RU2122837C1 - Method of purse-string pharyngoplastics - Google Patents

Abstract

FIELD: stomatology. SUBSTANCE: method consists in using pharyngeal flaps on upper feeder legs cut on posterior wall of pharynx conditionally divided into parts, in side compartments of pharynx, followed by sewing in flaps into tissues of side wall of pharynx and palatal curtain. EFFECT: accelerated treatment and improved quality of speech estoration. 4 dwg

Description

 The invention relates to medicine, namely to maxillofacial surgery, and can be used in primary uranoplasty, as well as in the treatment of patients with speech disorders due to insufficiency of the palatopharyngeal ring (NGC).

 A known method of pharyngoplasty according to Schoenborn (Tikhov P.I. Private Surgery. Vol. 1, Petrograd: Practical Medicine. - 1916. - p. 284) to eliminate palatopharyngeal insufficiency (NGN) in the middle third of the posterior pharyngeal wall (ZGH) ) cut out the mucus-muscular flap on the leg and hem to the tissues of the soft palate in the midline.

 Closest to the proposed method is the “Method of velopharyngoplasty” (Ad. A. Mamedov, 1987, author certificate. N 1568984 of 12/9/08), where incisions are made under endotracheal anesthesia along the posterior-lower edge of the soft palate and the lateral pharyngeal walls (BSG) ) on both sides, thereby forming two mucus-muscular layers: oral and nasal. Next, on the back wall of the pharynx, conditionally divided into three parts, in its lateral sections, two pharyngeal mucus-muscular flaps on the upper feeding legs are cut to the prevertebral fascia with two vertical sections connected to each other at the apex. Under the base of the pharyngeal flaps, medial lateral incisions are made. The mucous membrane of the posterior pharyngeal wall is bluntly mobilized, brought together and sutured, thereby closing the wound surfaces after taking pharyngeal flaps. To the nasal mucous and muscular layer of the soft palate and the lateral walls of the pharynx, pharyngeal flaps are fixed with inverted catgut sutures, the wound surfaces of which are covered with the oral mucous and muscular layer.

 In studying the causes of speech pathology associated with impaired functional activity of the structures of NGC, using objective research methods, we came to the conclusion that the use of a pharyngeal muscular-muscular flap from the middle third of the SGH leads to a violation of the anatomical shape and function of the NGC associated with "pathological standing flap as an obstacle in the middle of the gate, "and the BSG do not take part in closing, or their activity is not taken into account. If the anatomical formation is normal, the palatopharyngeal ring is inherently and form a ring, then as a result of reconstruction it should repeat its anatomical shape, and the presence of an unnatural barrier inside the ring leads to complications from the upper respiratory tract and ENT organs. When using known methods of speech recovery occurs only after 6 - 8 months.

 The objective of the invention is the elimination of palatal pharyngeal insufficiency associated with impaired mobility of all structures of the palatine pharyngeal ring: the lateral pharynx, palatine curtain (NC), which will reduce the recovery time of speech up to 3-4 months and improve speech quality.

 To solve this problem, the “Pouch pharyngoplasty” method is used, which consists in the use of pharyngeal mucus-muscular flaps on the upper feeding legs cut on the pharynx, conventionally divided into three parts, in its lateral sections, followed by suturing of the lateral edges of the pharyngeal flaps into the previously formed nasal mucous and muscular layer of the palatine curtain and lateral wall of the pharynx. The medial edges of the pharyngeal flaps are sutured into the previously formed oral mucous-muscular layer of the lateral pharynx and palatine curtain. The distal ends of the pharyngeal flaps are sutured together along the midline “butt to butt” or “lap”.

The method is as follows:
- under endotracheal anesthesia, incisions are made along the posterior-lower edge of the soft palate with the transition to the lateral pharyngeal walls behind the posterior palatine arch on both sides to the level of the borders of the transition of the lateral pharyngeal walls to the posterior one so that two mucous-muscular layers are formed: the oral and nasal (Fig. 1).

 Next, the back wall of the pharynx is conditionally divided into three parts, and in its lateral sections two vertical sections connected to each other at the apex cut two pharyngeal muscular-muscular flaps on the upper feeding legs to the prevertebral fascia (Fig. 2).

 The cut lines, lowered from the NS to the BSG at the borders of the transition of the lateral pharyngeal walls to the posterior, are connected with the lateral lines of the cut, going from the tops of the farenheal flaps to their bases. Thus, a single cut line is obtained, going from the middle of the NS to the lateral side of the pedicle and the top of each pharyngeal flap.

 The lateral edges of the pharyngeal flaps are sutured into the pre-formed nasal mucous-muscular layer of NS and BSH. The medial edges of the pharyngeal flaps are sutured into the previously formed oral mucous-muscular layer of BSH and NZ (Fig. 3). Thus, the closure of the wound surface of the pharyngeal flaps is achieved. The distal ends of the pharyngeal flaps are sutured together along the midline “butt to butt” or “lap” (Fig. 4).

 In the place of taking the pharyngeal flaps, the edges of the defects of the mucus-muscular layers of the MHG are bluntly mobilized, brought together and sutured in layers. Hemostasis throughout the operation.

 Example. Patient Zaniev S., 8 years old, was admitted to the clinic of reconstructive and aesthetic surgery of the NGO “Bonum” on 10.21.95 with complaints of nasalization of speech.

 On the basis of clinical, speech therapy, endoscopic - NG deficiency due to poor mobility of BSH and NS, a spectral analysis system for speech and other objective research methods, the diagnosis was made: Rinolalia on the background of palatopharyngeal insufficiency after previously performed uranoplasty of an isolated cleft palate.

 Pharyngoplasty was performed according to our proposed method. The postoperative course is smooth, without complications. Sutures were removed on the 6th day. Primary healing. On the 6th day, the patient was transferred to the rehabilitation treatment department, where he was given a two-week course of physiotherapy, including magnetotherapy, laser therapy, massage of the structures of the palatopharyngeal ring, and the initial course of exercise therapy. Speech therapy training was aimed at setting the right breathing, sounds, syllables during spontaneous speech. After this course, the patient was discharged home in satisfactory condition. To continue speech therapy training, the patient was given homework assignments for breathing and speech. During the control examination after 3 months, the complete closure of the structures of NGC, the participation of all components of the NGC in the closing mechanism and the absence of air leakage through the nose during spontaneous speech were endoscopically observed. Clinical and speech therapy examination rated it “good”.

 According to the developed method, 8 patients aged from 6 to 14 years were operated on (two with primary uranoplasty). All received positive results, consisting in the elimination of palatopharyngeal insufficiency, the restoration of the mechanism of closure of NGC and the elimination of nasal speech, improving the quality of speech in terms of up to 3-4 months.

Claims (1)

 A method of purse-string pharyngoplasty, including cutting out two pharyngeal muscular-muscular flaps on the upper feeding legs from the posterior pharyngeal wall in its lateral thirds, followed by suturing them to the nasal mucous and muscular layer of the lateral pharynx and palatine curtain, the wound surfaces of which are closed by the mucous-oral mucosa the fact that the lateral edges of the pharyngeal flaps are sutured into the nasal muscular-muscular layer, the medial edges of the pharyngeal flaps are sutured into the oral mucous-muscular layer.

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