The way plastics defect of the front wall of the frontal and maxillary sinuses

 

(57) Abstract:

The invention relates to medicine, namely to ENT surgery. On the bone of the front wall of the frontal and maxillary sinuses over trepanation hole after the removal of pathological content, stack transplant of the flat bones of the cranial vault of the human fetus in excess of 3-4 mm diameter trepanation holes. The graft is fixed to the bony walls of the sinuses of the distal part of the end face of the optical fiber, the semiconductor laser “ATCUS-15” on contact with the output power of the laser radiation 8 watts in continuous mode. The method allows to increase the effectiveness of the treatment, which is achieved by thorough fixation of allowreboot to the bony walls of the sinus.

The invention relates to medicine, namely to laser ENT surgery.

There are ways to restore the anatomic integrity of the frontal and maxillary sinuses after opening and removal of pathological content in them by means of a variety of types of transactions using cartilage xenografts. In ENT surgery, there are reports of the use of animal cartilage in humans (1).

As the plastic material of IP is 1 to 12 months. The model of the bone cavity was frontal sinuses of dogs, the cavity after the operation type of radical frontotomia was filled with fragments of canned cartilage volume of about 0.5 cm2. Drugs frontal sinus investigated standard histological techniques after implantation.

The disadvantages are the counterpart

1. Due to the fact that the implanted tissue of the animal is genetically alien to humans, there are frequent instances of its resorption.

2. Resorption of the graft often happens with his festering and development of complications.

3. Due to processes of reconstruction of cardiac tissue in the cavity of the sinus develops scar tissue, which divides the cavity of the sinus into multiple, isolated cavities, with possible development of suppurative process in the past.

4. The lack of a front wall of the sinus can lead to the formation of a cosmetic defect in the retraction of the soft tissues of the forehead and cheeks in the sinus cavity with infringement of the I-St and II-nd branch of the trigeminal nerve.

5. Formalin inhibits the restructuring of the graft and its replacement in the recipient in the mother's bed for up to 12-18 months and has cancer and maxillary sinuses flat bone of the skull vault of the human fetus (5).

After opening the frontal and maxillary sinuses carefully removed all their pathological content and all altered mucosa. Recovering the message of the frontal sinus to the nasal cavity by means of the restoration of patency of the frontal-nasal fistula, with maxillary sinus nasal cavity was connected imposed sostem in the lower nose. In place trepanation holes in the front wall of the frontal and maxillary sinuses were placed transplant of the flat bones of the cranial vault of the human fetus in excess of 0.3 to 0.4 cm size trepanation holes, recorded the flap of flat bones to the edges of the bone defect using the “splitting”, in which the split between the flaps of the graft are edge trepanation openings of the sinuses. Postoperative wound was usuals layers.

The disadvantages of the prototype are

1. “Splitting” is superimposed on the bone graft from the flat bones of the cranial vault of a fruit person, do not allow it firmly commit to the edges trepanation holes and do not provide him tight fixation to the bone walls of the frontal and maxillary sinuses.

2. The lack of thorough fixation of the graft and the wound defect in the front wall of the frontal and maxillary sinuses.

The purpose of this invention is to commit allbritton (flat bones of the skull vault fetal human) to the bone walls of the frontal and maxillary sinuses laser “biological” welding using a semiconductor laser “ATCUS-15” contact method.

This objective is solved in that on the facial bone wall of the frontal and maxillary sinuses over trepanation hole after the removal of pathological content fits transplant of the flat bones of the cranial vault of the human fetus in excess of 3-4 mm diameter trepanation holes, the graft is fixed to the bone walls of the frontal and maxillary sinuses method LBC, the distal part of the end face of the optical fiber, the semiconductor laser “ATCUS-15” on contact with the output power of the laser radiation 8 watts in continuous mode was carried out welding of allowreboot to the bone of the front wall of the frontal and verhneketskiy sinuses. Contact laser “biological” welding allowed to obtain thorough fixation of allowreboot to the bony walls of the sinus without overlap on the surface of the splitting, which carried out its fixation to the edges trepanation holes, fully s.

Example 1 specific performance. The study included 17 patients at the age from 20 to 62 years with various forms of recurrent purulent-polyposis; sinuitis. All operations were performed under General anesthesia.

