RU2137447C1 - Method for treating the cases of rhonchopathy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying YAG-holmium laser or erbium glass laser for carrying out contact soft palate destruction with its arches and uvula palati in known places applying depth- and area-controlled action. It causes inflammation and cicatrization resulting in stopped vibrations of thinned and stretched soft palate in breathing. That means that snore vanishes. EFFECT: provided functional and cosmetic safety of the soft palate.

Description

 The invention relates to medicine, namely to otorhinolaryngology.

 Regardless of the cause of rohnopathy, the mechanism of snoring is based on the vibration of the soft palate and its tongue, which occurs due to relaxation of their muscles, increase in their volume and size. In this regard, all methods of treating rohnopathy are primarily aimed at eliminating the causes of relaxation of the soft tissues of the palate, and then at its pulling (pulling), compaction and thinning, which leads to the disappearance or reduction of soft palate vibration in a dream.

 There are several surgical treatments for snoring that can be divided into two groups. The first is when in one way or another they injure soft palate tissues (galvanic caustics, cryotherapy, laser destruction, alcohol solution sclerotization), causing inflammation, followed by scarring and tightening of soft tissues around the scar, which leads to compaction, thinning and tightening of the soft palate. The second - when one way or another cut off (excised, removed) the edge (free edge) of the soft palate with its tongue.

 There is a method of cryodestruction of the palate, its arches and tongue using liquid nitrogen and a special cryo-instrument (I. V. Nikolaeva, V. M. Shevtsov "Application of the cryodestructive method to eliminate snoring." In the book "Scientific advances in practical work." 6, Moscow, 1992, pp. 186-189).

 However, cryodestruction makes it impossible to evenly distribute the area of influence on the soft tissues of the sky in area and depth, which leads to uneven scarring (pulling up, pulling), thinning and densification of the palate, which reduces the effectiveness of the intervention.

There is also known a surgical method for changing the structure of the sky (uvulopalatinoplasty) using a CO ₂ laser, which consists in using a laser beam to cut off the edge of the soft palate with a tongue (RTDickson, DRMintz "One-Stage Laser-Assisted Uvulopalatoplasty". The Journal of Otolaryngology Volume 25, Number 3, June 1996).

 However, this rather radical method does not provide a 100% cure for snoring, but significantly changes the cosmetics of the oropharynx, and sometimes leads to a violation of the dividing function of the palate.

 The objective of the invention is to provide a method that would allow the destruction of the tissues of the soft palate, its arches and tongue, strictly in certain places, dosed in terms of area and depth of exposure, followed by inflammation and scarring, as a result of which the altered palate (thinned and pulled up) ceases to vibrate in a dream on inhale (exhale), i.e. snoring disappears.

 The technical result of the invention is uniform scarring, thinning and densification of the soft palate, leading to the disappearance of snoring, with its functional and cosmetic safety.

 The problem is solved in that it is proposed to use radiation with a pulse energy of 1.0-1.5 J and a pulse time of 250-300 μs of a YAG (yttrium-aluminum-garnet) holmium laser with a wavelength of 2.09 μm, or an erbium laser in a glass with a length radiation waves of 1.54 μm pulses with an energy of 1.0-5.0 J and a pulse time of 200-300 μs, while the working end of the fiber touches the mucous membrane of the soft palate, its arches and tongue with a depth of 3-5 mm alternately at different points (50 to 80) until the laser wounds cover the required surface.

 The method is as follows.

