DE202004010360U1 - Epiglottis prosthesis, fixed in an upper zone of the larynx prosthesis by sewing, is made of a biologically compatible material, in particular, a material with fungicidal and/or bactericidal properties - Google Patents

Abstract

The epiglottis prosthesis (5), preferably positioned in an upper zone of the larynx prosthesis (1) and fixed by sewing, is made of a biologically compatible material, in particular, a material with fungicidal and/or bactericidal properties.

Description

1.1. diseases

The Larynx cancer is the most common malignant tumor the head and neck region. Every year around 246,000 people fall ill worldwide laryngeal cancer (Lannx carcinoma), across Germany there are approximately 3000 people. Men are currently six times affected more often than women. (Source: Bremen Cancer Registry Annual Report 2001). The mortality for the Larynx cancer approx. 1500 people a year in Germany. The incidence and the mortality fall for Men since Beginning of the nineties. For By contrast, there is an increase in women. The frequency summit the disease is in the 5th to 7th decade of life. However, it falls also an increase in the disease in patients younger than 40 years (keyword: juvenile smokers).

On essential risk factor for Smoking is the development of cancer of the larynx. The increased Disease rate in women is mainly due to their changing Attributed to smoking behavior. The Combining smoking with an increased alcohol consumption leads to a considerable Increase in risk. Occupational exposures such as wood dust and certain chemicals (halogenated hydrocarbons) also lead to an increased risk of illness. Laryngeal cancer caused by asbestos can in Germany as Occupational disease are recognized.

1.2. anatomy

The Larynx (nomina anatomica: larynx) is an independent organ, the top part of the trachea sits and serves for voice training. It consists of a skeleton of several cartilage plates, interconnected by ligaments and muscles are connected. A special cartilage plate, the epiglottis cartilage (nomina anatomica: Epiglottis) closes the entrance when swallowed to the larynx and thus prevents the penetration of food and liquids into the airways.

1.3. therapy

How with every cancer is also for the therapy of the larynx cancer the stage of the disease is crucial.

you makes an anatomical distinction able to the vocal cords three big ones Groups of these tumors: supraglottic (above the vocal cords), subglottic (below the vocal cords) as well the actual vocal cord tumors (glottic larynx carcinomas).

in the Contrary to most other cancers that have no early signs cause, they already make through persistent hoarseness up early be attentive. For treatment of larynx cancer is subject to surgery (with complete resection of the larynx during advanced tumor growth or partial resection in early stages) and radiation therapy is available. In the early stages of the disease both methods can be used alternatively. In advanced Tumors combine both procedures and complement each other. The earlier the cancer is diagnosed, the better the chances of a cure and the more aggressively he's treated.

The Surgery ranges from the removal of the tumor alone to remove the entire larynx, usually including the removal the cervical lymph node. Tumors limited to the vocal folds removed by microlaryngoscopy. This is done with either Scalpel ("bloody") or with the laser ("Bloodless"). For larger tumors, which, however, can be safely removed in the healthy, are partial resections, that is, the removal of certain parts of the larynx. To this Wise can often do both voice and normal breathing remain.

We consider here the serious cases with extensive tumors of stages T3 and T4 (T3 stage, criteria: vocal cords are fixed, so no longer movable. T4: spread of the tumor over the Larynx out into the surrounding tissue.}. These are often only by a so-called laryngectomy (hereinafter abbreviated to LE) a complete Removal of the entire larynx with epiglottis. The above However, criteria are not the only and most important criteria that lead to a laryngectomy, many other clinical criteria also play a role.

On another patient base that has to be treated with a LE, are accident victims with severe neck and larynx injuries, for example after motorcycle accidents with impact of the front neck on the handlebar or wind deflector.

1.4. State of rehabilitation technology

The operation leads to considerable disabilities for the patient. Due to the loss of the epiglottis, an artificial separation of the food passages (throat and esophagus) and the air passages (trachea and lungs) is necessary to prevent food from entering the air passages. To maintain respiratory function, an artificial exit on the neck, i.e. a permanent tracheal incision, so-called tracheostoma, is placed at the level of the throttle pit (nomina anatomica: fossa jugularis). The humidification and warming of the air we breathe, which normally takes place in the nose, is eliminated in this way. this has an increased rate of bronchitis and pneumonia (respiratory infections and pneumonia). In addition, the patient can no longer perceive any smells because inhalation through the nose is no longer possible.

2. Problem

Summarized remains an extreme unsatisfactory picture of the patient back: Due to the surgical removal the larynx, especially the epiglottis, is missing the connection the trachea Mouth / throat and the patient loses the ability to breathe and close through the nose smell and thus taste. The natural function of the epiglottis, thus the separation of food passages (throat and esophagus) and Airways (trachea and Lungs) to prevent food from entering the airways, is not possible anymore.

3. Approach

in the As part of this work, an epiglottis cartilage is presented, that enable the patient should continue to breathe normally despite removal of his larynx to be able because the epiglottis replication prevents food and liquids into the trachea prevented.

