RU2316274C1 - Method of introducing endoscope into paranasal sinuses and device for realization - Google Patents

Abstract

FIELD: medicine; otolaryngology.

SUBSTANCE: method can be used for trepano-puncture of paranasal sinuses. Opening is made in front wall of skull. Area of planned intervention is found by X-ray method. After that opening with diameter of 2,6 mm is made by chopper in soft tissues in area of front wall of paranasal sinus; local infiltration anesthesia is used for the operation by device for trepano-puncture of forehead sinuses. After that bone is subject to drilling by drill with diameter of 2,5 mm and depth of sinus is inspected by probe. Then improvement in diameter of created opening in soft tissues is made around primary trepanation opening by means of chopper with diameter of 6,1 mm and first narrow bone opening is subject to drilling by second drill having diameter of 6 mm. When conducting trepano-puncture of paranasal sinuses, device having cylindrical case is used. Shaft-sleeve for drill, buffer and spring are disposed inside the case. Device also has two replaceable choppers with diameters of 2,6 mm and 6,1 mm correspondingly and removable cylindrical spiral drills with diameters of 2,5 mm and 6 mm. Front wall of bone is less traumatized and sequestrum osteomyelitis can be prevented.

EFFECT: better conditions for conducting endoscopy of paranasal sinuses; reduced post-operational complications.

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Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used to insert an endoscope into the paranasal sinuses.

From practical medicine, methods are known for introducing an endoscope into the paranasal sinuses using the following devices: trocar, puncture needles, standard or modified trepanopuncture device. With their help, the endoscope can be inserted into the sinus both endonasally and extranasally through the front or orbital wall. For endonasal administration, otorhinolaryngologists use a trocar, and the puncture is performed through the lower nasal passage (E. Kalkis. Endoscopy of the maxillary sinus in the diagnosis of its diseases. // Journal of ear, nose and throat diseases, No. 6 - 1970. - P.90-91 ), puncture of the maxillary sinus followed by the use of especially thin endoscopes (Pluzhnikov MS et al. Possibilities of using especially thin endoscopes in otorhinolaryngology. // Journal of ear, nose and throat diseases, No. 2 - 1982. P.34-38) , for extranasal endoscopy use a trocar with a diameter of 3 mm, which is inserted through the front wall of the sinus (Aleksashin Y. V. Endoscopy of the maxillary sinuses. // Bulletin of Otorhinolaryngology, No. 6 - 1954.- P.66-67) or a trocar with a trihedral drilling end and a narrow one worn on it an ear funnel (Zadorozhnikov GK About methods of endoscopy of the maxillary sinus. // Bulletin of otorhinolaryngology, No. 2 - 1982. - P. 64-66), for the perforation of the front wall also use the method of trepanopuncture using special cannulas (Volkov A.G. Complications of trepanopuncture of the frontal sinus and the possibility of their prevention. // Bulletin of otorhinolaryngology, No. 6 - 1981. - P.41-44), a 2.5 mm trepanation drill with further visualization through the ear funnels (Shaparenko B.A., Zadorozhnikov G.K. Method for endoscopy of the maxillary sinus. // Journal ear, nasal and throat diseases, No. 1 - 1986. - P.61-64), a device for trepanopuncture of the frontal sinus, in which the standard instrument is equipped with an additional spring that prevents injury to the posterior wall of the trepanised sinus (S. Phrikyan et al. Device for trepanopuncture of the frontal sinuses. // AS No. 2103926 from 1998.02.10), trepanopuncture of the frontal sinuses through the orbital wall, while it is proposed to use a large diameter drill for the size of the endoscope (Schneider B.M. Diagnosis and treatment of chronic diseases of the frontal sinuses by trepanopuncture: Diss ... Ph.D. in medical sciences. - Grodno, 1969. - 222 p. ), trepanopuncture with an enlarged drill, in which a skin incision is made 1 cm long above the inner edge of the eyebrow and a hole 5-6 mm in diameter is drilled in the front wall of the frontal sinus, then endoscopes are inserted through the lumen of the trocar sleeve (Arefieva N.A. et al. Diagnosis and treatment of chronic frontitis: Method, recommendations. - Ufa, 1996 .-- 20 p.).

The main drawback of introducing an endoscope into the paranasal sinuses with a trocar is that the insertion site of the instrument leaves a defect with a diameter larger than the size of the trocar due to the surrounding broken bone fragments and the appearance of fragments of the edematous mucous membrane. In this case, sometimes there is a shift in significant sections of the bone around the trocar inlet into the sinus cavity. This phenomenon is understandable, since the bone of the anterior sinus wall is thin and brittle, and before the trocar makes a round hole, there is a bone fracture in several places. After this, endoscopic examination is difficult due to tucking and winding fragments of the mucous membrane, as a result of which the instrument has to be carried out as deep as possible, and then rotate it, which increases the likelihood of damage to the posterior sinus wall. Secondly, when a trocar is inserted into the paranasal sinus, bone fragments often fall out into its cavity, which may end up unnoticed during endoscopy, but will continue to serve as a source of osteomyelitic sequestral decay.

