Method for restoring voice in single-sided larynx paralysis

FIELD: medicine.

SUBSTANCE: method involves introducing two types of biopolymer Argiform having different molecule link degree. The procedure is carried out under local anesthesia with 10% S. Lidocaini solution in two stages using two Bruenings syringes. Gel distinguished by lesser cross-link degree is introduced into superficial layers at a depth of 2 mm at the first stage. Preparation characterized by greater cross-link degree is introduced in the amount of 0.3-0.5 ml from the second syringe at the second stage. The gel is introduced at this stage into deep layers at a depth of 3-4 mm. Needle edge is introduced as far as possible from the free end of Ferrein cords and laterally to push off vestibular fold.

EFFECT: enhanced effectiveness in restoring voice.

 

The invention relates to medicine, in particular to otorhinolaryngology.

Designed to restore the voice of unilateral paralysis of the larynx. Can be used in clinical practice otolaryngologists and phoniatrics. The urgency of the problem of unilateral paralysis of the larynx due to its prevalence.

The problem of regeneration of voice in patients with unilateral paralysis of the larynx despite the successful application of existing and waste, as well as perfecting new methods of treatment and remains today one of the most complex and pressing in laryngology. The larynx is an organ that performs many functions, such as breathing, safety, voice and speech, a violation of the latter and is at the forefront in persons with unilateral paralysis of the larynx. The increased rate of postoperative complications during surgery on the thyroid gland, increasing injuries in the home, increasing the number of surgical interventions for tumors of the bronchi, the upper and middle lobes of the lungs, esophagus and mediastinum, the increase in the number of operations in cardiovascular anomalies certainly brings its contribution in increasing the prevalence of this disease. Damage to the recurrent laryngeal nerves (namely the recurrent laryngeal) is one of the heavy donkey is jnani surgical treatment of diseases - the percentage of paresis and paralysis of recurrent laryngeal nerves during operations about endemic and sporadic nodular goiter varies from 1 to 4.5%, diffuse toxic goiter is from 0.1 to 10 and above according to various authors, thyroid cancer 3%, but the highest percentage of damage to the recurrent laryngeal nerves is observed in repeated operations on the thyroid gland, particularly regarding the recurrence of the disease and is about 5% (2).

For the treatment of patients with unilateral paralysis of the recurrent laryngeal nerve is used monopedigree treatment, acupuncture, electrical stimulation of the neuromuscular apparatus of the larynx. The most common is the stimulation of the muscles of the larynx diadynamic currents. Since 1992, applied fluctuosa currents having anti-inflammatory resorptive, regenerative effect. Apply termodinamica (the basis of the method is thermal effect causes the expansion of blood vessels, improve microcirculation, and consequently, improvement of metabolic processes). All these treatments are combined with the use of bio-stimulants and vitamin therapy. The use of surgical treatment methods are not widely used, because even sparing methods of surgical treatment of traumatic and often do not give the desired result. Preference in deciding treatment dnastar nih paralysis of the larynx is given injectable implant in vocal fold different synthetic materials and biopolymers as least traumatic and quickly feasible method. However, this method has its pros and cons, so we need to search for new biomaterials for implantation.

In 1911 Brunings (8) first used the method of increasing vocal fold injection of paraffin at direct laryngoscopy. Student Brunings Arnold (4) in 1955, the newly revived injection method. He enjoyed the cartilage of nasal septum and tantalum, and then spent the injection of Teflon particles mixed with an equal volume of glycerol.

Was proposed as a way of introduction to the voice of the fold of hydrophilic polymer gels. A distinctive feature of the implants of this type is their permeability to water-soluble compositions, porosity and adjustable plasticity, enzymatic stability. Some opportunities to increase the effectiveness of surgical treatment of persistent disponi in degenerative lesions of the neuromuscular apparatus of the larynx opens the application of high-molecular compounds - polyacrylamide gel. This material is characterized by the absence of a General toxic, allergic, irritant or carcinogenic effects, which confirms its biological inertness.

Arnold et al. (1986) (10) used injection gelatinous paste. Gelatinous paste does not cause tissue irritation, after resorption remains reactive phenomena.