 After local anesthesia (superficial and infiltration) in the sitting position of the patient after examining the oropharynx and assessing the condition of the palate, its arches and tongue, the areas (area) of their surface that must be subjected to laser destruction are determined. Depending on the degree of thickening of the soft palate, it is recommended to increase the energy of the laser pulse. For a YAG - holmium laser (wavelength 2.09 μm, 250-300 μs) pulses with an energy of 1.0 to 1.5 J, and for an erbium laser in glass (wavelength 1.54 μm, 200-300 μs) from 1.0 to 5.0 J per pulse. Spot laser wounds are applied at intervals of 1-2 mm, covering them with the necessary surface. As a rule, bleeding does not occur, but if the laser wound begins to bleed, it is necessary from a distance of 1-3 mm with a defocused laser beam with three to five laser pulses to coagulate the edges of the bleeding wound and stop the bleeding. After the above manipulation has been correctly performed, the mucous membrane of the soft palate, its arches and tongue is covered with a network of small wounds that quickly become covered with fibrin. The result of this procedure is local inflammation both on the surface and in the depths of the tissues of the sky. The patient is given appropriate recommendations for 10-14 days until the inflammatory process ends. The dynamics of observation (10, 20, 30, 60 days) showed that as the inflammation disappears and the scars develop, the soft palate, arches and tongue become thinner, denser and tighten, which leads to the disappearance of their vibration, i.e. snoring. Sometimes (about 20%), 2 months after the intervention, the result of treatment does not completely satisfy the patient. In such cases, a reassessment of the state of the sky is carried out. Usually, an insufficient degree of compaction and tightness of the soft palate or insufficient pulling of the tongue is revealed. In the first case, repeated exposure to the tissue of the sky with laser radiation is carried out according to the above method. In the second case, they resort to partial amputation (by 2/3) of the tongue with the help of a loop and the subsequent "infusion" of the wound with a laser beam for the purpose of hemostasis.

 Example 1. Patient Z.I., 47 years old, went to the ENT clinic MONIKA on 09/13/97 with complaints of snoring over the past 6-7 years. Snores in any position constantly. The snoring is loud, causing inconvenience to home. Objectively, when examining the throat and nose, a thickening of the soft palate with sagging back arches and tongue was revealed. Nasal breathing is free. On the day of treatment under local anesthesia using a holmium laser with a wavelength of 2.09 μm, the soft palate tissue was destroyed along the midline in the form of a triangle with its top turned upward, the back arches along their entire surface in the upper 2/3 and the tongue over the entire surface. Pulses of laser radiation (energy of 1.0-1.5 J and a pulse time of 250-300 μs) were delivered to the surface of the mucous membrane using a quartz-polymer fiber with a diameter of 600 μm. In total, about 80 laser wounds to a depth of 3-5 mm were applied to the tissues of the sky. There was no bleeding during the operation. The postoperative period was uneventful. Pain was observed when swallowing for 2 weeks. From the 3rd week, according to the patient, the snoring became less loud, and after 2 months the relatives stopped noticing snoring at 3.I.

 Example 2. Patient V.R., 34 years old, complained of snoring on 10/06/97. According to the patient, she began to snore after enduring endotracheal anesthesia 3 years ago. Nasal breathing is free, but the soft palate and especially its tongue sag significantly. The tongue touches the root of the tongue. The patient was offered treatment with an erbium laser in the glass (wavelength 1.54 μm, 200-300 μs, 1.0-5.0 J) and amputation of 2/3 of the tongue. Under local anesthesia, about 50 wounds were first applied to a depth of 3-5 mm on the tissues of the palate, and then 2/3 of the tongue were amputated with a loop. The wound is coagulated by laser radiation. The postoperative period is smooth. Snoring became much quieter after 3 weeks, and after 1.5 months - completely stopped.

 Thus, the proposed method for the treatment of rochnopathy is highly effective, functionally and cosmetically safe.

Claims (1)

 A method for treating rochnopathy, including the action of laser radiation, characterized in that the destruction of the soft palate, its arches and tongue to a depth of 3-5 mm at 50-80 points is performed by radiation from a YAG-holmium laser with a wavelength of 2.09 μm, pulse energy 1 , 0-1.5 J and a pulse time of 250-300 μs or Erbium radiation in a laser glass with a wavelength of 1.54 μm, an energy of 1.0-5.0 J and a pulse time of 200-300 μs.