Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
.pdf
Results
https://t.me/med1917
a
5 Eyelid Surgery – Blepharoplasty
Fig. 5.42
b
a Before:
b After: The same patient 12 months later following upper and lower
A 54-year-old man with upper eyelid ptosis and lacrimal sacks
eyelid blepharoplasty with silk purse string suture
a
Fig. 5.43
b
a Before: Patient with pronounced baggy eyes and drooping eyelids. She
experiences swelling (which is most noticeable in the morning)
intheentirelowereyelidregion
b After: The same patient 12 months after upper and lower eyelid
blepharoplasty
223
5 Eyelid Surgery – Blepharoplasty
https://t.me/med1917
Tips and Tricks
Up per eyelid surgery is as easy to perform as lower eyelid surgery is
difficult. Lower eyelid surgery is one of the most difficult operations
in aesthetic facial surgery. The surgeon requires extensive skill and
experience. Rather than the skin resection taking priority, the
removal of the adipose tissue compartment (lateral, intermediary,
andmedial)andastripofmusclearedecisive.Novicesshouldexercise great caution during skin resection, since even millimeters can
make a difference. It is preferable to leave a little extra skin in order
to avoid ectropion.
During blepharoplasty of the upper lid, the orbital septum should
only be divided in the medial region, as injury of the lacrimal gland
in the lateral region of the lid can occur.
In eyelid surgery, bleeding should be avoided under all circumstances.
The principle errors include removing too little or too much adipose
tissue (sunken eye), as well as excessive skin removal. Upper eyelid
surgery is easy to perform. It is important that marking is carried
out while the patient is awake and upright. Excess skin must be
accurately marked. Following skin resection, removal of the medial
adipose tissue compartment should not be forgotten. Exact hemostasis is very important (three-stage hemostasis).
224
The inexperienced surgeon has a tendency towards excessive cutaneous and adipose tissue resection. It is not rare that this will lead to
ectropion or a sunken eye. On the lower lid, “less is more.”
https://t.me/med1917
6 Otoplasty
https://t.me/med1917
Mang Procedure:
Combination of the Stenström and Converse Procedures
䊏
Introduction 228
䊏
Anatomical Overview 229
䊏
Instruments and Medication 230
䊏
Photographic Documentation 232
䊏
Preliminary Examination of the Ear 232
䊏
Surgical Planning 233
䊏
Disinfection 233
䊏
Preliminary Marking of Incision Lines 234
䊏
Local Anesthesia 234
䊏
Incision 236
䊏
Skin Resection 238
䊏
Exposure of the Dorsal Surface of the Auricular Cartilage 240
6 Otoplasty
䊏
Preparation of the Auricular Concha 242
1. Marking with Fine Needles 242
2. Marking of Incision Lines 242
3. Incision of Conchal Cartilage 244
4. Blunt Cartilage Dissection 244
䊏
Resection of the Concha 246
䊏
Reshaping the Anthelix 248
䊏
Cartilage Sutures 254
䊏
Wound Closure 256
䊏
Identical Approach on the Contralateral Side 256
䊏
Dressing 258
䊏
Postoperative T reatment and Precautions 258
䊏
Results 259
䊏
Tips and Tricks 261
The symbol indicates parts of the procedures shown in the video
227
6 Otoplasty
https://t.me/med1917
Introduction
Among the numerous anomalies which can occur in the head and neck
region, protruding ears are certainly one of the most common. The two
most frequent causes of this condition are a disproportionately shaped
cavity of concha and an underdeveloped anthelical fold.
The standard operations for otoplasty make use of the techniques
developed by Pitanguy, Converse, Stenvers, Stenström, and Mustard e,
among others. Our own procedure is a combina tion of the surgical
procedures developed by Stenvers and Stenström.
The aim of otoplasty is to reduce the angle between the ear and the
head to 25°–30° . The incision is placed on the dorsal side of the auricle
to ensure that the operation leaves no visible scars.
