RU2286753C1 - Method for epidermalization of trepanation cavity in patients after radical operation upon auris media - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology.

SUBSTANCE: it is necessary to remove hypertrophied mucosa up to the bone by saving epidermis. Then one should apply a polymeric film with cultivated allofibroblasts into the cavity onto the edge of saved healthy epidermis according to the shape of removed mucosa, then cavitary tamponade should be fulfilled with tampons, moreover, in postoperational period one should change them daily, as for polymeric film , it should be removed on the 7^th d. The application of the present innovation enables to stimulate reparative processes in postoperational wound at achieving complete epidermalization of postoperational cavity.

EFFECT: higher efficiency.

2 ex

Description

The invention relates to medicine, namely to otorhinolaryngology.

Radical surgery on the middle ear, proposed at the end of the XVIII century in the treatment of patients with chronic purulent otitis media (epithympanitis), has not lost its significance at the present time. However, this type of sanitizing operation on the middle ear does not always lead to the complete elimination of the inflammatory process.

So, according to Anikin I.A. (2000) in patients undergoing radical surgery, constant or periodic discharge from the ear occurred in 28.9% of patients, frequent exacerbations of the inflammatory process in 30%, noise in the ear - 33.1%, headaches - 32.4%, disorders of vestibular function - 50.2%, hearing loss in 100% of patients. The presence of a similar symptom complex in this category of patients is indicated in their works by Dmitriev N.S. et al., 1972; Radugin K.B., 1981; Tarasov D.I. et al., 1988; Tolstov Yu.P., 1995, 1999; Palva T et al., 1979, 1989; Sterkers J. et al., 1989.

Considering the above nuances of radical surgery on the middle ear, in order to eliminate them, modifications of sanitizing operations and methods of formation and plastic surgery of the postoperative cavity are proposed, aimed at rehabilitation and creation of conditions for the complete epidermization of the trephine cavity, in particular:

1) A method for forming a non-tympanic cavity after a general cavity operation. SU 1793919 A3, 1993

2) The method of ossiculoplasty in reconstructive hearing-improving surgery. SU 1792682 A1, 1993

3) The method of forming the mucous membrane of the lining of the non-tympanic cavity during reconstructive surgery in patients undergoing radical surgery on the ear. RU No. 2145829 C1, 2000

4) A method for the surgical treatment of hearing loss in chronic otitis media. RU No. 2192830 C1, 2002

5) A device for postoperative tamponade during operations on the middle ear. RU No. 0002207096 C2, 2003

Closest to the proposed method of surgical treatment is the method of mastoidoplasty, No. RU 2074688, 1997, developed by Kozlyuk Anatoly Stepanovich. We take this method as a prototype.

As follows from the application, the author proposes the use of an autologous, bone marrow-rich spongy bone of the superior iliac crest treated with a suspension of in vitro activated autologous lymphocytes as a plastic material for mastoidoplasty.

The disadvantages of this method are:

1) the technical complexity of the operation;

2) additional surgical trauma - taking of the cancellous bone from the iliac crest, which is associated with a potential risk of complications;

3) the use of a laborious method of processing plastic material with cultured and in vitro activated autologous lymphocytes;

4) the use of autologous lymphocytes excludes the possibility of creating a "bank" of cells;

5) elimination of the inflammatory process only in the mastoid region of the postoperative cavity.

To eliminate these shortcomings, a developed method is proposed for achieving complete epidermisation of the trepanation cavity in patients undergoing radical surgery on the middle ear using cultured allofibroblasts.

The purpose of the invention is to stimulate reparative processes in the postoperative wound and achieve complete epidermization of the postoperative cavity.

This goal is achieved by the rehabilitation of the inflammatory process and the use of allofibroblasts on a polymer film to stimulate and "directed" epidermization of the trepanation cavity in patients undergoing radical surgery on the ear.

The proposed method can be used in the surgical treatment of patients undergoing radical surgery on the ear and having incomplete epidermization of the trephine cavity with an ongoing inflammatory process (operated ear disease).

