RU2199964C2 - Method for surgical treatment of nasal septum's fractures in children at acute period of trauma - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology. SUBSTANCE: one should carry out open endonasal reposition by removing small osseous fragments, sparing resection of quadrangular cartilage's edges along fracture line simultaneously with its perforation to provide reliable fixation in strictly vertical position due to formation of scars. Moreover, correct physiological growth of nasal septum and nose as a whole is observed. The method suggested prevents postoperational complications. EFFECT: higher efficiency of therapy. 1 cl, 2 ex

Description

 The invention relates to medicine, namely to otolaryngology.

 One of the essential features of nasal injuries in children is frequent damage to the nasal septum (PN) (16.5%), while in adults this is observed in 6.5% of cases (Shevrygin B.V., 1996). Injury of PN in children violates its proper growth and leads to deformation of the external nose and a violation of its functions.

 When displaced fragments of the bones of the nose or nasal septum (PN) it is necessary to restore them. The displacement of the nasal septum is eliminated by means of Mikulich forceps inserted into the nasal cavity, or by means of an elongated nasal dilator (Bokshtein F.S., 1956, Iskhaki Yu.B.; Kalshtein L.I., 1977).

 The prototype of the proposed method for the treatment of PN fractures is the reduction of the osteo-cartilaginous backbone of the PN using an elongated nasal dilator (F. Bokshtein, 1956).

 When using this method, it is possible to replicate the bone section of the PN, while its cartilaginous section cannot be established in the correct position. In the future, the osteo-cartilaginous backbone of PN undergoes cicatricial changes, deformation of the nasal septum becomes persistent, the respiratory function of the nose is impaired, and deformation of the external nose often develops. Subsequently, such patients require a complex, large-scale, traumatic surgical treatment - rhinosepticoplasty (Piskunov G.Z., Lopatin A.S., 1994), which most rhinosurgeons recommend starting from the age of 16 (Martinkenas J. B., 1987).

 The purpose of the invention is to eliminate the deformation of the septum of the nose and the outer nose, restore its function and ensure the correct growth of ST and the nose as a whole in the first three days after the injury before the formation of cicatricial changes in the tissues forming it.

 This goal is achieved by the fact that under intubation anesthesia and infiltration anesthesia, a PN mucoperichondria is cut at the site of skin transition into the mucous membrane with a transition to the bottom of the nasal cavity to the base of the lower nasal concha.

 Mucoperichondria are separated on both sides of the PN and, through wide access, sparing resection of the edges of the broken quadrangular cartilage is performed within 0.5-1.0 mm.

 In order to fix the most mobile sections of the injured cartilage by directed formation of scars, it is perforated through it (hole diameter no more than 2.0 mm). In this case, the location of the cartilage growth zones is strictly taken into account, the additional intraoperative trauma of which in childhood is unacceptable. Next, the small ones are removed and large bone fragments of PN are repositioned in a strictly vertical position, after which the mucoperichondrial flap is placed in its original position and, if necessary, sutured with catgut sutures. The operation ends with anterior tamponade of the nasal cavity, which is removed 2-3 days after the operation.

The advantages of the proposed method are:
- the ability to visually assess the nature of traumatic injuries of PN;
- the possibility of a detailed reposition of the bone section of the injured PN with the removal of small bone fragments;
- the possibility of reconstruction of the cartilaginous part of the PN with its reliable fixation in a strictly vertical position by means of directed scar formation;
- prevention of the development of post-traumatic hematomas and PN abscesses;
- prevention of gross cicatricial deformations of PN that violate the respiratory function of the nose;
- Prevention of the development of post-traumatic deformities of the external nose.

 Example 1. The medical history 15821.

 Patient Tsalkov O.V., 13 years old. Diagnosis: Fracture of the nasal bones and nasal septum with displacement, deformation of the external nose.

 The operation was performed: under intubation anesthesia and infiltration anesthesia, a Z-shaped incision of mucoperichondria of the nasal septum was made on the left with the transition to the bottom of the nasal cavity. Separated by a raspator of the bone-cartilaginous skeleton of the nasal septum: the quadrangular cartilage is broken linearly along the lower edge and is shifted to the left, the fracture line continues to the opener. Perforated quadrangular cartilage in six places (aperture diameter 1.0 mm), excised along the fracture line within 1-2 mm and reposition quadrangular cartilage and opener in a strictly vertical position, the leaves of mucoperichondria were laid back, the incision was sutured with two catgut sutures . At the same time, Yu.N. Volkova's elevators reposition of nasal bones performed. In both halves of the nose, gauze swabs with syntomycin emulsion are introduced.

 Example 2. Medical history 17096.

 Patient Makeev P.A., 14 years old. Diagnosis: Fracture of the nasal bones and nasal septum with displacement, deformation of the external nose.

 The operation was performed: under intubation anesthesia and infiltration anesthesia, a Z-shaped incision of mucoperichondria of the nasal septum was made on the left with the transition to the bottom of the nasal cavity. The bone-cartilaginous skeleton of the nasal septum was separated by a raspator: the quadrangular cartilage was broken in two places in its upper and posterior parts and sharply shifted to the left, the bone part of the nasal septum was not damaged. Perforated quadrangular cartilage in five places (hole diameter 1.0 mm), mobilizing a linear incision in the lower sections and reposition it in a strictly vertical position. The leaves of mucoperichondria are laid back, the incision is sutured with two catgut sutures. At the same time, Yu.N. Volkova's elevators reposition of nasal bones performed. In both halves of the nose, gauze swabs with syntomycin emulsion are introduced.

Sources of information
1. Bokshtein F.S. Intranasal surgery. M .: Medgiz. - 1956. - S. 46-48.

 2. Iskhaki Yu.B., Kalstein L.I. Children's otorhinolaryngology. M., Dushanbe, 1977 - S. 31.

 3. Martinkenas JV. Surgical treatment of persistent traumatic deformities of the nose (issues of diagnosis, clinic, instrumental technique and functional surgery). // Abstract. Doctoral dissertation. - Leningrad, 1987 - p. 18.

 4. Piskunov G.Z., Lopatin A.S. The main types of sections in rhinosepticoplasty. // Russian rhinology 1994.

 5. Shevrygin B.V. Diseases of the ear, throat, nose in children. M., Avicenna. - 1996 .-- S. 166-167.

Claims (1)

 A method of surgical treatment of nasal septal fractures in children in the acute period of trauma by reposition of the bone-cartilaginous region, characterized in that they produce open endonasal reposition with removal of small bone fragments, sparing the resection of the edges of the quadrangular cartilage along the fracture line with its perforation, provide reliable fixation in a strictly vertical position, the formation of scars, while ensuring the correct physiological growth of the septum of the nose and nose as a whole.