RU-2861319-C1 - METHOD FOR ELIMINATING SADDLE NOSE DEFORMITY

RU2861319C1RU 2861319 C1RU2861319 C1RU 2861319C1RU-2861319-C1

Abstract

FIELD: medicine. SUBSTANCE: invention relates to plastic surgery, otorhinolaryngology, maxillofacial surgery, and can be used to eliminate saddle nose deformity. A perforated membrane made of 100% PDLLA measuring 25 mm × 30 mm × 0.2 mm is overlaid with thin cartilage grafts 1.5 mm thick and fixed with PDS 5/0 suture material so as to cover the entire surface of the membrane. The formed graft is placed between the mucosal layers after mobilisation of the nasal bones and fixed with PDS 4/0 sutures to the anterior nasal spine and nasal bones. EFFECT: reduction of the risk of infection and extrusion of the graft, restoration of the lost nasal septum, and due to the fact that the new strong septum lifts the entire complex of nasal bones and triangular cartilages, eliminating saddle nose deformity due to the combination of techniques of the claimed invention. 1 cl, 1 ex

Inventors

Makarov Andrej Vitalevich
Korableva Natalya Petrovna
PAVLOV PAVEL VLADIMIROVICH

Dates

Publication Date: 20260504
Application Date: 20250207

Claims (1)

A method for eliminating saddle-shaped nasal deformity involving the application of a polymer membrane, characterized in that thin cartilage grafts 1.5 mm thick are applied to a perforated membrane made of 100% PDLLA measuring 25 mm × 30 mm × 0.2 mm and fixed with PDS 5/0 suture material in such a way as to cover the entire surface of the membrane, the formed graft is placed between the mucous membrane layers after mobilization of the nasal bones and fixed with PDS 4/0 sutures to the anterior nasal spine and nasal bones.

Description

The invention relates to medicine, in particular to plastic surgery, otolaryngology, maxillofacial surgery, and can be used in functional operations to straighten a deviated nasal septum in patients with nasal obstruction and simultaneously eliminate saddle-shaped deformity of the nose. A method for eliminating saddle nose deformity using preserving rhinoplasty is known (Toriumi DM, Kovacevic M. Correction of the Saddle Nose Deformity Using the "Push Up" Technique. Facial Plast Surg. 2022 Sep 29. doi: 10.11055/a-1803-6341. Epub ahead of print. PMID: 36174648.) The main disadvantage of this method is the need for a large amount of plastic material - sometimes it is necessary to take cartilage from two ribs. The closest to the claimed method is the elimination of saddle nose deformity using a polymer membrane made of lactic acid [Kim JG, Rhee SC, Cho PD, Kim DJ, Lee SH. Absorbable plate as a perpendicular strut for acute saddle nose deformities. Arch Plast Surg. 2012 Mar;39(2):1 13-7. doi: 10.5999/aps.2012.39.2.113. Epub 2012 Mar 14. PMID: 22783509; PMCID: РМС3385309]. A disadvantage of the prototype method is that it is used for saddle-shaped deformities following nasal bone fractures and is aimed at localized elevation of the nasal bones at the fracture site. The cartilaginous portion of the nasal dorsum, consisting of the triangular cartilage complex and the nasal septum, is not elevated. In the prototype, the membrane is 2 mm thick. When placed deep under the nasal bones, breathing problems will not occur because the septum in this area is normally of the same thickness. If it is placed under the cartilaginous dorsum (the triangular cartilage complex and the septum), the nose will not breathe due to its thickness and the long time it takes to dissolve. Anatomically, the septum thickness at the anterior septal angle is up to 0.9-1 mm. In the prototype, surgeons use a membrane designed for orthopedics and traumatology, so its length and thickness are quite large. Because the polymer contains not only lactic acid but also glycolic acid, the resorption period is also very long - 2 years, which can potentially cause implant extrusion or an infection if, for example, the patient is injured. The objective of the present invention is to achieve a stable and long-term result in the formation of a straight nasal septum and the elimination of saddle-shaped deformity. The technical result of the set task is achieved by the fact that in the method for eliminating saddle-shaped deformity of the nose, including the application of a polymer membrane, thin cartilage grafts with a thickness of 1.5 mm are applied to a perforated membrane made of 100% PDLLA with dimensions of 25 mm × 30 mm × 0.2 mm and fixed with PDS 5/0 suture material in such a way as to cover the entire surface of the membrane, the formed graft is placed between the layers of the mucous membrane after mobilization of the nasal bones and fixed with PDS 4/0 sutures to the anterior nasal spine and nasal bones. The formed sandwich graft is placed between the mucoperichondrial flaps of the nasal septum after mobilization of the bony pyramid and fixed with 4/0 PDS sutures to the anterior nasal spine and 4/0 PDS sutures to the nasal bones. The implantation of a sandwich graft made of a perforated membrane of 100% PDLLA (Poly-D-L-lactic acid) and cartilage grafts between the mucoperichondrial flaps allows for the restoration of the lost nasal septum and, due to the fact that the new strong septum lifts the entire complex of nasal bones and triangular cartilages, the saddle-shaped deformity is eliminated. The 100% PDLLA (Poly-D-L-lactic acid) membrane, measuring 25 mm x 30 mm x 0.2 mm, dissolves within 3 months, leaving dense connective tissue. Therefore, the risk of infection and implant extrusion is minimal, unlike the prototype. Structural support of the nasal dorsum after resorption is provided by cartilage grafts. The membrane acts as a matrix that holds the cartilage fragments in place until resorption occurs. Because the cartilage covers the entire surface of the membrane, after its resorption, a nasal septum is formed whose parameters closely match those of an intact, healthy person. The membrane size of 25 mm × 30 mm is important, as this length and width correspond to the natural dimensions of the nasal septum in most cases. The minimum membrane thickness of 0.2 mm eliminates the risk of airway obstruction. The membrane is sufficiently rigid, so despite its relatively thin thickness, it allows for secure fixation of cartilage autografts. The risk of infection and implant extrusion is minimal. The use of 5/0 polydioxanone threads is due to the fact that they have a minimal inflammatory reaction during resorption, cause less tissue damage, and provide long-term fixation of cartilage grafts until a solid cartilaginous septum is formed. The technique is as follows. An open approach to rhinoplasty in cases of saddle-shaped deformity is preferred. During the s