RU2312625C1 - Method for surgical treatment of chronic otitis at applying meatomastoidoplasty - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology.

SUBSTANCE: the present innovation deals with the plasty of auditory canal and forming periosteal-fascial fragment of parotid area. Moreover, one should fulfill parotid incision prior to intersecting the skin of auditory canal at the level of spina suprameatum, then dissect the skin of auditory canal against underlying periosteal-fascial fragment, continue this incision being above auditory canal vertically upwards by intersecting soft tissues and in direction from the back downwards by performing a bow-shaped incision from the top downwards along the posterior edge of the wound. The developed periosteal-fascial flap upon inferior pedicle should be separated. With the help of the incision along the upper edge of auditory canal's skin one should form a flap upon an inferior pedicle. On finishing the trephination, periosteal-fascial and cutaneous flaps should be put into trephination cavity. Application of the present innovation enables to decrease the traumatism of surgical therapy, decrease blood losses, prevent post-surgical complications (such as hematomas, wound suppurations) and shorten the duration of the operation in question.

EFFECT: higher efficiency.

1 ex

Description

The invention relates to medicine, mainly purulent osteology, and can be used in the surgical treatment of patients with chronic otitis media.

A known method of plastic surgery of the auditory canal, performed during radical surgery on the ear (V.K. Lyulko, V.M. Marchenko. "Atlas of ear surgery", Kiev, "HEALTH", 1989).

The known method consists in the fact that at the final stage of the operation, a transverse dissection of the membranous part of the auditory canal in the vertical direction is performed. A second cut along the upper or lower wall dissects the ear canal tube and forms an upper or lower plastic flap depending on the anatomical features of the patient.

The disadvantages of the traditional method of plastic surgery of the auditory canal are increased trauma to the cartilaginous part of the auditory canal, and often wound a. atricularis posterior, accompanied by significant bleeding. Injury to the cartilage of the auditory meatus is often complicated by the development of perichondritis of the auricle. The final stage of the operation, performed under local anesthesia, occurs at the time of residual anesthesia and is often extremely painful for patients.

The invention is aimed at rapid rehabilitation of patients, reducing the number of bleeding and purulent complications in the postoperative period.

The novelty of the claimed method consists in creating a fundamentally new sequence of surgical intervention, providing optimal conditions for operations and healing.

The use of meatomastoidoplasty required the creation of a new sequence of techniques and the anatomical site of their implementation. The new sequence is the conversion of the steps of the operation. The stage of plastic surgery of the auditory meatus with its vertical intersection is performed during the formation of access and follows the skin incision and with the simultaneous formation of the periosteal-fascial flap.

The most preferred sequence of stages of the operation should be considered as a simultaneous dissection of the auditory meatus, cutting it off and the formation of a periosteal-fascial flap. In contrast to the prototype method, the execution of the above sequence allows the first stage of the operation to simultaneously perform plastic surgery of the ear canal and the formation of the periosteal-fascial flap, and ultimately plastic closure of the temporal bone defect by the periosteal-fascial flap. As a result, the most traumatic final moments of the operation become minimally invasive due to changes in the geometry of the wound canal and the simultaneous formation of a plastic flap as a stage of advancement to the pathological focus of osteomyelitis.

A new technical result that can be achieved using the invention is to reduce the morbidity, decrease blood loss, and shorten the duration of the operation. The invention is illustrated by the figure, which depicts the steps of the operation.

The technical means for implementing the claimed method of meatomastoidoplasty is an electrosurgical radio wave scalpel. The needle cutting nozzle was identified as the most convenient for surgical intervention. The best working direction of the incision is determined by the tangential direction at an acute angle of 35 ° to the auricle. In this case, there is no excessive bleeding, the process of crossing the auditory meatus and its dissection from the periosteal-fascial flap is clearly visualized. The miniature size of the needle electrode, fixed in the handle of the power tool, provides a sufficient overview, without limiting the actions of the surgeon.

The method is implemented in general cavity radical surgery on the middle ear and is performed as follows. After anesthesia, an electric knife is cut in the behind-the-ear area with a needle electrode in the behind-the-ear area in a tangential direction at an acute angle of 35 ° until the skin of the ear canal intersects at the level of Spina suprameatum. Then cut off the skin of the ear canal from the underlying periosteal-fascial flap. Further, the incision is continued above the auditory meatus, vertically upward, crossing the soft tissue both in the posterior and downward direction, making an arcuate incision from top to bottom along the posterior edge of the wound. The formed periosteal-fascial flap on the lower feeding leg is separated with a Doyen raspator. A cut along the upper edge of the skin of the ear canal forms a flap on the lower feeding leg. Produce trepanation of the temporal bone. After completion of trepanation, the periosteal-fascial and skin flaps are placed in a trepanation cavity. The wound is sutured in layers.

Example. Patient Zh., 45 years. Complaints of suppuration from the ear, pain in the ear that occurred after hypothermia. In the ear - hyperemia of the tympanic membrane, marginal perforation, purulent discharge in the ear canal. On the computer tomogram of the temporal bone, a zone of destruction of bone tissue with blurred contours and rarefaction of bone tissue in the antrum, a cavity with destruction of bone tissue in the antrum region is determined.

General condition - pulse of 100 beats per minute, blood pressure of 140/90 mm Hg, pathology from the cardiovascular system, parinchymal organs of the abdominal cavity, chest organs were not found.

Preparation for the operation is traditional. After anesthesia, an electric knife is cut in the behind-the-ear region with a needle electrode in the behind-the-ear region in a tangential direction at an acute angle of 35 ° until the skin of the ear canal intersects at the level of spina suprameatum. Then cut off the skin of the ear canal from the underlying periosteal-fascial flap. Further, the incision is continued above the auditory meatus, vertically upward, crossing the soft tissue both in the posterior and downward direction, making an arcuate incision from top to bottom along the posterior edge of the wound. The formed periosteal-fascial flap on the lower feeding leg is separated with a Doyen raspator. A cut along the upper edge of the skin of the ear canal forms a flap on the lower feeding leg. Produce trepanation of the temporal bone. After completion of trepanation, the periosteal-fascial and skin flaps are placed in a trepanation cavity. The operation is completed by layering the wound.

This method operated on 76 people, complications in the form of a hematoma, suppuration of the wound was not observed.

The combination of methods of the claimed operation allows for quick rehabilitation of patients. Studies have shown that the patented method provides a significant reduction in the number of complications, reduces the time of surgery.

Claims (1)

A method for surgical treatment of chronic otitis media using meatomastoidoplasty, including ear canal plasty and the formation of a periosteal-fascial flap in the ear region, characterized in that an incision is made in the ear region before the skin of the ear canal intersects at the level of Spina suprameatum, then the skin of the ear canal is cut off from the underlying periosteal fascial flap, the incision continues above the ear canal vertically upward, crossing the soft tissue in the direction posteriorly and downward, performing an arcuate The incision is from top to bottom along the posterior edge of the wound, the formed periosteal-fascial flap on the lower feeding leg is separated, then a cut along the upper edge of the ear canal skin is used to form a flap on the lower feeding leg, after completion of trepanation, the periosteal-fascial and skin flaps are placed in a trepan cavity.