RU2371105C1 - Repair procedure for lateral wall of attic and posterior wall of external acoustic meatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology and can find application in repair of lateral wall of attic and posterior wall of external acoustic meatus. Substance of the procedure consists in use of a split strip of cartilage with involving a single chondral graft from auricle according to the dimensions of a defect of posterior wall of external acoustic meatus and lateral wall of attic. Lateral wall is formed by bending the graft. If bending is laboured, cartilage is notched from a convex side of the graft. The chondral graft is fixed in a groove pre-formed on border of a bone defect of posterior wall of external acoustic meatus.

EFFECT: application of the present invention allows for reliable formation of walls of attic and external acoustic meatus.

2 ex, 2 dwg

Description

The invention relates to medicine, namely to otorhinolaryngology. There are a number of ways to restore the lateral wall of the attic and the posterior wall of the external auditory meatus during reconstructive operations on the middle ear (1, 2, 3, 4). With these methods, the lateral wall of the attic and the posterior wall of the external auditory canal are formed by individual transplants (cartilage, bone) or the use of organic materials.

One of the drawbacks of these methods in our opinion is the difficulty of fixing the newly formed walls and the probability of their displacement, as well as the probability of rejection.

In this regard, the reconstruction of the lateral wall of the attic and the posterior wall of the external auditory meatus with a single autograft is a guarantee of successful tympanoplasty.

The closest solution is:

Patyakina O.K., Sidorina N.G. New variants of thymanoplasty (types II-IV) after general cavity sanitizing surgery of the middle ear. Guidelines. - M.: Moscow Research Institute of Ear, Throat and Nose, 1980. - 15 p.

We take it as a prototype. The method involves the reconstruction of the posterior wall of the external auditory meatus and the lateral wall of the attic using a cartilaginous plate. In our opinion, the disadvantage of this method is to reduce the lumen of the aditus by the graft and the lability of the split cartilage used to create the lateral wall of the attic.

To eliminate these shortcomings, we propose a method for reconstructing the lateral wall of the attic and the posterior wall of the external auditory meatus, which differs from the previously proposed methods.

The aim of the present invention is to provide a securely fixed lateral wall of the attic and the posterior wall of the external auditory meatus with a single cartilage graft from the auricle.

The method is as follows.

To restore the lateral wall of the attic and the posterior wall of the external auditory canal, use a single cartilage graft from the auricle according to the size of the defect of the posterior wall of the external auditory canal and lateral wall of the attic, taking into account the flexibility of the cartilage transplant (A), form the lateral wall by bending the graft, making it difficult to bend cartilage incisions (B) on the convex side of the graft (Fig. 1) and cartilage graft (A) are installed in a preformed, along the border of the bone defect days of the outer meatus (C), a groove (D) (Figure 2).

An example of a specific implementation.

Ilyukhin Viktor Vasilievich, 51 years old, medical history No. 4157.

Diagnosis: main: chronic left-sided purulent otitis media (epithympanitis).

Complaints: hearing loss on the left, periodic discharge from the ear.

Anamnesis: sick since childhood, exacerbations occur up to 3-4 times a year.

Upon enrolment

Nose: nasal breathing is free, the septum of the nose is in the midline, the shells are not hypertrophied.

Pharynx: palatine arches are not hyperemic, palatine tonsils are not hypertrophied, there is no discharge in the gaps, the mucous membrane of the posterior wall is pink.

Ears: AD-eardrum gray, mobile.

AS-perforation of the eardrum in the unstretched part, the stretched part of the eardrum in the posterior sections is somewhat retracted, there is no detachable.

Accurate AS: - a / s, p. - 2 m.

Audiometry - conductive hearing loss on the left II tbsp.

In a hospital, a sanitizing operation on the left ear with tympanoplasty was performed.

