METHOD FOR SURGICAL MANAGEMENT OF ADVANCED TUMOURS OF MIDDLE ONE-THIRD OF FACIAL SKELETON, NASAL CAVITY AND PARANASAL SINUSES Russian patent published in 2025 - IPC A61B17/24 A61B17/56 A61B18/08 A61B17/86 A61K31/26 G01N33/533 A61P43/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery. Hydropreparation of soft tissues of upper and middle one-third of facial skeleton is performed. Preoperative marking and full-thickness incision 2 cm posteriorly from a hairline between apexes of auricles in a coronary projection is performed using a scalpel blade and a bipolar coagulator, performing haemostasis. That is followed by additional marking around the lower and upper eyelids on one side. It involves blunt dissection of soft tissues with inclusion of superficial and deep muscular-aponeurotic systems, facial muscles, facial nerve from periosteum of facial skull. Temporal muscle and the covering fascia are not included in the volume of the lifted tissues. Supratrochlear nerve bundle is separated. Longitudinal incision of an aponeurosis of a supracranial muscle is made within 15 mm from a projection of its exit from an orbit. Supratrochlear branch of the trigeminal nerve is visualized. Prolene 6-0 is used to mark places where nerve transection is planned. Nerve between the marking points is cut with a sharp blade. Skin and soft tissues are incised at the ciliary edge according to the preliminary marking bordering the upper and lower eyelids from the side of interest. Dissection of soft tissues is continued with inclusion of circular muscle of eye in volume of lifted tissues up to zygomatic arch. Approach is prolonged below the zygomatic arch by separating and transecting an infraorbital nerve bundle. Then attachment points of tendons of facial muscles to bones of facial skull are fixed with miniscrews of diameter 2.5 mm and length of 5 mm. Appropriate edges of facial muscles are marked with Prolen 6-0. Muscles are transected by a sharp path between a miniscrew and a marking thread. Dissection of soft tissues is continued caudally, providing access to eye socket, paranasal sinuses, nasal cavity. Tumour spread is visually assessed, and the main stage of the operation is the removal of the tumour within healthy tissues. Facial soft tissues are repositioned. Then 1 ml of indocyanine green is injected intravenously, performing fluorescent visualization and evaluation of blood supply of soft tissues of buccal and zygomatic areas – "mask" of face, as well as blood supply of displaced tissues used at reconstructive stage. Tendons and transected facial muscles are sutured with precision in places of preliminary marking. Anastomosis is applied between axons of the transected supratrochlear nerve using a microsurgical technique with Prolen 10-0 suture. Latex tissue adhesive is applied on the frontal bone for 5 minutes. Reduction of soft tissues is continued. Layer-by-layer wound closure is performed with leaving passive drains. In the area of the previously incised lower and upper eyelids, suture is applied with Prolen 6-0.

EFFECT: method enables to avoid disorders of upper eyelid movement, paresis of facial muscles and sensory disturbances in frontal region during surgical treatment of advanced tumours of middle one-third of facial skeleton, nasal cavity and paranasal sinuses, reducing the risk of facial soft tissue sagging, rejection and necrosis of the facial soft tissue flap, achieving a satisfactory aesthetic result.

6 cl, 2 dwg, 3 ex