Method for performing plasty of perforation foramen in nasal septum

FIELD: medicine, ORL-surgery.

SUBSTANCE: one should apply a transplant out of human fetal nasal septum into perforation foramen of nasal septum. Moreover, transplant's sizes should be 5 mm higher against the diameter of perforation foramen. Fixation to mucosa of nasal septum should be performed due to laser biological welding in 7-8 points being around perforation foramen due to contact technique. The suggested innovation enables to achieve tight fixation of a transplant to mucosa of nasal septum without separating opposite mucosal leaves and perichondrium.

EFFECT: higher efficiency of plasty.

1 ex

 

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

There are ways to restore the anatomical integrity of the septum of the nose after a previously completed her surgical interventions with subsequent formation directly during surgery or in the remote terms after perforating holes by means of a variety of types of operations with the use of grafts. In ENT-surgery use of demineralized bone allografts for closing perforating holes in the septum of the nose in animals [1].

As the plastic material for closure of defect of septum of the nose was used demineralized a allobone in the experiment at 25 rabbits. Through the front wall of the nose, without entering into its cavity, resellable plot skeleton septum of the nose 0.7×0.7 cm, followed by its replacement plate allogeneic demineralized bone. After 3 months all planted plate demineralized bone was reconstructed and consisted of new spongy bone of the recipient, closing the operating perforation. Bone region of the former operational defect was soldered end-to-end" with the newly formed bone and differed from it by a greater degree of calcification.

The disadvantages of analog is:

1. Deminer sovanna the allobone loses its osteoinductive properties in the process of its treatment by hydrochloric acid solutions of different concentrations.

2. Because of the implantable human tissue is genetically alien to the animal, there are frequent transplant rejection with his suppuration [2].

As the prototype was taken way to close the perforations in the septum of the nose deionized allobone covered Autopista temporal muscle [3, 4].

In place of the perforated openings in the septum of the nose after ofseparate sheets mucosa and Nadirashvili was used vinyl demineralized of allocate, exceeding the length value of the replaced defective 8-10 mm, locking bone plate by forming a "rags-languages" in the front and ask the departments of transplant, with which it is pushed on the remaining sections of bone and cartilage skeleton of the septum of the nose. When large perforating holes in the septum of the nose is exposed wall of the graft was covered with outofarea temporal muscle, which together with allobone was placed between the split on the edge of the perforated sheets of the mucous membrane of the septum of the nose.

The disadvantages of the prototype is:

1. Demineralized a allobone loses its osteoinductive properties after treatment with hydrochloric acid solutions of different concentrations.

2. Hydrochloric acid helps to wash away from the bone graft mineral salts, th is leads to the loss of frame options.

3. The deionized allobone a long time does not undergo rearrangement with the formation of new bone, it may be suppuration and resorption [2].

4. The necessity of using autopaste temporal muscle for plastics perforations of the septum of the nose will result in the need to perform additional surgery in the patient with the aim of taking his transplant.

The purpose of this invention is the fixation of the graft (graft of Dura mater of the human fetus) to the mucosa of the septum of the nose around the perforations of the septum of the nose laser "biological" welding (lbs) using a semiconductor laser "ATCUS-15" contact method.

This objective is solved in that in the perforation defect in the septum of the nose was introduced transplant graft of Dura mater of the human fetus in excess of 5 mm diameter perforations. The Dura mater of the human fetus is fixed to the mucous membrane of the septum of the nose around the perforations method LAN 7-8 points on each side, 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 8,0 W in pulsed mode, the pulse duration of 600 MS. Contact laser "biological" welding allowed EXT is be thorough fixation of the graft of Dura mater of the human fetus to the mucosa of the septum of the nose around the perforations without ofseparate opposite leaves mucosa and Nadirashvili the septum of the nose around the perforations.

Specific example:

We observed 3 patients aged 15 to 25 years with perforating holes in the septum of the nose. All operations were performed under local infiltration anesthesia.

The proposed method of closure of perforated holes in the septum of the nose transplant from flat allowreboot and Dura mater of the human fetus using laser "biological" welding (LBC) was preceded by a comparative assessment of different existing up to the present time how perforating holes in the septum of the nose with the use of grafts, different methods of preparation and preservation used donor tissue that subsequently when conducting experimental studies have confirmed the feasibility of using Dura fetal human and LBC with the aim of restoring the anatomical integrity of the septum of the nose.

Implantable Dura fetal human two weeks after implantation, and lbs subject 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 after them is santali. It should be emphasized that in the area of lbs the old structure of the graft is not restored, and is only stimulating matrix to form their own loose irregular connective tissue.

Example. Patient N., 16 years were hospitalized with a diagnosis of Perforation of nasal septum. After the examination the patient underwent an operation - Allobetulin perforating holes in the septum of the nose using biological laser welding (lbs).

After local infiltration anesthesia of the mucous membrane of the septum of the nose around the perforations, the diameter of which reached 0.3 cm, punching a hole was introduced flap of Dura mater of the human fetus, exceeding the size of the perforation 0.5 cm, and was fixed to the surface of the mucous membrane of the septum of the nose around the perforations through LBC. The distal end of the optical fiber, the semiconductor laser "ATCUS-15" was mounted directly on the border of the contact surface of the graft with the mucous membrane of the septum of the nose, which was applied laser radiation power of 8.0 W in pulsed mode, the pulse duration was 600 MS at 5 points on each side that provided the welding of the Dura of the human fetus to mucosal Perigord the nose. Lbs allowed to achieve thorough fixation of the graft around its diameter, excludes offset and education again through perforated holes in the nasal septum. Given the short duration of laser irradiation on the graft and the mucous membrane of the septum of the nose with pulsed laser irradiation, were completely excluded factor charring of the graft in its contact with the distal end part of the fiber and education in the following coagulation necrosis. This method plastic sprocket holes are allowed to fix the graft on the surface of the mucous membrane of the septum of the nose without incision and ofseparate opposite leaves mucosa and Nadirashvili around the sprocket holes. Control over the restructuring of the transplant was carried out dynamically conducted inspections with videoendoscopes inspection performed biochemical and immunological studies. So after 1 month after implantation of Dura mater of the human fetus in place of the perforated holes noted the complete replacement of the Dura mater graft own mucous membrane of nasal septum, which covered the entire defect. In the postoperative period the patient received anti-inflammatory therapy, relapse is the perforations were observed.

Sources of information

1. Pokotilenko A.K., Gorbachev V.N., Makashev V.E. //Ukr. USN., of throats. and nose. bol. - 1991. No. 5. - p.44-46.

2. Toriumi D.M., Larrabee W.F., Walike J.W. et al. //Arch. Otolaryngol Head Neck Surg. - 1990. - Vol.116. No. 6. - P.676-680.

3. Gorbachev V.N., Sushko Y.A., B. I. Pavlik et al. //Orthopaedics, traumatology and prosthetics. - K.: Health, 1990. - s.138-140.

4. Gorbachev V.N., Makashev V.E., Minin J.V. //Ukr. USN., nose. and throats. bol. - 1991. No. 2. - pp.33-38.

How plastic the perforations of the septum of the nose, including the implantation of the graft, characterized in that the perforation hole septum of the nose introduce transplant graft of Dura mater of the human fetus in excess of 5 mm diameter perforation holes, and fix it to the mucosa of the septum of the nose around the perforations in 7-8 points biological laser welding by contact of the distal part of the end face of the optical fiber, the semiconductor laser with the output power of laser radiation 8,0 W in pulsed mode with a pulse duration of 600 MS.



 

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