The method of restoring the integrity of the skeleton of the septum of the nose

 

(57) Abstract:

The invention relates to medicine, namely to ENT surgery. Between Tsaparang opposite leaves Nadirashvili and mucous membrane of nasal septum, after removal of the curved cartilaginous and bony parts, introducing the graft of cartilage of nasal septum of the human fetus in excess of 5-7 mm defect size remote bone and cartilage skeleton of the septum of the nose. The graft is fixed to the edges of the bone and cartilage skeleton, the distal part of the end face of the optical fiber, the semiconductor laser “ATCUS-15” on contact with the output power of laser radiation to 8.0 watts in continuous mode. The method allows to reduce postoperative complications, which is achieved by thorough fixation of the graft.

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

There are ways to restore the anatomical integrity of the septum of the nose using different grafts after completing her surgical interventions, the objective of which was the removal of the curved part and the restoration of nasal breathing. In ENT surgery, there are reports of the use of holograma ribs and septum of the nose to vosstanovitelnyi (1).

As the plastic material to replace the deformed cartilage of nasal septum in its total destruction took allegras ribs and septum of the nose, preserved in 0.5% formalin solution in isotonic sodium chloride. Implantable cartilage was placed on a remote location previously deformed bone and cartilage skeleton of the septum of the nose to regain its elasticity.

The disadvantages of analog is:

1. There is no reliable fixation of the grafts, which often leads to their displacement in the postoperative period and adversely affects the effectiveness of surgical treatment (2).

2. The lack of fixation of the graft is introduced in place of the lost bone and cartilage skeleton of the septum of the nose may result in the postoperative period to perforation of nasal septum in preneuring its departments during tamponade of the nasal cavity after surgery (3).

3. Formalin inhibits the restructuring of the graft and its replacement in the body, implanted in the mother's bed for up to 12-18 months and does not provide true healing.

4. Formalin has a carcinogenic effect (4, 5).

In CA the mi Autorama and bone (6).

After removal of the curved part of the septum of the nose including cartilage and bone base bone and cartilage skeleton of the septum of the nose, performed the reconstructive remote parts. The resected pieces of cartilage and bone were ground to malabranca state and using autofiring glue of them formed plate, which is subsequently placed between the sheets of the mucous membrane instead of the previously deleted curved parts. This technique, according to the authors, produces a smooth, elastic, solid autograft required sizes for plastics defect in bone and cartilage skeleton of the septum of the nose.

The disadvantages of the prototype is:

1. There is no fixation of the graft is inserted between the sheets of the mucous membrane, causing it to shift in the postoperative period and the violation of nasal breathing (2).

2. The lack of fixation of the graft is put in place of the lost bone and cartilage skeleton of the septum of the nose may result in the postoperative period to perforation of nasal septum during tamponade of the nasal cavity after surgery (3).

3. Method of manufacturing autofiring glue manufactured from plasma is mcim (7, 8).

The purpose of this invention is the fixation of the graft (cartilage of nasal septum of the fetal human) to the edges of the bone and cartilage framework of the columella laser “biological” welding using a semiconductor laser “ATCUS-15” contact method.

This objective is solved in that between Tsaparang opposite leaves Nadirashvili and mucous membrane of nasal septum, after removal of the curved cartilaginous and bony parts were introduced into the graft of cartilage of nasal septum of the human fetus in excess of 5-7 mm defect size remote bone and cartilage skeleton of the septum of the nose. The graft is fixed to the edges of the bone and cartilage framework of the lbs method, the distal part of the end face of the optical fiber, the semiconductor laser “ATCUS-15” on contact with the output power of laser radiation to 8.0 watts in continuous mode was carried out welding cartilage of nasal septum of the human fetus to the edges of the defect bone and cartilage skeleton. Contact laser “biological” welding has allowed to achieve a tight fixation of the implanted cartilage graft to the edges of the bone and cartilage framework of the columella without overlap on the surface of the splitting or kathodavid LASS="ptx2">Specific example:

The study included 10 patients aged 19 to 45 years with a deviated septum of the nose. All operations were performed under local infiltration anesthesia.

We proposed the method to restore the integrity of the skeleton of the septum of the nose graft of cartilage of nasal septum of the human fetus using laser “biological” welding (lbs), was preceded by a comparative assessment of different existing and up to date methods of repair defects in bone and cartilage skeleton of the septum of the nose using different grafts, methods of preparation and preservation used donor tissue that later when conducting experimental studies have confirmed the feasibility of using cartilage of nasal septum of the human fetus and lbs to restore the anatomic integrity of the bone-cartilage skeleton of the septum of the nose by fixing the graft to the edges.