Recently, finds a wide p is the physical alteration of collagen, which is a biological implant, easily injected, well tolerated by patients, little is resolved. Quality injectable collagen, such as strength, elasticity, good vascularization of the drug at the correct dosage to give good results (3). Data Forda (1984)(9) indicate that the nature of the resorption of collagen depends on the depth of its introduction. The best is the injection of collagen into the submucosal layer. Implantation Teflon paste in the paralyzed vocal fold is used for many years (Beck, 1980 [5]) is carried out both in direct and indirect micro laryngoscopy. Developed the technique of transcutaneous injection of Teflon paste in the paralyzed vocal fold (Hanson et al. 1985 [7]).

There are several requirements that should have implantable materials: good tolerance and fine dispersion, allowing the drug to easily pass through the needle. Among the available materials that meet the requirements of Teflon. At the macro - and microhistorical study material larynx after injection of Teflon paste-marked fibroblastic reaction. Implant surrounded by foreign body granuloma, acquires a thick consistency and saves it on the injection site. According to the light electron microscopy installed, is it Teflon, introduced in vocal fold is not indifferent material. It causes an inflammatory reaction with the formation of granuloma foreign body, which consists of cells that are related to phagocytic system that provides isolation and resorption of foreign material. In the productive formation reaction Teflon granuloma is gradually increasing size of the vocal fold, it is possible to move particles of Teflon within the larynx, which requires careful applying it in endolaringealnah plastic surgery (4). Injection of voice crease is an intervention that requires great precision and care, the drug overdose may cause narrowing of the Airways. After injection of Teflon paste in the paralyzed vocal fold sometimes there are long flowing inflammatory processes leading to the formation of granulomas, there is a migration of the particles of the drug in the upper and lower cervical lymph nodes, rejection of the implant, as well as other complications in the early period: redness and swelling of the vocal fold, the formation of a hematoma at the injection site, mild rigidity of the neck muscles. If an incorrect operation is performed introducing a suspension of Teflon voice may remain the same or even get worse. This happens when injected too m is on drugs or he is injected close to the edge of the vocal fold and Vice versa, as well as very deep or lateral. Therefore, we believe it is very important use of spiral computed tomography of the larynx before and after implantation, the use of stroboscopic studies during implantation, introduction to the practice of videolaryngoscopy and videolaryngoscopy. The above disadvantages have led to the search for new effective myimplementation.

There is a method of treatment of patients with unilateral paralysis of the larynx: Clinical and experimental rationale for the use of polyacrylamide gel with lesions of the neuromuscular apparatus of the larynx" ( Kucherenko TI - author's abstract on competition of a scientific degree of the candidate of med. of Sciences, Kiev - 1992 [1]) in the literature, which we take for

The prototype, but the disadvantage of this method is that the polyacrylamide gel, as allmaterials, subject to replacement by fibrous connective tissue in full unlike biopolymer "Aliform", morphological studies show that the bulk of the gel does not undergo biodegradation. Only its marginal (peripheral) layers formed around the connective tissue capsule are subjected to lysis and resorption macrophage cells, and the later period is not significantly expressed sprouting connective tissue cells in the narrow space around the capsule. And, Vadodara the nd gel Aliform" is a cross-linked copolymer of acrylamide and N,N, - methylenebisacrylamide on the active centers, which imparted a certain way silver ions, so that it has the properties of suppression of bacterial activity, which distinguishes it from other fillers on the basis of polyacrylamide. Produced two types of gel with varying degrees of cross-linking molecules, gel for plastic surgery soft tissue has a lower degree of cross-linkage than for urology. With the aim of eliminating the disadvantages of polyacrylamide gel we offer your way. Biopolymer "Aliform" is used in such medical fields as cosmetology, plastic surgery, orthopedics, urology, otorhinolaryngology.

The goal of our proposal is to restore vocal function in patients with unilateral paralysis of the larynx.

This goal is achieved by the fact that we used the implant "Aliform" by injection into paritycheck voice crease.

The method is as follows: under local application anesthesia S. Lidocaini 10% using two syringes of Brunings (6), equipped with a needle length of 20 cm, curved in such a way that it can be used in indirect laryngoscopy. In the first syringe is filled with a gel having a lower degree of cross-linking molecules, the second with a greater degree of cross-linking molecules. The tip of the needle skalyvaetsya as far as possible on the free edge of the vocal folds and lateral, pushing while the vestibular fold. The injection site is selected depending on the shape and the position in which it is fixed. Due to the fact that the voice crease has a layered structure, we select gel with varying degrees of cross-linking molecules. In the surface layers is injected gel with a lesser degree of cross-linking than in deeper layers.