3.1. Technical characteristics the epiglottis cartilage replica

It a prosthesis is used for this, which lies between the pharynx (pharynx) and tracheal end after the larynx has been removed. The prosthesis itself consists of a biologically well-tolerated material that, once sewn with the trachea begins with the trachea to grow together and through its fungicidal and bactericidal coating is largely safe against fungal and bacterial colonization.

Around to ensure breathing the inside of the prosthesis is over a cavity of ordinary Trache diameter (approx. 1.0-1.5 for average Caucasians cm).

Around The epiglottis will prevent swallowing when eating of the patient if possible exactly replicated. With the help of a spring mechanism by the When the tongue is pressed down while swallowing, it closes it Throat cartilage simulation then the upper opening of the laryngeal prosthesis and thus prevents the penetration of food and liquid in the upper respiratory tract.

this Locking mechanism comes in extremely important as the patient follows Removal of his larynx no sensation in the lower pharynx if he chokes, causing a cough reflex that is from the upper regions of the airways was triggered, no longer arise can. The patient would choking, without noticing it immediately. So must this opening be absolutely tight.

Emotional the tongue back after the swallowing phase and are food or liquids Completely opens in the esophagus Throat cartilage replica access to the upper respiratory tract.

4. Summary

The severely impaired patient after surgical larynx removal using this, the food passages (pharynx and esophagus) and Airways (trachea and lungs) to prevent food from entering Airways, separating, epiglottis replica no longer can swallow.

By the use of a larynx prosthesis, which bridges the airway when in condition Larynx removal, the patient is again able to use the mouth to breathe and nose and thus smell and taste again.

5. Schematic drawings the laryngeal prosthesis

1 represents the lateral median sectional view of the laryngeal prosthesis and the epiglottis cartilage ( 5 ) in the normal breathing position 1 is also the esophagus ( 3 ) the trachea ( 4 ) the soft palate ( 6 ) and the tongue ( 2 ) mapped.

In 2 is the enlarged representation of the normal breathing position, with the epiglottis cartilage replica ( 5 ) open.

3 shows the coronal section through the middle of the epiglottis cartilage ( 5 ).

In 4 you can see the top view of the opening of the laryngeal prosthesis ( 1 ).

5 represents the swallowing act. The tongue ( 2 ) presses the chyme ( 8th ) against the hard and soft palate ( 6 ) and thus backwards into the upper throat opening. At the same time, it closes the epiglottis cartilage ( 5 ) by pressing down on the tongue body replica ( 7 ). Breathing stops here for a short time as a reflex. This is a natural human reflex.

In 6 is the chyme ( 8th ) have already moved further down (caudal). The epiglottis cartilage replica ( 5 ) is like the healthy one People too, meanwhile completely on the upper back opening of the laryngeal prosthesis ( 1 ) has come to rest and thus closes the upper windpipe and prevents swallowing.

After the chyme ( 8th ) on the epiglottis cartilage ( 5 ) past the upper section of the esophagus ( 3 ), the epiglottis cartilage replica opens ( 5 ) again due to an integrated spiral spring ( 11 ) ( 7 ).

8th shows the emergency ventilation of the wearer. Anyone who needs emergency ventilation is intubated. For this purpose, a thin plastic tube, hereinafter tube ( 9 ), using a so-called laryngoscope ( 10 ) inserted into the trachea. The laryngoscope ( 10 ) serves to tongue ( 2 ) and simulated epiglottis cartilage ( 5 ) to the front towards the jaw to avoid a so-called false intubation, in which the tube ( 9 ) erroneously in the esophagus ( 3 ) to stop lying. The wearer of the laryngeal prosthesis ( 1 ) can also be performed artificially per tube as part of an emergency, just like an otherwise healthy person ( 10 ) are ventilated because the integrated coil spring ( 11 ) the train through the laryngoscope ( 10 ) gives way.

Claims (7)

Epiglottis cartilage replica, characterized in that it is preferably used in the upper region of a larynx prosthesis, which can be inserted in particular between the pharynx (pharynx) and end of the trachea and can be sewn in particular and consists of a biologically well-tolerated, in particular fungicidal and / or bactericidal material, or at least partially thereof is surrounded. Epiglottis cartilage replica according to claim 1, characterized characterized that the epiglottis cartilage replication as possible the anatomical features and dimensions of the natural epiglottis equivalent. Epiglottis cartilage replica according to claim 1 or 2, characterized in that the epiglottis cartilage replica preferably consists of a rubber-like material. Epiglottis cartilage simulation according to one of claims 1 to 3, characterized in that the epiglottis replica the top opening the trachea closes, to penetrate liquid or prevent solid foods. Epiglottis cartilage simulation according to one of claims 1 to 4, characterized in that the epiglottis cartilage replica by a locking mechanism, preferably a spring mechanism through tongue activity is pressed down. Epiglottis cartilage simulation according to one of claims 1 to 5, characterized in that preferably a spiral spring Epiglottis cartilage replica back turns to its starting position after the chyme is fully on the epiglottis replica flowed past into the esophagus is. Epiglottis cartilage simulation according to one of claims 1 to 6, characterized in that in the event of necessary emergency ventilation (Intubation) by the usual Aids the spiral spring of the epiglottis replica gives way to a certain train and thus the epiglottis replica can be pulled towards the tongue and increases access to the trachea.