Method for plasty of perforation foramen of tympanic membrane

FIELD: medicine, ORL-surgery.

SUBSTANCE: the present innovation deals with treating the lesions of tympanic membrane. For this purpose one should fix a transplant out of a flat bone of human fetal cranial arch. The transplant mentioned should be of 1 mm width, 0.1 mm thickness and its length being 2 mm higher against the size of perforation foramen. Fixation should be fulfilled due to laser biological welding in two points. One should put a fragment out of fetal dura mater above an osseous transplant being 2 mm higher against perforation foramen. Distal part of light guide's edge of semiconductor laser should be put on the transplant perpendicularly its surface. Welding should be carried out by contact technique in impulse mode at impulse duration being 450 msec and output laser radiation power being 8.5 W in 8 points. The method enables to achieve transplant's tight fixation, exclude its shift and prevent penetration of infection into tympanic membrane and keep sound passage through tympanic membrane.

EFFECT: higher efficiency of plasty.

1 ex

 

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

There are ways to prevent displacement of the graft in the tympanic cavity with the pads of artificial materials. In ENT surgery, there are reports of the use of catgut in the form of a strip, precluding displacement of the graft in the tympanic cavity (1).

The free end methodoloy thread, laid under the graft in the tympanic cavity, taken in the ear canal, and then deleted methodology thread of the tympanic cavity, when the danger of displacement of the graft in the tympanic cavity has passed. In some cases, the catgut was left in the tympanic cavity to six months - full time self suck.

The disadvantages are the counterpart:

1. Duration tamponade external ear canal.

2. The lack of control over the condition of the graft.

3. Remove methodoloy threads of the tympanic cavity leading to violation of the fixation of the graft to the eardrum.

4. Insufficient fixation of the graft leads to displacement of implanted flap (2, 3).

As the prototype is taken, the method of introduction into the drum cavity to prevent displacement of the graft is laid over a sprocket hole Teflon and Teflon paste(4, 5, 6, 7).

Disadvantages proto the IPA are:

1. Develops an inflammatory reaction in the tympanic cavity, gradually turning into fibrosis with the development of scar tissue in the tympanic cavity or obliteration(4, 5, 6, 8, 9).

2. Lack of monitoring of the transplant and the effectiveness of its fixation with long-term tamponade ear canal.

3. It is difficult to conduct in the early postoperative period additional stimulation of regeneration processes.

The purpose of this invention is to commit allbritton (flat bones of the skull vault fetal human) to the edges of the perforations of the eardrum laser “biological” welding (lbs) using a semiconductor laser “ATCUS-15” contact method in pulsed mode.

This objective is solved in that at the eardrum on the edge of the perforation holes after it decapitalization before putting graft of Dura mater of the human fetus in excess of 2 mm diameter perforation holes, put the graft from the flat bones of the cranial vault of the human fetus width of 1 mm, a thickness of 0.1 mm and a length of 2 mm larger than the perforations. For better fixation of the bone graft with the edges of the perforations of the eardrum it was recorded by the method of lbs distal part of the end face of the light guide popup vodnikova laser “ATCUS-15” contact method in a pulse mode with a pulse duration of 450 MS and the output power of laser radiation 8.5 W, carried out the welding of bone allbritton to the edges of the perforations of the tympanic membrane in 2 points, then on top of the bone graft and punched a hole stack flap of Dura mater of the human fetus in excess of 2 mm perforation hole, directly on the graft perpendicular to its surface install the distal portion of the end face of the optical fiber, the semiconductor laser and carry out his welding in 8 points in the pulse mode by the contact method. This method plastics the perforations of the eardrum is possible to eliminate the offset of the graft of Dura mater in the tympanic cavity, to prevent the penetration of infection into the tympanic cavity through the ear canal and to maintain conduction of sound through the drum cavity toward the inner ear.

Specific example

The study included 5 patients aged 19 to 50 years with chronic one - and two-sided mesotympanum and lack of relapse from 4 to 6 months. All operations were performed under local infiltration anesthesia.

Our proposed method of closure of perforated holes in the eardrum Dura mater of the human fetus using laser “biological is th” welding (lbs) and laying to prevent displacement of the tympanic cavity bone grafts from the flat bones of the cranial vault of the human fetus was preceded by a comparative assessment of different existing up to the present time of closure of the perforating defects in the ear-drum, different methods of preparation and preservation of donor tissue that later when conducting experimental studies have confirmed the feasibility of using Dura fetal human and lbs to restore the anatomic integrity of the eardrum.

