10.0 mm, restore the functions of mimic muscles.

1 cl, 13 dwg, 2 ex