Our proposed method of closure defects of the walls of the frontal and maxillary sinuses by allbritton laser “biological” welding (LBC) was preceded by a comparative assessment of different existing and up to date methods of treatment of recurrent purulent-polyposis; sinuitis, closure of defects in the front wall of the frontal and maxillary sinuses, different methods of preparation and preservation used donor tissue that subsequently when conducting experimental studies have confirmed the feasibility of using LBC in order to restore their anatomical integrity.

The transplantation of the flat bones of the skull vault fetal human marked some staging. So by the 10th day of the experiment on the laser fixation is formed coarse-fibered connective tissue with areas of coarse-fibered bone. By the 20th day enchondral growth is accompanied by signs of destruction. Different the time on the periphery of callus from the periosteum begin to grow new bone tissue. To the 30-th day of the experiment the border of the defect are determined with difficulty. The laser exposure periosteal bone merges with enchondral and form a continuous bone plate. To the 40-th day the internal structure of the bone is a finally formed bone, consisting of parallel oriented bone plates.

Example 2. Patient Z., 49, was hospitalized with a diagnosis of Chronic left-sided frontal sinusitis, purulent form. After the examination the patient underwent surgery radical frontonia left with the plastic of the front wall of the sinus flat bone of the skull vault of the human fetus using laser “biological” welding (lbs).

After incision of the skin and periosteum on the eyebrows with the transition to the slope of the external nose to the left was exposed front wall of the frontal sinus, the bit were performed her autopsy, pathological contents of the cavity of the sinus was completely removed bone with a spoon.

Spoon-rasputia extended fronto-nasal fistula. On bare bone wall of the frontal sinus over trepanation hole fit transplant of the flat bones of the cranial vault of the human fetus, exceeding the size of trepanation of oversteer “ATCUS-15” was mounted directly on the border of the contact surface of the graft with bone wall of the sinus, to which is supplied a laser power of 8.5 W in continuous mode, which provided the welding of a bone graft to a bone. Lbs allowed to achieve thorough fixation of the graft around its diameter, excludes penetration of wound from the cavity of the frontal sinus under the soft tissues of the forehead. Given the short duration of laser irradiation on bone labradorescence and underlying bone were excluded factor charring of the graft in its contact with the distal part of the end face of the light guide. Surgical wounds were usuals layers. Control over the restructuring of the transplant was carried out dynamically carried out x-ray, biochemical and immunological studies. So on chest x-ray of the paranasal sinuses 3 months after implantation flat allowreboot noted ingrowth transplant in the structure of the formed bone spur, gradually merging with the bone edges recipient, turning in solid newly formed bone. In the postoperative period the patient received anti-inflammatory therapy, relapse was not observed.

Sources of information

1. Melnikov M. Roy conference of otolaryngologists and extended Plenum of MOLO (Irkutsk, on June 20-21, 1990). - M - 1990. - S. 94-95.

2. Didenko Century. And., Gusakov A. D. Primary and secondary reconstructive plastic surgery on the frontal sinuses using the sponge autoceste and bone marrow //Folia Otorhinolaryngologica. - Vol.3. - №3-4. - R. 28-37.

3. Ballenger, J. J. Some effects of formaldehyde on the upper respiratory tract //Laryngoscope. - 1984, 94. - №11. - P. 1411-1413.

4. Holstrom M., Wilhemsson Century, Hellgust H. et al. Histological changes in the nasal mucosa in persons occupationally exposed to formaldehyde alone and in combination with wood dust //Acta Otolaryngology. - 1989. - V. 107. - №1-2. - R. 120-129.

5. Blocky A. A. Labradorescence in reconstructive rhinosurgery of the nose and paranasal sinuses: author. dis....Kida. the honey. Sciences. - SPb., 1997. - 18 S.

The way plastics defect of the front wall of the frontal and maxillary sinuses, including the fixation of the graft from the flat bones of the skull vault fetal human to the bone walls of the frontal and maxillary sinuses, characterized in that the fixation have a “biological” welding radiation of a semiconductor laser “ATCUS-15” contact the distal part of the end face of the light guide output radiation power of 8 watts in continuous mode.



 

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