Under local anesthesia, an incision was made along the transitional fold in the left behind the ear region. Soft tissues are stupidly peeled off, the skin of the posterior wall of the external auditory meatus is separated, the mastoid area is exposed. Cells of the mastoid process and antrum were opened with boron; the latter is partially filled with cholesteatom masses. The back wall of the external auditory canal was removed and the spur was smoothed out, the lateral wall of the attic was removed, in the attic of the cholesteatoma, which is completely removed, the anvil has carious changes, and there is no long leg of the anvil. The head of the malleus is shrouded in the epidermis, it is resected. When revising the tympanic cavity, the adhesion process, the tympanic membrane in the posterior sections are soldered to the promontorium and the head of the stapes. Scars are excised, there are cholesteatomic masses in the region of the anterior pedicle, which are removed, the mobility of the windows is preserved, after removal of all pathological tissues, ossiculoplasty is performed by auto-cartilage, which is placed between the handle of the malleus and the head of the stapes. The outer wall of the attic and the posterior wall of the external auditory canal are formed from auto-cartilage. Tympanoplasty was performed by auto-fascia of the temporal muscle, the remains of the tympanic membrane and the skin of the posterior wall are laid on the fascia. Stitches on the wound. Loose tamponade of the external auditory meatus. Aseptic dressing.

Discharged home in satisfactory condition.

The repeated examination of May 16, 2006 does not present any active complaints. Objectively, AD is a non-otimal membrane of gray color, mobile, the back wall of the external auditory canal is well-to-do.

Example 2. Karchevskaya Elena Andreevna 42 years old, case history No. 59016.

Diagnosis: Chronic bilateral purulent otitis media on the right (epithympanitis)

Complaints: hearing loss in the right ear, scanty discharge from it.

Anamnesis: suffers from chronic otitis media since childhood, rare exacerbations.

ENT status: with anterior rhinoscopy - pink mucosa, midline septum, shells are not hypertrophied. Pharyngoscopy - palatine arches and tonsils are contoured.

Otoscopy: AD-perforation in the unstretched part, cholesteatomic scales in perforation. AS-perforation in the unstressed part, cholesteatomic scales perforation. Accurate on the right - 6 m, p.p. - 6 m on the left 3 m, p.p. - 6 m. Audiometry hearing loss on the left in the conductive type II degree.

September 5, 2007, a sanitizing operation was performed with tympanoplasty on the left. Under local anesthesia (2% lidocaine solution), a behind-the-ear incision was made, then a transverse section along the posterior-upper wall of the external auditory meatus. The aditus was enlarged with the posterior wall of the auditory meatus demolished along the cholesteatoma matrix. The cholesteatoma spreads to the antrum and cells of the mastoid process, the cholesteatoma is removed with the matrix. The chain of auditory ossicles is mobile, there are scars that are removed. Plastic surgery of the posterior wall of the auditory meatus and the lateral wall of the attic by the auto-cartilage, plastic perforation of the perichondrium were made. Loose tamponade of the external auditory meatus. Stitches on the wound. Aseptic dressing.

Discharged home in satisfactory condition.

Re-examination: February 2008 AS - non-otimal membrane is movable gray, the posterior wall of the external auditory meatus and the lateral wall of the attic are well-to-do.

Information sources

1. Clinical and X-ray examination of endoprosthetics of the middle ear with titanium nickelide implants / K.Z. - St. Petersburg, 1995, volume 1. - S.437-441.

2. Mishenkin N.V. Clinic issues, diagnosis and treatment of chronic otitis media. Educational-methodical manual / N.V. Mishenkin. - Omsk, 1979.- 87 p.

3. Patyakina O.K. New variants of thymanoplasty (types II-IV) after general cavity sanitizing surgery of the middle ear. Methodical recommendations / O.K. Patyakina, N.G. Sidorina. - M.: Moscow Research Institute of Ear, Throat and Nose, 1980. - 15 p.

4. Eviator H. Tragal perichondrum and cartilage in reconstructive ear surgery / H. Eviator // Laryngoscope. - 1978, vol. 88, Suppi 111. - P.1-23.

Claims (1)

A method for reconstructing the lateral wall of the attic and the posterior wall of the external auditory canal by using a split cartilage strip, characterized in that they use a single cartilage graft from the auricle according to the size of the defect of the posterior wall of the external auditory canal and lateral wall of the attic, form the lateral wall by bending the graft, with difficulty bendings produce cartilage incisions on the convex side of the graft and the cartilage graft is installed in a preformed, on the border of the bone defect of the posterior wall of the external auditory meatus, groove.

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