METHOD OF ULTRASONIC OSTEOPLASTY FOR SURGICAL CORRECTION OF NASAL HUMP Russian patent published in 2024 - IPC A61B17/24 A61N7/00 A61B18/00 

FIELD: medicine; plastic surgery; otorhinolaryngology.

SUBSTANCE: under general anesthesia with an open approach with an inverted V incision on a columella, soft tissues are mobilized and elevated in the area of inferolateral cartilages in the plane above the superficial muscular-aponeurotic system of the nose. Then mobilization is performed above superolateral cartilages supraperichondrium and in the area of the bony pyramid subperiosteally in the longitudinal direction from the key zone to the root of nose and in the transverse direction from one ascending frontal process of the upper jaw to the other side. Ultrasonic osteoplasty is performed on both sides of the bony pyramid. Bone thickness is removed in the required places: first in the area of the most lateral part of the bony pyramid, then in the area of the central part of the bony pyramid. Further, the bone cap is removed with the help of ultrasound, and the cartilaginous fornix is exposed in the cranial direction by 5 mm. Base of the bony pyramid is shifted inwards. Piezoelectric instrument is used to perform an inferior lateral osteotomy combined with an incomplete transverse osteotomy. If the required displacement is not achieved, a paramedial or medial oblique osteotomy is additionally performed with the obligatory preservation of an intact portion of the bony pyramid between the osteotomy lines. Then cartilage hump is shaved off with a scalpel with preservation of intact mucosa. Cartilaginous part of the septum and the upper lateral cartilages are lowered to a height of up to 3 mm without the reconstruction of the middle arch. Through incisions of the perichondrium on both sides on the caudal edge of the septum, the perichondrium is mobilized and performing the cartilage graft sampling for the cartilage grafts leaving the L-shaped frame at least 10 mm wide. Small cartilage grafts up to 20 mm long are fixed on both sides to the caudal edge of the septum. Septum-elongating cartilage graft is fixed between grafts, to which medial pedicles of alar cartilages are fixed on both sides. New domes are created by oblique suturing on the tip of the nose and fixed to each other.

EFFECT: method enables to preserve the integrity of the osteochondral pyramid of the nose during rhinoplasty, to limit mobility of upper part of nose, to reduce perioperative trauma, postoperative pain, intensity of edema and periorbital ecchymosis.

1 cl, 2 dwg, 1 ex