When transplanted cartilage of nasal septum of the human fetus, noted some staging. So 10 days of implantation of the cartilage in place of the laser fixation is determined by lymphoid infiltration, on the border of the cartilage and mucosa which lasts until the 30th day of the experiment, and finishes with the formation of strips of connective tissue at the border of the cartilage plate and underlying loose connective tissue and the growth of blood capillaries. In this zone, the stimulation of collagenopathy fibroblasts, therefore, to the 40-th day of the experiment, the area of contact of the graft presents an increased number of loose connective tissue, in the course of the blood capillaries are found in the fat cells that have close contact with fat cells. Degranulation of the latter leads to resorption of the fat drops of lipocytes. Laser treatment in places of joining tissue stimulates the process of engraftment and fibrillogenesis with activation of trophic and plastic processes with the participation of the fat and fat cells.

Example. Patient N., 20 years were hospitalized with a diagnosis of:

A deviated septum nose with impaired nasal breathing. After the examination the patient underwent surgery Submucous resection of nasal septum with simultaneous allobrephotympanoplasty cartilage using laser “biological” welding (lbs).

After incision of the mucous membrane of nasal septum to the left some distance 0.5 cm from the beginning the run of the cartilage and bone of the skeleton of the septum of the nose, then ran his excision. In place of the formed defect in bone and cartilage skeleton of the septum of the nose was administered to transplant cartilage of nasal septum of the human fetus, which exceeded the defect size of 0.5 cm and was fixed to the edges of the bone-cartilage skeleton of the septum of the nose using LBC. At the distal portion of the end face of the optical fiber, the semiconductor laser “ATCUS-15”, mounted directly on the boundary of the contact surface of the graft with the remains of a quadrangular cartilage of nasal septum and bony part of her skeleton was served a laser power of 8.0 W in continuous mode, which provided the welding cartilage of nasal septum of the human fetus. Lbs allowed to achieve thorough fixation of an implantable graft, as cartilage and bone the skeleton of nasal septum due to welding of the effect of laser irradiation were excluded offset from the midline and as a consequence of impaired nasal breathing in the immediate and late postoperative period. Given the short duration of laser irradiation on the graft and the remains of bone and cartilage skeleton of the septum of the nose, were excluded factor charring of the graft in its contact with dItalia section was fixed to each other using LBC. The status of the transplant was carried out dynamic monitoring videoendoscopic control performed biochemical and immunological studies. So 3 months after submucous resection of nasal septum and implantation of the cartilage of the human fetus was determined by the Central nasal septum with pink mucous membrane covering its entire surface, the mucosa was stripped of any defects and deformities. In the postoperative period the patient received a short course of anti-inflammatory therapy.

Sources of information:

1. Melanin C. D., Kalaev I. I., Satpaev A. K. Application formalisation cartilage allografts in rhinoplasty, " Vestn. Otorhinolaryngology. - 1981. No. 3. - S. 52-54.

2. ACK cyber I. J., Protasevich, S., ACK cyber T. I. Repeated surgical interventions on the columella about its deformation // Ukr. ear, nose and throat diseases. - 1982. No. 5. - S. 56-57.

3. Demenkov C. P., Barat Ali Rezaee the Reinstatement auto-holograma and bones after submucous resection of the nasal septum, Zh. ear, nose and throat diseases. - 1983. No. 1. - S. 66-68.

4. Ballenger, J. J. Some effects of formaldehyde on the upper respiratory tract // Laryngoscope alone and in combination with wood dust // Acta Otolaryngology. - 1989. - V. 107. - №1-2. - R. 120-129.

6. Gorbachev C. N., Makashev C. E., Minin Y. C. the Use of demineralized bone for the plastic septum of the nose, Zh. ear, throat and nose diseases. - 1991. No. 2. - S. 33-38.

7. Veremeenko K. N., Kizim A. I. Fibrin glue and its application in otorhinolaryngology // Ukr. ear, throat and nose diseases. - 1988. No. 5. - S. 86-88.

8. Veremeenko K. N. Biological fibrin polymers, their properties and applications in otorhinolaryngology // Ukr. ear, throat and nose diseases. - 1991. No. 1. - S. 47-56.

The method of restoring the integrity of the skeleton of the septum of the nose, including the fixation of the graft of cartilage of nasal septum of the human fetus to the edges of the bone-cartilage skeleton of the septum of the nose, characterized in that the fixation of the graft perform biological welding radiation of a semiconductor laser “ATOX-15” by contact of the distal part of the end face of the light guide output radiation power of 8.0 W in continuous mode.



 

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