SURGICAL APPROACH TO PAROTID GLAND, FACIAL NERVE AND TEMPOROMANDIBULAR JOINT IN PATIENTS WITH ANOTIA

摘要

FIELD: medicine. ;SUBSTANCE: invention relates to medicine, namely to maxillofacial surgery, and can be used for surgical access to the parotid salivary gland, facial nerve and temporomandibular joint in patients with congenital anotia. According to the previously performed multislice computed tomography using software, a stereolithographic template is produced in a mirror image relative to the healthy ear. During the operation, the template is fitted to the area of the missing auricle and the skin is marked 3-4 mm outward relative to the lower, anterior and posterior edges of the template. The markings are extended forward and upward into the temporal region by 1-2 cm towards the outer edge of the eyebrow, extending the marking from the back surface of the template back along the border of the scalp to the projection of the posterior midline. According to the performed markings, an oblique skin incision is made with a length of 1-2 cm in the temporal region, the skin incision is extended by 60-70 mm vertically downward in the assumed pre-auricular region, not reaching 3-4 mm to the edge of the template. The incision is extended, bending around the area of the intended earlobe. The incision is extended vertically upward in the intended area behind the ear, not reaching 3-4 mm to the edge of the template. The incision is extended horizontally along the border of the scalp to the projection of the posterior midline. Then the stereolithographic template is removed. The skin, subcutaneous fatty tissue and the superficial musculo-aponeurotic system are cut. Using the method of acute and blunt dissection, the cutaneous-subcutaneous-fascial flap is peeled down, anteriorly and posteriorly, without affecting the area of the subsequently formed auricle from the costal cartilaginous autograft. To access the temporomandibular joint, the capsule of the joint is dissected, the branch of the lower jaw and the glenoid fossa of the temporal bone are skeletonized; to access the parotid gland and the facial nerve, the large ear nerve is isolated in the region of the anterior edge of the sternocleidomastoid muscle. Anteriorly and inward from the greater auricular nerve, the styloid opening of the temporal bone, the trunk of the facial nerve are isolated, the capsule of the parotid salivary gland is dissected, and the branches of the facial nerve are isolated.;EFFECT: method provides a high functional and aesthetic result of operations on the parotid salivary gland, facial nerve and temporomandibular joint in patients due to wide access to the parotid salivary gland, facial nerve and temporomandibular joint and maintaining the intactness of soft tissues in the area of possible implantation of costal cartilaginous autotransplant to eliminate the defect of the auricle.;1 cl, 3 dwg, 1 ex