When transplants of Dura mater of the human fetus after 2 weeks of the experiment is razvlechenie 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 formation of native collagen fibers. In the area of contact of the graft with the parent bed are determined by a single lymphoid cells. The laser effects observed acceleration of collagenopathy in the zone entered transplant due to activation of auxiliary reserves (fat and fat cells), the old structure of the graft of Dura mater is not restored, being thus only stimulating matrix to form their own loose irregular connective tissue.

Example. Patient G., 46 years old, was in outpatient treatment with a diagnosis of Chronic right mesotympanic, without exacerbation. After providinng the examination the patient underwent surgery Tympanoplasty Dura mater fetal human right laser “biological” welding (lbs) contact method using a bone graft to prevent its displacement.

At the eardrum after it decapitalization on the edge of the perforation holes, which achieved a size of 3x3 mm before placing the graft of Dura mater, laid transplant from a flat bones of the cranial vault of the human fetus width of 1 mm, a thickness of 0.1 mm and a length of 2 mm larger than the perforations for better fixation of the bone graft with the edges of the perforations of the eardrum it was recorded by the method of lbs, the distal part of the end face of the optical fiber, the semiconductor laser “ATCUS-15” contact method in a pulse mode with a pulse duration of 450 MS and the output power of laser radiation 8.5 W, carried out the welding of bone allbritton to the edges of the perforations of the eardrum at 2 points. Then on top of the bone graft and punched a hole put the flap of Dura mater, which exceeded the size of the perforations 2 mm and additionally recorded to the eardrum via LBC contact method. At the distal portion of the end face of the optical fiber, the semiconductor is about laser “ATCUS-15”, mounted directly on the graft perpendicular to its surface, was applied laser radiation power of 8.5 W in pulsed mode with a pulse duration of 600 MS, which provided the welding of graft in place, touch the end face of the light guide. Point welding transplant was 8.

Bone graft fixed to the edges of the perforations of the tympanic membrane contact, biological laser welding is possible to eliminate the offset of the graft of Dura mater in the tympanic cavity, which prevented the penetration of infection into the tympanic cavity through the ear canal and to maintain conduction of sound through the drum cavity toward the inner ear.

Patient after surgery noted improvement in hearing, which was subsequently confirmed by audiometric examination, which revealed a decrease of the threshold of perception at low and medium frequency air conduction to 20 dB. In the postoperative period to prevent pressure build-up in the tympanic cavity through the wound exudate was conducted short course dehydratation therapy. For the reconstruction of the graft was performed dynamically conducted biochemical and immunological studies with mandatory endophytic what stralem status of the graft. In the late postoperative period after 4 months the patient has a relapse, perforation of the eardrum was not observed.

Sources of information

1. Superamento, A. //journal of otorhinolaryngology. - 1986. No. 1. - p.72-73.

2. Mechaniken NV Issues of clinic, diagnostics and treatment of chronic otitis. Omsk, 1979.

3. Kanzaki J. //J. Arch. Otorhinolaring. (Basel). - 1979. 25:3. - P.181-184.

4. Sushko Y.A //Ukr. USN., nose and neck. bol. - 1974. No. 1. - p.34-38.

5. Sushko Y.A //Ukr. USN., nose and neck. bol. - 1977. No. 2. - p.70-74.

6. ACK cyber IA //Ukr. USN., nose and neck. bol. - 1976. No. 2. - p.53-56.

7. Mestrez f //Acta otorhinolaryng. Belg. - 1976; 30: 3: 315-317.

8. Kerr A.G., Smyth G.D.L. //Arch. Otolaryng. - 1970; 91:4: 327-333.

9. Bauer M. Ful-orr-gegegyogy. - 1982; 28: Suppl: 46-53.

How plastic the perforations in the eardrum, which includes the welding of the graft to the edges of the perforations, wherein the edges of the perforations of the eardrum fix the graft from the flat bones of the cranial vault of the human fetus width of 1 mm, a thickness of 0.1 mm and a length of 2 mm larger than the perforations biological laser welding contact method in a pulse mode with a pulse duration of 450 MS and the output power of laser radiation 8.5 W at two points, and then on top of the bone graft and punched a hole stack flap of Dura mater the Lod man, exceeding 2 mm perforation hole, directly on the graft perpendicular to its surface install the distal portion of the end face of the optical fiber, the semiconductor laser and carry out his welding in 8 points in the pulse mode by the contact method.



 

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