METHOD OF ELIMINATION OF PARALYTIC EVERSION WITH RESTORATION OF THE SUPPORTING FUNCTION OF THE LOWER EYELID Russian patent published in 2023 - IPC A61F9/07 A61L27/36 

FIELD: medicine, ophthalmology, reconstructive, plastic and maxillofacial surgery.

SUBSTANCE: invention can be used to eliminate paralytic eversion with the restoration of the support function of the lower eyelid. Multislice computed tomography of the orbit and periorbital region is performed. A 3-D model of the orbit and periorbital region is made. In the region of the lower and lower outer edges of the 3-D model of the orbit, a medical wax template is formed. The template has a supporting lower part corresponding to the lower and lower outer edge of the orbit, represented by the anterior, corresponding to the anterior upper surface of the upper jaw, and the posterior wing, corresponding to the lower and lower outer surface of the orbit wall in its anterior sections, an elevated console from the place of their contact, at the level of the lower and lower outer edges of the orbit. Next, it is tried on and adjusted in such a way as to raise the costal edge of the lower eyelid by 2–3 mm above the lower limbus. Then a plaster mold is made according to the template. A polymer endoprosthesis is formed in the mold, which is then perforated by making through holes along its anteroinferior wing. Then it is subjected to pre-sterilization treatment and sterilization in an autoclave for 40 minutes at 120 degrees Celsius and 1.1 atmosphere pressure. The operation is performed under combined endotracheal anesthesia. The operating field is treated with antiseptics. Next, hydropreparation of the tissues of the lower eyelid is performed. A scalpel is used to make a subciliary skin incision from the projection of the lacrimal punctum to the projection of the outer edge of the orbit along the edge of the eyelid, 1–1.5 mm away from the ciliary edge, and then laterally and downward along the skin fold. Then the skin is separated along the entire length of the incision from the circular muscle by 6–8 mm towards the orbital edge. At the same level, the circular muscle is bluntly opened with scissors parallel to the skin incision throughout. The musculoskeletal flap is separated towards the orbital edge, parallel to which the orbital septum is opened along the lower and lower outer edges of the orbit. Further, in the lateral sections of the eyelid, a pentagonal fragment is excised, starting with its base from the costal edge of the eyelid, forming its through defect. Two opposite lateral edges of the fragment continue throughout the entire thickness of the inner (posterior) surgical plate of the eyelid, are 10–12 mm long and are perpendicular to the base, and then continue towards each other, forming a pentagonal defect. Its top is turned to the lower orbital edge. Then, through the top of the formed pentagonal defect of the eyelid, from the side of the palpebral conjunctiva, a U-shaped ligature suture is made. Next, the lateral edges of the pentagonal eyelid defect are sutured together in layers. First, nodal sutures are placed on the tarsal plate so that the nodes are above its anterior surface. Then, the sutured pentagonal defect is covered from above with a mobilized flap of orbital tissue and fixed with non-through interrupted sutures 6-0 to the intact tissues of the internal surgical plate of the eyelid from the lateral and medial sides of the sutured incision to create a layer. Further, the through defect of the gray border of the costal edge of the eyelid is sutured with three interrupted sutures, which are applied to the inner rib, outer rib and in the area of the plane of the gray line. Then the periosteum is opened along the lower and lower outer edge of the orbit from the level of the projection of the nasolacrimal canal to the projection of the outer commissure of the eyelids. The periosteum is separated forward from the upper jaw and posteriorly from the lower and lower outer walls of the orbit by 10–15 mm. Hemostasis is carried out and an individually modeled polymer perforated endoprosthesis is installed in such a way that its anteroinferior wing adjoins the anterior surface of the upper jaw, the posterior inferior wing to the lower and lower outer orbital walls, and the place of their contact adapts to the lower and lower outer edges of the orbit. Then it is fixed with 3–4 U-shaped 5-0 interrupted sutures to the anterior and posterior leaf of the separated periosteum in such a way that each U-shaped suture passes through the upper edge of the anterior, from the side of the upper jaw, leaf, the base protruding towards the lower edge tarsal plate, console and upper edge of the posterior, from the side of the orbit, periosteum. At the same time, a U-shaped ligature suture previously applied to the top of the pentagonal defect covered with orbital tissue is fixed to the upper edge of the posterior periosteum. Then the orbital septum is laid and fixed with 4–6 U-shaped 5-0 interrupted sutures to the upper edge of the anterior periosteum sheet in such a way that it completely covers the console protruding towards the lower edge. After that, an interrupted suture is applied to the skin in the region of the sutured through defect of the costal edge of the eyelid between the eyelashes and the edge of the subciliary skin incision of the eyelid. The lateral edge of the orbicular muscle is fixed with an internal U-shaped 5-0 interrupted suture to the periosteum of the outer edge of the orbit in the projection of the external commissure of the eyelids. Further, an interrupted provisional suture is applied in the region of the outer corner of the eye, matching the edges of the longitudinal subciliary skin wound, and the skin wound is sutured with a continuous intradermal suture with synthetic monofilament 6-0. At the final stages of the operation, a sterile compression bandage is applied to the lower eyelid, which is changed daily in the postoperative period.

EFFECT: invention provides restoration of the anatomical and functional consistency of the lower eyelid in case of paralytic eversion due to its strengthening with the help of an individually modeled polymer endoprosthesis based on the lower edge of the orbit, made on the basis of 3-D reconstruction using MSCT data of the orbits, as well as restoration of the normal shape of the overextended atonic lower century with its tight fit to the eyeball.

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