By the end of the operation the auricle should have assumed its final
desired position without any tension. The belief that the aesthetic outcome can be influenced by the application of corrective dressings is fallacious. The modified technique described in this chapter will substantially lower the recurrence rate. In the hands of a competent surgeon,
otoplasty is an uncomplicat ed procedure within the field of aesthetic
facial surgery. For patients with deformities of the ears (e.g., protruding
ears), it can be recommended from ages 5–6 onward.
228
1
https://t.me/med1917
6 Otoplasty
23
22
21
20
19
18
17
16
15
Anatomical Overview (Fig. 6.1)
2
3
4
5
6
7
8
9
10
11
12
13
14
1. Temporoparietal muscle
2. Crura of anthelix
3. Greater muscle of helix
4. Cymba
5. Anterior incisure of the ear
6. Lesser muscle of helix
7. Crus of helix
8. Bony external acoustic meatus
9. Muscle of tragus
10. Tragus
11. Antitragus
12. Intertragic incisure
13. Antitragohelicine fissure
14. Auricular lobe
15. Helix
16. Antitragus muscle
17. Cavity of concha
18. Posterior auricular muscle
19. Concha of auricle
20. Auricular tubercle
21. Anthelix
22. Scapha
23. Triangular fossa
229
6 Otoplasty
https://t.me/med1917
Instruments and Medication (Fig. 6.2)
1 Delicate long single-pronged wound retractor
2 Delicate long two-pronged wound retractor
3 Sharp two-pronged roller hook Mang
4 Dissecting scissors Wullstein
5 Scalpel handle
6 Tweezers Adson-Brown
7 Large surgical tweezers
8 Needle holder small
)
4 20-gauge needles
)
Electrocoagulation forceps
)
Marking pen
)
Scandicaine with epinephrine (mepivacainehydrochloride),
1:200,000 (approx. 30 ml)
)
Cetrimide solution (1%) for hair and skin disinfection
)
Antibiotic ointment
)
Gauze strips (approx. 2 m × 1 cm)
)
Compresses(10×10cm)
)
Prolene suture material (6/0)
)
PDS suture material (4/0)
)
Elastic bandage (6 cm × 5 m)
)
Zinc oxide dressing
230
1
https://t.me/med1917
6 Otoplasty
2
3
4
5
6
7
8
Fig. 6.2
231
6 Otoplasty
https://t.me/med1917
Photographic Documentation
Overview image: Whole head with neck
Borders: Cranial: crown
Caudal: jugulum
Right/left: edge of the helix
– From the front
– From the back
– 90° Laterally from right to left
Detailed images: Whole ear
Borders: Cranial: 2–4 cm cranially from the helix
Caudal: mandibular angle
Right/left: zygomatic process, mastoid process (ear in the centre)
Preliminary Examination of the Ear
䊏
Determination of the shape, size, and position of the auricle
䊏
Evaluation of the auricle position ventrally, cranially, dorsally, and in
profile
䊏
Determination of the conchal-scapha angle (normally 90° )
䊏
Determination of the mastoid-scapha angle (normally 30°)
䊏
Evaluation of auricle shape (helix, anthelix, concha, lobule). The preliminary examination should include an inspection of the external ear
canal and tympanic membrane.
232
Surgical Planning
https://t.me/med1917
Otoplasty can generally be performed in patients aged 5 years and
older, since no significant growth of the auricle is expected after this
age.
In patients 10 years of age and older, the procedure can be carried out
without any difficulty under local anesthesia.
䊏
Measurement of the distance between the helix and the lateral facial
region
䊏
Evaluation of the shape of the anthelix fold
䊏
Evaluationofthecavityofconcha
䊏
Evaluation of the lobule of the auricle
In general, the objectives of this procedure are to reduce the size of the
cavity of concha, reshape the anthelix, and reposition the smaller,
reshaped auricle closer to the head.
Disinfection
䊏
As is done before facelift and brow lift surgery, the entire head, including the hair, is disinfected.
6 Otoplasty
Shaving is not necessary .
233
Соседние файлы в папке Библиотека им академика М.И. Перельмана