Method for plasty of vast defects in tympanic membrane

FIELD: medicine, ORL-surgery.

SUBSTANCE: beforehand one should form a carcass out of two transplants of flat bone of human fetal cranial arch at width up to 1 mm, thickness of 0.1 mm each of them that correspond to the width of osseous part of patient's auditory canal. At first, transplants should be fixed in mutually perpendicular position in two points with laser biological welding (LBW) performed with distal part light guide's edge of semiconductor laser "ATKUS-15" in impulse mode at impulse duration being 450 msec and output power of laser radiation being 8.5 W. Then the transplant should be fixed to osseous walls of auditory canal due to LBW in similar mode in four points. Then one should apply a flap of human fetal dura mater onto osseous transplants that completely cover perforation foramen of tympanic membrane which should be, also, fixed with LBW technique to the rest of tympanic membrane. The innovation suggested enables to exclude transplant's shift and keep sounding 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 synthetic and biological materials. In ENT surgery, there are reports of the use of collagen film in the form of a strip, precluding displacement of the graft in the tympanic cavity (1).

The disadvantages of analog is:

1. Duration tamponade external ear canal.

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

3. Reduced vibration properties restored the eardrum due to layering used grafts.

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

As the prototype was taken the way of fixing autopaste or meatal skin on the base plate of the auto - or holograma, which were placed between the layers of the split membrane, and in the absence of the latter were placed one end on the handle of the Malleus or the wall of the ear canal, while others on the area of the annulus (4).

The disadvantages of the prototype is:

1. The lack of good fixation plates from the auto or holograma results from the offset of the latest and flap autopaste and metallinou skin tympanic cavity with the gradual development of scar tissue in b is rabanni cavity or obliteration (5, 6, 7, 8).

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.

4. The complexity of plastics of extensive defects of the tympanic membrane.

The purpose of this invention is to commit allbritton (flat bones of the skull vault fetal human) between itself and the edges of the bony part of the external ear canal with extensive perforation holes eardrum laser "biological" welding (LAN) using a semiconductor laser "ATCUS-15" contact method in pulsed mode.

This objective is solved in that at extensive perforation holes in the eardrum in the ear canal before putting graft of Dura mater of the human fetus enter the pre-formed frame of grafts flat bones of the cranial vault of the human fetus to a width of 1 mm, a thickness of 0.1 mm each, matching the width of the bony part of the external auditory canal, which first fixed in perpendicular position 2 points biological laser welding the distal part of the end face of the optical fiber, the semiconductor laser "ATCUS-15" contact is the principal way in pulsed mode with a pulse duration of 450 MS and the output power of laser radiation 8.5 W. It excluded their displacement relative to each other. Then, the bone graft is fixed to the bony wall of the external acoustic meatus biological laser welding in a similar mode to the four points on the bone grafts stack flap of Dura mater of the human fetus to completely cover the perforation hole in the eardrum. Bone grafts fixed between them and the bone walls of the external ear canal biological laser welding, to form the frame, then fit the flap of Dura fetal human, fully demarcates the tympanic cavity from the external ear canal. The bone grafts were excluded displacement of the Dura of the fetus in the tympanic cavity and allowed 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 from 29 to 52 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 perforating about the holes in the eardrum Dura mater of the human fetus using laser "biological" welding (lbs) and laying to prevent displacement of the tympanic cavity bone grafts from the flat the bones of the vault of the skull of a 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 subsequently when conducting experimental studies have confirmed the feasibility of using Dura mater of the human fetus and LAN 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 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, the only incentive matrix for the formation of loose irregular connective tissue.

Example. Patient T., 37 years was ambulatorium treatment with a diagnosis of Chronic left mesotympanic, out of aggravation. After the examination the patient underwent surgery Tympanoplasty Dura mater fetal human right laser "biological" welding (LAN) contact method using bone grafts fixed to the bone walls of the outer ear canal to prevent its displacement.

For closing large perforation holes pre-to the bone walls of the external auditory canal on the border of the latter to the tympanic cavity before placing the graft of Dura mater of the human fetus has introduced two transplant from a flat bones of the cranial vault, corresponding to the width of the bony part of the external auditory canal, the bone plate to a width of 1 mm and thickness of 0.1 mm is first recorded in the perpendicular position between a method lbs 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, which excluded their displacement relative to each other, and then the bone grafts were fixed to the bone walls of the external auditory canal of the distal part of the end face of the optical fiber contact in a pulsed mode with a pulse duration of 450 MS and output the th power of the laser radiation 8.5 watts at 4 points. On the generated skeleton from bone grafts were placed flap of Dura mater of the human fetus, which is also the method of LBC was fixed to the remnants of the tympanic membrane. This helped to delineate the tympanic cavity from the external ear canal, the bone grafts were completely excluded the displacement of the Dura in the tympanic cavity and allowed to keep holding drum sounds through the cavity toward the inner ear.

Patient after surgery reported improvement of hearing in the left ear, which was subsequently confirmed by audiometric examination, which revealed a decrease of the threshold of perception at low and medium frequency air conduction to 25 dB. In the postoperative period to prevent pressure build-up in the tympanic cavity through the wound exudate was conducted short course of dehydration therapy. For the reconstruction of the graft was performed dynamically conducted biochemical and immunological studies with mandatory individualtree 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. Transfiguration N.A., Goldman I.I., Shachter A.B. //Bulletin of the of orienlanguage. - 1973, No. 6, - p.57-62.

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

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

4. Potekhina O.K., Alina V.L. //Bulletin of otorhinolaryngology. - 1977, No. 3, - p.18-21.

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

8. Bauer M. Ful-orr-gegyogy. - 1982; 28: Suppl: 46-53.

The way plastics of extensive defects of the tympanic membrane, comprising the laying of a graft of Dura mater of the human fetus, wherein the pre-form the skeleton of the two grafts flat bones of the cranial vault of the human fetus to a width of 1 mm, a thickness of 0.1 mm each, matching the width of the bony part of the external auditory canal, which first fixed in perpendicular position at two points biological laser welding the distal part of the end face of the optical fiber, the semiconductor laser "ATCUS-15" in a pulsed mode with a pulse duration of 450 MS and the output power of laser radiation 8.5 W, and then is fixed to the bony wall of the external acoustic meatus laser biological welding in a similar mode to the four points on the bone grafts stack flap of Dura mater of the human fetus, t is d closing punching a hole in the eardrum, which is recorded by the method of lbs to the remains of the eardrum.



 

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