Includes the removal of all mucous membrane and filling of frontal bosom a free autogenic transplant or bone-plastic material with the aim of complete liquidation of frontal bosoms.

Nasalization is applied at frontal-basic breaks from of eye socket wall. Thus delete bits and pieces of bone basis of bottom of bosom for creation of wide connection of bosom with the cavity of nose.

Foresees the removal of the damaged mucous membrane of at maintenance of existent limits and walls of frontal bosom.

The debatable are remained by such questions: terms of realization of operation, volume and character (methodology) of operative intervention, type of surgical access to the front wall of frontal bosom, choice of method of fixing of wreckages, method of removal of bone defects that arose up, and others like that.

Experience testifies that anatomic structures are destroyed it is necessary. Fragments of front wall of frontal bosom it follows and to fix wire guy-sutures or titanic net in thick a 0,2-0,5 mm In bottom a titanic net needs to be designed on a form the root of nose. Viable fragments of bone it is desirable and to fix to the net spirally. After the reconstruction of frontal bone it is necessary to conduct the replicon of partition and bones of nose, departments of eye socket, that also expediently to the titanic net (fig. 350).

There are numerous surgical accesses that apply at the breaks of cerebral and facial skull (middle area of person) : coronal and semicoronal.

Except marked, apply also accesses through already present wounds (scars) on the skin of forehead and face. The choice of operative is predefined concrete clinical and by the tasks of operative intervention.

MAXILLUFACIAL ONCOLOGY

Tumours of the marked localization, as well as in other departments of body of man, can be of high quality or malignant, therefore and require corresponding radical treatment. Features of operations from the removal of such tumours : to the participating in the operation of highly skilled surgeons a few for an operation in a few contiguous anatomic areas without clear standard methodology of operation (because each such operation is individual), duration of operations, large, heavy and protracted period, substantial curvature of face and formation of considerable defects of soft tissues and bones, risk of postoperative complications, relapses of disease and others like that.

Principles are removals of tumours, that is localized — but in the area of eye socket, cavity of nose, front and middle cranial fossulas is general for oncology, is radicalism of oncotomy with maintenance of adherent anatomic structures.

Maxillufacial operations after to the removal widespread good— but evil-quality tumours conduct stage-by-stage — execute in good time discussed and concerted by all participants of operation operative access, then execute self operative intervention (doctors-surgeons execute their stages of operation by turns), whereupon close an operating wound, on possibility, tight. For this purpose in case of origin of large postoperative defects of soft and bones of skull plan the possible most complete non-permanent removal of these defects (mainly at presence of of high quality oncologic process).

In maxillufacial oncology distinguish two types of operations :

creation of operative access to the tumours, located (mainly in the area of basis of skull);

removals of tumours, that spread to a few anatomic areas.

To the operations of the first group take to the Turkish saddle (hypophysis), tumours in the area of slope of basis of skull, fossula. Operations of the second group calculation and, as a rule, they are executed in accordance with an anatomy by distributions of tumour.

7. Materials of activation of students are during teaching of lecture. Tasks for self-control:

1. On a reception patient К appeared to the surgeon., 44, with a diagnosis is there involution Ptimalum of skin of overhead and bottom eyelids? At implementation of what operative intervention expedient partial of fatty hernia?

2. Surgeon at primary to the review set a diagnosis for a patient Л., 27: break of nasal bones, S of curvature of nasal septum. What stages of rhinoplasty maybe it to forecast for this patient?

3. To the patient, 22, a diagnosis is set: nee deformation of cartilage of auricles, lop-earedness of II of degree. It is objectively set to relief of and his legs. What type of cosmetic otoplasty must be chosen?

Standards of answers :

1. At implementation of bottom.

2. Partial resection of cartilage of nasal septum through a middle cut in combination with the osteotomy of nasal bones.

3. Cosmetic otoplasty with the simultaneous design of cartilage of and his legs.

8. Materials are for preparation of students to the lecture.

Question and task :

- To define a concept "paralysis of mimic musculature".

- To know.

- To capture the technique of surgical treatment of facial nerve.

- To give a concept " face".

- To know basic methodologies of hemiatrophys of face.

- To know symptoms and syndromes in plastic and reconstructive surgery.

- To define maxillufacial traumatology.

- To define maxillufacial oncology.

- To define maxillufacial reconstructive surgery.

Materials for test control:

1. In what case is not it necessary to delete to fat of during realization of bottom?

А) At the diseases of buds.

Б) At the diseases of ШКТ.

В) At presence of defect of area.

Г) At presence of wrinkles of skin of area.

Д) At presence of new formations within the limits of eye socket area.

2. What cut is necessary to be conducted for the removal of legs of cartilages of wings of nose at implementation of cosmetic rhinoplasty for women?

А) Front.

Б) Middle.

В) Back.

Г) External.

Д) Cut filter of mind of overhead lip.

3. What cut is recommended in an eye socket area during realization of overhead?

А) Mirtopodibnyy.

Б) Rectilineal.

В) Napivlunnyy.

Г) Ovalopodibnyy.

Д) Hvylopodibnyy.

4. What stages must be plugged in realization to the operation of cosmetic rhinoplasty for the corrections of tag of nose?

А) Correction of legs of cartilages of wings of nose.

Б) Correction of legs of cartilages of wings of nose.

В) Correction of and legs of cartilages of wings of nose.

Г) Correction of and legs of cartilages of wings of nose with the correction of nasal septum.

В) Correction of nasal septum.

5. What type of guy-sutures rationally to sew the skin of papillary area after realization of cosmetic otoplasty (removal of lop-earedness)?

А) Continuous.

Б) Key.

В) Endermic cosmetic.

Г) Mattress.

Д) bust.

Standards of answers :

1 – And, 2. - Б, 3 - And, 4 is G, 5 - And.

9. Used literature.