Aşağı Göz Qapağının Bərpasının Optimallaşdırılması Metodu Əməliyyatdan sonrakı subsiliar çapıqla məhdudlaşan funksiyalar

N.N Qasımova; A.A Huseynov; Q.İ. Qurbanəliyeva; Ş.R. Yusubova

doi:10.28942/ajoms.v26i1y2026.7

Abstrakt

Əməliyyatdan sonrakı çapıq deformasiyaları və kontrakturaların qarşısının alınması və korreksiyası plastik və rekonstruktiv cərrahiyyədə çətin həll olunan problemlər olaraq qalır. Bu tədqiqatın məqsədi, subtsiliar kəsik vasitəsilə icra edilən yanaq-orbital nahiyə sınıqlarının müalicə nəticələrini yaxşılaşdırmaq üçün Kenaloq, müxtəlif məlhəmlər və alt göz qapağı əzələlərinin mioqimnastikasından ibarət müalicə üsulunun effektivliyini təhlil etmək idi. Tədqiqata 87 pasiyent cəlb edilmişdir. Metod çapıq toxumasına Kenaloq inyeksiyasının tətbiqini nəzərdə tuturdu; əldə edilən nəticələr göstərir ki, Kenaloq çapıq əmələ gəlməsi səbəbindən məhdudlaşmış alt göz qapağı funksiyasının bərpasında effektivdir və kosmetik, eləcə də funksional nəticələri yaxşılaşdıra bilər.

Əsas mətn

32. Introduction
Prevention of postoperative scar deformities and contractures, as well as their subsequent correction, is a complex problem in plastic and reconstructive surgery. In the face and neck region, where scars occur most frequently—in 87% of the total number of observations—they cause not only functional but also pronounced aesthetic defects. This leads to psychological disturbances in the patient. Rehabilitation of patients with scar deformities and contractures must solve two tasks: elimination of the contracture and restoration of a full skin covering.

In recent years, a significant increase has been noted in the frequency of fractures of the facial bones and, in particular, of the zygomatic-orbital complex, largely due to increases in road-traffic, occupational, domestic, and sports injuries. When providing first aid, the surgeon must perform primary wound treatment, apply plastic sutures, and ensure that the soft tissues of the zygomaticorbital region and the lower eyelid assume an anatomically correct position, which prevents the formation of a scar band. Data on the frequency of zygomatic bone fractures are contradictory; these injuries account for 4.3% to 25% of all facial bone fractures and 67–71% of fractures of the middle facial zone.

In most cases, the subciliary approach is used, which provides a good view of the defect area and allows adequate fixation of bone fragments. When a subciliary incision is made, the skin, thin subcutaneous tissue, and muscle tissue are dissected; layer-by-layer suturing with appropriate suture sizes and avoidance of linear incisions are important. Normotrophic scars form during uncomplicated healing— inconspicuous, soft-elastic formations that do not cause functional or aesthetic defects. However, quite often, as a complication, a scar band forms that limits movement of the lower eyelid.

Objective. To improve the results of treatment of fractures of the zygomatic orbital region through a subciliary incision by reducing the time required to restore lower eyelid function during treatment of a postoperative subciliary scar using Kenalog, various ointments, and myogymnastics of the lower eyelid muscles.

33. Materials and Methods
The studies were conducted in 87 patients who presented with fractures of the zygomatic-orbital complex (68 men and 19 women), aged 20 to 50 years. The method is based on acting on scar tissues in the operative field for early restoration of eyelid function. For this purpose, we propose injecting Kenalog into the scar tissues, beginning three weeks after suture removal.

The Kenalog injection procedure is performed under aseptic and antiseptic conditions. The intervention area is treated 2–3 times with 96% alcohol or furacilin. Because Kenalog is a crystalline suspension, the ampoule must be shaken thoroughly before opening; the contents should be close to body temperature to reduce pain. Kenalog is administered at a dose of 1 mg of active substance diluted with 2% novocaine solution or 1% lidocaine (or physiological saline in cases of anesthetic intolerance). Injections are performed with an insulin syringe; 3–4 punctures are made along the scar line, and the solution is injected slowly. Uniform blanching of the scar indicates sufficient infiltration. Depending on drug effectiveness, the course includes one to three injections at intervals of 3–4 weeks, with simultaneous myogymnastics. Follow-up examinations were performed at 6 months and 1 year, including clinical, photometric, radiological, computed tomography, myographic, and anthropometric methods.

34. Results and Discussion
The quality of scarring processes is influenced by the thoroughness of approximation of the wound edges. The steroid drug Kenalog has a pronounced anti-inflammatory and antiallergic effect and activates collagenase activity, thereby slowing the formation of collagen fibers. If only ointments and myogymnastics are used, the treatment period is about 6–8 months. With Kenalog, partial restoration of functions occurs 1 month after the start of treatment, and full restoration occurs after 2–3 months.

These data were confirmed by myographic studies. The best-known current methods for treating pathological scars include local use of lidase (injections, electrophoresis or phonophoresis); pyrogenal injections; Contractubex ointment; terrilytin electrophoresis; Bucky rays; mechanical crushing of scars; cryodestruction; phosphorus applications; and curiosin. Such a variety of conservative methods, used separately or in combination, does not lead to complete disappearance of pathological conditions of the integumentary tissues.

In 2005, E.V. Chuguy used a complex of therapeutic cryoexposure technologies with porous titanium nickelide applicators, showing that cryoexposure on a forming scar from the second week up to 1 year promotes replacement of destroyed tissue with delicate connective tissue and helps avoid pathological scars. In 2008, S.V. Bondarev used collagenase preparations, finding that administration into skin scars destroys excess collagen. In 2009, T.N. Karpova performed electro- and ultraphonophoresis of Fermencol, concluding that it causes scars to transition from hypertrophic to normotrophic. In 2005, Saray Y. and Güleç A.T. studied intralesional bleomycin for keloid and hypertrophic scars (14 patients, 15 scars): complete flattening occurred in 73.3% of cases with no recurrence. In 2006, Stewart C.E. 4th and Kim J.Y. proposed a combined method of surgical excision with subsequent mitomycin-C administration (10 patients with head/neck keloids), reporting treatment success in 90% of patients.

35. Conclusions
The conducted study allows us to recommend the use of Kenalog for the restoration of eyelid functions limited by a postoperative subciliary scar, in order to improve the cosmetic and functional results of operations performed using a subciliary incision.

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İstinadlar

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