METHOD OF SURGICAL ACCESS WHEN PERFORMING OPERATIONS TO REMOVE BENIGN TUMORS OF THE PAROTID SALIVARY GLAND Russian patent published in 2023 - IPC A61B17/00 A61B17/322 A61N1/18 

FIELD: medicine.

SUBSTANCE: invention relates to maxillofacial, reconstructive, plastic surgery. Marking is carried out with a solution of brilliant green in the pre-auricular region. Hydropreparation of soft tissues is carried out. A horizontal linear incision is made in the hairy zone of the temporal region with a length of 30–35 mm to the projection of the helix of the auricle. The incision is continued intraauricularly: along the inner surface of the helix of the auricle, the top of the tragus, up to the lobe of the auricle, bordering the latter. The incision continues to the mastoid region, where it further descends in the scalp of the occipital region up to 70 mm long. The skin-fat flap is mobilized to the vertical border drawn from the lateral corner of the eye, the corner of the mouth, and the anterior edge of the masticatory muscle. Next, hydropreparation of the SMAS flap is performed. Using monopolar electrocoagulation in cutting mode, a horizontal SMAS incision is made over the projection of the upper edge of the zygomatic arch, 30–35 mm long. Further vertically to the projection of the anterior edge of the sternocleidomastoid muscle 60–70 mm long. The SMAS flap is isolated and mobilized up to the vertical border drawn from the lateral corner of the eye, the corner of the mouth, and the front edge of the masseter muscle. The posterior edge of the parotid gland is isolated and mobilized from the cartilaginous part of the outer ear — the tragus and the intertragus notch. The trunk of the facial nerve is isolated in the region of exit from the stylomastoid foramen. The parenchyma of the parotid gland is excised above the trunk and branches of the facial nerve: temporal, zygomatic, buccal, marginal, cervical, followed by resection of the parotid gland and removal of the tumor, depending on its location. The SMAS flap is rotated into place, distributed along the perimeter of the wound over the trunk and branches of the facial nerve, and fixed with interrupted sutures with 4-0 Vicryl suture. The skin-fat flap is returned to its place and fixed along the perimeter of the wound in the temporal zone with a twist suture with a 5-0 Prolene thread, intraauricularly and in the region of the lobe with interrupted sutures with a 5-0 Prolene thread, in the behind-the-ear region with a twist suture with a 5-0 Prolene thread, in the mastoid and occipital regions with interrupted sutures at a distance of 0.5 cm with a 5-0 prolene thread. Drainages are brought into the wound in the amount of 2–3 pieces from silicone tubes, which are removed for 3–4 days.

EFFECT: method makes it possible to widely visualize the area of the parotid-masticatory region and freely perform the selection of the branches of the facial nerve of the parotid salivary gland, prevent the formation of salivary fistulas, achieve a high aesthetic result, and avoid scar corrections in the future.

1 cl, 4 dwg, 2 ex