Method for plasty of perforation foramen of tympanic membrane

FIELD: medicine, ORL-surgery.

SUBSTANCE: one should apply a thin layer of 10%-Syntomycin emulsion onto the edges of perforation foramen, then one should apply 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 to the edges of perforation foramen with distal part of light guide's edge in impulse mode. 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 600-700 msec in 6-8 points. The method enables to achieve transplant's tight fixation, exclude its shift and excessive coagulation of tympanic membrane in the site of light guide's edge application.

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 autologous denatured fat, put into the tympanic cavity in the form of a strip, precluding displacement of the graft in the tympanic cavity (1).

The disadvantages are the counterpart:

1. Duration tamponade external ear canal.

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

3. The lack of long-term monitoring of conductive tympanic cavity.

4. Adipose tissue while in the tympanic cavity in the conditions of an infected ear is a good nutrient medium for microorganisms and contributes to the formation of scar tissue (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).

The disadvantages of the prototype 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 transplant and EF is aktivnosti his 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) through the solder, which is used as a 10% emulsion of Syntomycin 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 tympanic membrane was laid on a thin layer of 10% emulsion “Syntomycin and, in addition, 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 pulsed mode, with pulse duration of 450 MS and the output power of laser radiation 8.5 watts at 2 points. Priyayi contact laser “biological” welding allowed to obtain thorough fixation of bone allbritton to the edges of the perforations, to exclude bias and excessive coagulation of the eardrum in the place of application of the end face of the fiber, due to partial absorption of laser energy by emulsion “Syntomycin”.

Specific example:

The study included 6 patients aged 19 to 49 years with a 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” welding (lbs) and laying to prevent displacement of the tympanic cavity 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 perforating defects in the ear-drum, which confirmed the feasibility of using Dura mater of the human fetus 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 leads to razvlecheniy and degeneration of the collagen fibers of the graft. The process ends with the introduction of a new cell the cells (fibroblasts), participating in the education of their 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 O., 35, was in outpatient treatment with a diagnosis of Chronic left mesotympanic, without exacerbation. After the examination of the patient performed the surgery Tympanoplasty Dura mater of the fruit of the man on the left with the help of laser “biological” welding (lbs) contact method using solder and a bone graft to prevent its displacement.

At the eardrum after it decapitalization on the edge of the perforation holes, which achieved a size 2×3 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 best the first fixation of a bone graft with the edges of the perforations of the tympanic membrane was laid on a thin layer of 10% emulsion “Syntomycin and, in addition, 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 pulsed mode, with 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 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 to 700 MS, which provided the welding of graft in place, touch the end face of the light guide. Point welding transplant was 6.

Solder and contact method lbs allowed to obtain thorough fixation of bone allobrephotympanoplasty to the edges of the perforations of the eardrum, preclude the use of additional fixation of the graft from the ear. Given the short duration laser radiation (pulse duration of 450 MS) solid is Yu brain shell of fetal human and subject to the ear drum with in between the solder (10% emulsion “Syntomycin”), they were bonding, were excluded factor expressed coagulation eardrum, due to partial absorption of laser energy by the solder. The 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 35 dB. In the postoperative period to prevent pressure build-up in the tympanic cavity through the wound secretion was conducted short course of dehydration therapy. For the reconstruction of the graft was performed dynamically conducted biochemical and immunological research, with the obligatory individualtree status of the graft. In the late postoperative period after 3.5 months the patient has a relapse, perforation of the eardrum was not observed.

Sources of information

1. Storrs L. // Larungoscope. - 1963; 73: 6:699-670.

2. Transfiguration SHE Proceedings of the 5th Congress of otolaryngologists of the USSR. - HP - 1959. - s.

3. Transfiguration SHE //Bulletin of otorhinolaryngology. - 1959. No. 4. - p.24-25.

4. Rams VP //Bulletin of otorhinolaryngology. - 1981. No. 5. - p.30-32.

5. Kaufman RS //Laryngoscope. - 1974. - Vol. 84. No. 5. - R-804.

6. Maeta M., Saito R., F. Nakagawa et al. A clinical comparison of orthodox myringoplasty and a simple method with fibrin glue //Nippon Jibiinkoka Gakkai Kaiho. - 1998. - Vol. 101. No. 9. - P.1062-1072.

p> 7. Moles Y.A Myringoplasty with extensive perforations of the eardrum //Bulletin of otorhinolaryngology. - 2001. No. 5. - p.57-59.

How plastic the perforations of the eardrum, which includes the welding of the graft to the edges of the perforations, characterized in that the edges of the perforations apply a thin layer of a 10% emulsion of Syntomycin, then stack the transplant of 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, the transplant weld biological laser welding at 2 points to the edges of the perforations of the distal part of the end face of the light guide in a pulsed mode, then on top of the bone graft and punched a hole stack flap of Dura fruit larger than 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 the welding of the contact method in a pulse mode with a pulse duration of 600-700 MS 6-8 points.



 

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