The method of fixation of allbritton in the frontal and maxillary sinuses
The invention relates to medicine, namely to ENT surgery. On the bone wall of the frontal and maxillary sinuses inside after removal of the diseased mucous membrane stack Dura and the mucous membrane of the septum of the nose of a human fetus, which is fixed to the bony walls of the sinuses. Fixation carry out 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 W in pulsed mode with a pulse duration of 500-700 MS. The way laser "biological" welding improves the efficiency of treatment, which is achieved by thorough fixation of the flap allbritton to the bony walls of the sinus without the introduction into the cavity of the sinus endotracheal tubes with cuffs and imposing large endonasal anastomoses for their conduct in the sinus cavity.
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 their pathological content through a variety of transaction types with ispace .
As the plastic material used costal cartilage pigs. The material was pre-preserved in 0.5% formalin solution in terms of 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 at different times after implantation.
The disadvantages of analog is:
1. Due to the fact that the implanted tissue of the animal is genetically alien to humans, there are frequent cases of resorption after transplantation.
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 and infringement I and II branches of the trigeminal tion in the mother's bed for up to 12-18 months.
6. Formalin has a carcinogenic effect[2, 3, 4].
As the prototype was taken way obliteration of frontal sinus formalisation fragments of allowreboot .
After opening the frontal sinus of them is carefully removed pathological content and all mucous membrane. Bone spoon was vystabliaite internal cortical layer of the bone wall of the sinus. Bone wall twice, rubbed 96° alcohol. Fronto-nasal fistula were not recovered. If by removal of the pathological content of the frontal sinus is formed message with the nasal cavity or restored cross natural or created during the previous operation fronto-nasal fistula, is the isolation of the sinus. This place fit the corresponding size of the bone flap from the vault of the skull of the fetus with the periosteum, facing the cavity of the nose. This flap was fixed fills the sinus bone “gravel” allopathist. The density was achieved by pressing on implantable bone mass by topfarm. In conclusion, it is made of plastic postoperative holes in the front wall of the sinus bone vault of the skull of the fetus.
The disadvantages of the prototype it is what was mentioned, characterized by the absence of her bezduhovnosti, resonatory ability, excretory, warming and moisturizing functions.
2. Allowreboot in an isolated space is often undergoes resorption with suppuration and the formation of multi-cavities inside the sinuses filled with pus fluid, and therefore often have inflammatory infiltrates the soft tissues of the forehead and cheeks, intraorbital complications.
The purpose of this invention is to commit allbritton (Dura and the mucous membrane of the septum of the nose of a human fetus) 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 by the fact that the bone wall of the frontal and maxillary sinuses inside after removal of the diseased mucous membrane fits Dura and the mucous membrane of nasal septum of the human fetus, which is fixed to the bony walls of the sinuses method LBC, the distal end of the optical fiber, the semiconductor laser “ATCUS-15” on contact with the output power of the laser radiation 8 watts, pulse reigh. Contact lbs allowed to achieve fixation of the flap allbritton to the bony walls of the sinus without the introduction into the cavity endotracheal tubes with cuffs and imposing large endonasal anastomoses for their conduct in the sinus cavity.
Specific example 1.
The study included 12 patients aged from 20 to 62 years with various forms of recurrent purulent-polyposis; sinuitis. All operations were performed under General anesthesia.
Our proposed method transplantation of allbritton in the frontal and maxillary sinus using a 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, different methods of preparation and preservation of donor tissue used for reconstructive surgery, which subsequently during experimental studies have confirmed the feasibility of using lbs to restore the anatomic integrity and physiology of the sinuses in this pathology.
The transplantation of the mucous membrane and Dura mater of the human fetus marked some hundred the and infiltrated by leukocytes. To the 20-th day is determined a significant reduction of lymphoid infiltration, epithelial cells swell in their cytoplasm contains a large amount of vacuole. To the 30-th day - in the area surrounding connective tissue, the stimulation of collagenopathy fibroblasts and growth of blood capillaries. To the 40-th day of the experiment the contact zone presents an increased number of loose connective tissue, in the course of blood capillaries is detected the accumulation of fat cells that have close contact with fat cells. Degranulation of the latter leads to resorption of the fat drops of lipocytes. Laser treatment stimulates the process of engraftment and fibrillogenesis with activation of trophic and plastic processes with the participation of the fat and fat cells.
Implantable Dura two weeks of the experiment after her lbs is subjected to razvlecheniy and degeneration of the collagen fibers of the graft. The process ends with the introduction of new cellular elements (fibroblasts) that are involved in the education of their collagen fibers to the 40-th day of the experiment. It should be emphasized that in the area of lbs the old structure of the graft is not vosstanovlyu is neither.
Example. 2 Patient T., aged 47, was hospitalized with a diagnosis of Chronic left-sided sinusitis, chronic polypous form. After the examination the patient underwent surgery radical hamartoma left with the plastic inner walls of the sinuses of the Dura mater of the human fetus using laser “biological” welding (lbs).
After incision of the mucous membrane on the transition to the crease of the upper lip to the gums and their ofseparate was exposed front wall of the maxillary sinus, the bit were performed her autopsy, pathological contents of the cavity of the sinus bone was removed with a spoon. Spoon-rasputia superimposed fistula between the maxillary sinus and nasal cavity in the lower nose go with partial resection of the anterior third of the lower turbinate. At the bare bone of the sinus walls fit flap of Dura mater of the human fetus, which was fixed to the walls of the sinus with the help of lbs. The distal end of the optical fiber, the semiconductor laser “ATCUS-15” was mounted directly on the surface of the graft, which was supplied to the laser radiation 8 watts in pulsed mode 500-700 MS, which was provided by welding the flap Teresa contact with the distal end of the optical fiber, the area of laser irradiation (ablation) corresponded to the diameter of the distal end of the fiber (600 μm). Plastic front wall of the maxillary sinus was performed flat bone of the skull vault of the human fetus. Surgical wounds were usuals layers. Control over the restructuring of the graft in maxillary sinus was performed using videoendoscopy. In the postoperative period the patient received anti-inflammatory therapy. On check in 1,5 month by videoendoscopy was determined by substitution of transplantati own mucous membrane of the maxillary sinus. The function of the maxillary sinus were saved, relapse was not observed.
Sources of information
1. Melnikov M. The results of obliterating operations canned xenodream. //Materials of the regional scientific-practical conference of otolaryngologists and extended Plenum of MOLO (Irkutsk, 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. - 19 and in combination with wood dust //Acta Otolaryngology. - 1989. - V. 107. - №1-2. - R. 120-129.
5. Camerino I. E. To the question of rehabilitation of patients with chronic recurrent sinusitis. //The Bulletin of otorhinolaryngology. - 1985. No. 4. - S. 45-47.
The method of fixation of allbritton in the frontal and maxillary sinuses, characterized in that the locking allbritton to the bony walls of the sinuses is performed by laser light "ATCUS-15", by contact of the distal part of the end face of the optical fiber, through which serves radiation 8 watts in pulsed mode with a pulse duration of 600-700 MS.