Description of the invention:

Under local anesthesia with a 2% lidocaine solution, through the external auditory canal under the control of an operating microscope, we revise the trepan cavity; we remove in a blunt and sharp way all pathologically changed tissues, the thickened (hyperplastic) mucous membrane to the bone, leaving the epidermis, the cavity is washed with physiological saline. According to the shape of the removed mucous membrane, we put a polymer film with cultured allofibroblasts into the trepanation cavity, we swab the trepanation cavity with cotton swabs. In the postoperative period, cotton swabs are changed daily, the polymer film is removed on the 7th day.

An example of a specific implementation 1.

Patient S., 18 years old, medical history No. 3156

Diagnosis: chronic right-sided operated otitis media with mucositis, a condition after radical surgery on the right ear. He entered the clinic for planned surgical treatment - a sanitizing reoperation on his right ear. Radical surgery on the right ear was performed in 1996 in the Republican Children's Clinical Hospital, in 2002, in the same place (RCCH), the right ear was reoperated due to incomplete epidermization of the trepanation cavity and its overgrowth with scar tissue and a thickened mucous membrane with purulent discharge. Over the past year, the patient is concerned about mucopurulent discharge from the right ear and decreased hearing in the right ear.

With otomicroscopy, the trepanation cavity is partially epidermized, the promontorium is covered with a thickened, inflamed mucosa, passing through the spur to the "roof" and the upper 1/2 medial and posterior walls of the trepanation cavity, the remaining sections of the postoperative cavity are epidermized. The patient in the hospital performed the operation according to the proposed method. After 7 days, the polymer film was removed, the trepanation cavity was covered with even flat granulations, the wound was epithelized from the edges of the epidermal part, there was no discharge. In the postoperative period, antibacterial, antihistamine therapy and daily dressings were performed. On the 15th day the patient was discharged from the hospital. The mucous membrane in the tympanic orifice of the auditory tube, all departments of the postoperative cavity are completely epidermized, there is no discharge.

Case Study 2

Patient D., 30 years old, medical history No. 4156

Diagnosis: chronic right-sided operated otitis media with mucositis and incomplete epidermization of the mastoid cavity, condition after radical surgery on the right ear. Was admitted to the clinic for planned surgical treatment - sanitizing reoperation on the right ear. Radical surgery on the right ear was performed in 1976 (at the age of 2) of the Republican Children's Clinical Hospital, in 1997 in the city hospital. In Nizhny Novgorod, the right ear was reoperated due to the ongoing chronic process (frequent purulent discharge from the right ear, 1-2 times a year) and incomplete epidermization of the trepan cavity. After surgery: over the past year, the patient is concerned about mucopurulent discharge from the right ear and decreased hearing in the right ear.

When otomicroscopy, the trepanation cavity is almost filled with purulent, epidermal and sulfur masses, after the toilet of the ear, the postoperative cavity is contoured in the drum, in the area of the “spur” there is a thickened, inflamed (in the form of a “pillow”) mucous membrane

The mastoid cavity is partially epidermized, the “roof” and the upper 1/3 are not epidermized, the bone wall is partially covered with loose, inflamed granulations, in places the bone is covered with a “crust” of deflated epithelium. The lower 1/2 of the mastoid cavity is also not epidermized, in the lower sections areas with loose inflamed granulations alternate with sections of the bare bone there is a mucous discharge, cholesteatomic masses and cholesteatoma matrix are found in the upper sections. The average 1/3 of the mastoid cavity is represented by the epidermal lining, in the form of a “strap”.

The patient in the hospital performed the operation according to the proposed method. After 7 days, the polymer film was removed, the trepanation cavity was covered with even flat granulations from the edges of the epidermal part (average 1/3), the wound was epithelized, the granulation surface was slightly moist, there was no detachment. In the postoperative period, antibacterial, antihistamine therapy and daily dressings were performed. On the 10th day the patient was discharged from the hospital, all departments of the postoperative cavity are completely epidermized, the mucous membrane in the tympanic orifice of the auditory tube, there is no discharge.

Claims (1)

A method for epidermisation of a trepanation cavity in patients undergoing radical surgery on the middle ear by debridement of the postoperative cavity, removal of altered tissues, characterized in that the hypertrophied mucous membrane is removed to the bone, leaving the epidermis, a polymer film with cultured allofibroblasts is laid in the cavity in the form of a removed mucous membrane on the edge of the left healthy epidermis, then the cavity is swabbed with cotton swabs, while tampons in the postoperative period are changed daily, the polymer film is removed on the seventh day.