METHOD OF EXTENDED ENDOSCOPIC FRONTOTOMY Russian patent published in 2024 - IPC A61B17/24 A61B17/94 

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: vascularized mucoperiosteal flap with a feeding base is formed on the lateral wall of the nasal cavity. A U-shaped incision is made to form the distal and proximal parts of the specified flap. After this, an endoscopic frontotomy of the Draf IIb type is performed. After the formation of the expanded anastomosis of the frontal sinus is completed and the pathological process is eliminated, the formed flap is placed in the area of de-epithelialized bone tissue. When performing a U-shaped incision, a ventral incision is made first. To form it, the anterior border of the roof of the nasal cavity is found. Next, an incision is made along the lateral wall of the nasal cavity from the anterior upper edge of the inferior turbinate vertically upward to the anterior border of the roof of the nasal cavity. After this, the incision is continued along the anterior border of the roof of the nasal cavity horizontally. The incision is then made vertically down the nasal septum to one third of its height, completing the incision. Next, through a ventral incision, the mucous membrane with the periosteum is separated towards the olfactory fossa to the point where the first filament of the olfactory nerve exits the cranial cavity. Moving 1.0–2.0 mm anteriorly from it, the point through which the dorsal incision is made is determined, starting on the lateral wall of the nasal cavity above the inferior turbinate, in a place immediately in front of the free end of the lower third of the middle turbinate. The incision is made vertically upward towards the place of attachment of the middle turbinate to the lateral wall of the nasal cavity in the area of the nasal tubercle. Next, the dorsal incision is continued horizontally through the above point along the roof of the nasal cavity. Then the incision is made along the nasal septum vertically down to one third of its height parallel to the ventral incision, after which the dorsal incision is completed. Then a horizontal incision is made between the ends of the ventral incision and the dorsal incision on the septum of the nasal cavity from back to front, combining them into a common U-shaped incision. Next, the mucous membrane and periosteum located inside the perimeter of the U-shaped incision are separated. First, the distal section of the flap is separated in the area of the horizontal incision, and then the entire flap from the bony skeleton of the nasal cavity with movements from front to back is completely mobilized, forming a vascularized flap with a donor site in the area of the lateral wall of the nasal cavity with further transition to the roof of the nasal cavity and the upper third of the septum nose.

EFFECT: method allows to prevent cicatricial stenosis of the formed anastomosis of the frontal sinus after extended frontotomy by intraoperative epithelization of exposed bone tissue.

3 cl, 4 dwg, 2 ex