Example No. 1.

Patient Onikienko Galina Vladimirovna 56 years were hospitalized with a diagnosis of paralysis of the right half of the larynx. Complaints of hoarseness, fatigue voices. Sick since December 2002, after the surgery - total resection of the thyroid gland.

Objectively voice hoarse, when laryngoscopy immobility right vocal fold, fixing her in a lateral position, the left voice crease movable in full. During phonation, the incomplete closure of the glottis. The glottis takes a triangular shape. The patient performed the implantation of the biopolymer in the paralyzed vocal fold, under local application anesthesia S. Lidocaini 10% to 5.0 ml, injected drug in a quantity of 0.5 ml At laryngoscopy - right vocal fold is provided in the median position. Closure of the glottis during phonation full. After implantation of improving speech was noted immediately after surgery. The voice is clear that C is scientific. Within 1 month the patient was under observation. Folds are in the same position. The voice function is not impaired.

Example # 2

Patient Godunov Valentina Nikolaevna 47 years no history 1368 was in-patient treatment in the ENT Department with 1.04.03, 6.04.03 years with a diagnosis of paralysis of the right half of the larynx. Was admitted with complaints of hoarseness, fatigue in the voice load. Considers herself a patient within two years after the surgery in 2001 to remove the tumor of the mediastinum.

Objectively voice hoarse, when laryngoscopy immobility right vocal fold is fixed in the paramedian position, the left voice crease mobile.

03.04.03, the patient underwent an operation - implantation of biopolymer "Aliform" in the right vocal fold in a quantity of 0.3 ml At laryngoscopy after implantation - right vocal fold is provided in the median position. During phonation, the complete closure of the glottis. It was also noted the improvement of the voice, the voice was sonorous. The patient began to notice the disappearance of fatigue voices.

Sources of information

1. Kucherenko TI "Clinical and experimental rationale for the use of polyacrylamide gel with lesions of the neuromuscular apparatus of the larynx", Kiev, 1992, abstract, dis. Caen. the honey. science.

2. Cherenko M Is. "Complications of thyroid surgery", Kiev, Health, 1977, P.30-39.

3. Ivanchenko GF "Implant microsurgery of the larynx", news otorhinolaryngology and logophilia. St. Petersburg, №3 (11), 1997

4. Ivanchenko GF "Functional microsurgery in patients with impaired voice paralysis, and cicatricial deformation of the larynx", Moscow, 1992 abstract. dis. Prof. The honey. science.

5. Chl. Beck: Unsere first experiences mit der intralaryngealen Tefloninjektion. Laryng. Rhinol. 59(1980) 715-718.

6. Beck, C., P.Pedersen: Verbesserte Bruningsspritze zur Injektion von Tefldnpaste. Laryng. Rhinol. 53 (1974) 577.

7. Hanson D.Z., P.H. Ward, Abermayor E. // Laryngoscope. - 1985.

8. Brunings, W.: Uber eine neue Behandlungsmethode der Recurrenslahmung. Int. Zbl. Laryng. 27 (1911) 371.

9. Ford C.N., D.W. Martin, Wamer T.F. Injectable collagen in laryngeal rehabilitation. // Laryngoscope. - 1984. - Vol.94. - P.513.

10. Arnold R., Laskawi R. Die Bedeutung der temporaren stimmlippen unterfuttemn fur die paralytischen Dysphonia. // Laryng. Rhinol. Otol. - 1986. - Vol.65. No. 1. - R.5-6.

Method of recovering voices with unilateral paralysis of the larynx by injecting implantation of the biopolymer in vocal fold thickness, wherein the local application anesthesia S. Lidocaini 10% is injected in two stages using two syringes of Brunings two types of biopolymer "Aliform" with varying degrees of cross-linking of the molecules, with the first syringe into the surface layers to a depth of $ 2 mm injected gel with a lesser degree of cross-linking molecules, and the second stage in the deeper layers at depth is 3-4 mm the preparation of the second syringe with a greater degree of cross-linkage in the amount of 0.3-0.5 ml, and the tip of the needle injected as far as possible from the free edge of the vocal folds and lateral pushing while the vestibular fold.



 

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