The disadvantages of introducing an endoscope into the paranasal sinuses using standard or modified tools with a large drill or cutter for trepanopuncture are that manipulation through the orbital wall is dangerous, given the uneven convex surface of the bone, as well as the possibility of slipping injuries and infections of the soft tissues of the upper eyelid. Secondly, drilling a hole with a drill of large diameter at once is accompanied by the formation of large chips, because it is known that a large drill leaves large chips that will fall into the sinus cavity and their removal will be extremely difficult and sometimes impossible due to inflammatory or traumatic swelling of the mucosa shell of the paranasal sinus and insufficient functioning of the natural anastomosis due to the disease.

A well-known prototype is a device for trepanopuction of the frontal sinuses, which includes a cylindrical body, in which there is a roller-cartridge for a drill, a buffer and a spring (A.S. SU 114963 A, A61B 17/16, 01/01/1958).

This prototype has the disadvantage that this device allows the application of a trepanation hole in the anterior wall of the paranasal sinus, not large enough for subsequent insertion of the endoscope.

The inventive method of introducing a device for trepanopuncture into the paranasal sinuses and a device for its implementation are new and not described in the literature.

The aim of the invention is the creation of the ability to perform trepanopuncture through the front wall with minimal trauma and reducing the risk of complications from the manipulation for subsequent endoscopy of the paranasal sinuses.

The goal of the invention is achieved by radiologically determining the area of the planned intervention, after which, under local infiltration anesthesia, a hole in the soft tissues in the area of the anterior wall of the paranasal sinus with a cutter with a diameter of 2.6 mm is created using a trepanopuncture device for the frontal sinuses, followed by drilling a bone with a drill with a diameter of 2 , 5 mm, the probe is examined with a probe for sinus depth, then around the primary trepanation hole, an increase in the diameter of the created hole in soft tissues is performed yah using a cutter with a diameter of 6.1 mm and drilling the first narrow bone hole with a second drill with a diameter of 6 mm.

The device for trepanopuncture of the frontal sinuses consists of a cylindrical body, in which there is a roller-chuck for drill, buffer and spring, there are two interchangeable cutters with a diameter of 2.6 mm and 6.1 mm, as well as interchangeable cylindrical twist drills with a diameter of 2.5 and 6 mm.

The proposed invention is illustrated by drawings, where:

figure 1 - trephine assembly;

figure 2 - cutter with a diameter of 2.6 mm in the Assembly;

figure 3 - cutter with a diameter of 6.1 mm in the Assembly.

A device for introducing an endoscope into the paranasal sinuses contains:

1 - a cylindrical body;

2 - buffer;

3 - cartridge roll;

4 - an adjusting nut;

5 - locking nut;

6 - spring;

7 - a torch body with a diameter of 2.6 mm;

8 - torch handle with a diameter of 2.6 mm;

9 - drill with a diameter of 2.5 mm;

10 - torch body with a diameter of 6.1 mm;

11 - a torch handle with a diameter of 6.1 mm;

12 - drill with a diameter of 6.0 mm;

13 - handle trepan;

14 - a cover having a bayonet lock.

The device consists of a cylindrical body (1), in which a roller-chuck for drill (3), a buffer (2), a spring (6), a cutter assembly (figure 2 or figure 3) are placed. An adjusting nut (4) and a lock nut (5) are located on the front of the housing. In the end part, the housing is closed by a cover (14) having a bayonet lock. The rotation of the drill, fixed in the roller cartridge (3), is carried out by turning the handle (13), mounted on the end of the roller passing through the cover cap.

The cutting torch assembly (figure 2 and figure 3) consists of a body (7, 10) with a hole for the drill (with a diameter of 2.6 mm or 6.1 mm, respectively), a handle (8, 11), a drill with a diameter of 2, 5 mm (9) or 6.0 mm (12) for the size of the torch.

The body and cover of the device are made of duralumin with an oxidized surface. Textolite handle, drill - made of carbon steel with electroplating. The remaining parts are made of stainless steel. Overall dimensions of the device: 177 × 58, torch diameter 2.6 mm and 6.1 mm.

Before performing trepanopuncture, it is necessary to carefully evaluate the x-ray picture of the paranasal sinuses. Considering that the inter-axial septum of the frontal sinuses can be shifted in one direction or another, in some cases hypoplasia or aplasia of the sinus is determined on the one hand, with a fairly well-developed sinus structure with an opposite, variable size, the anteroposterior size is also found, multi-cellular sinuses are found.

This method of introducing a device for trepanopuncture into the paranasal sinuses and a device for its implementation are characterized in that access to the sinus cavity is created using two successively changing cutters and drills. Initially, a drill with a diameter of 2.5 mm and a cutter with a diameter of 2.6 mm are used. After that, the torch body is replaced with a larger diameter (6.1 mm) and the drill with 6 mm. A sequential increase in the diameter of the torch and drill body will allow you to create a perfectly even hole in the soft tissues and in the anterior bone wall of the sinus, as well as maintain an adjustable drilling depth to prevent damage to the posterior wall of the paranasal sinus. An increase in the diameter of the created hole in the bone wall to 6 mm is necessary for the possibility of the subsequent introduction of a standard endoscope with a diameter of 5 mm. The final diameter of the bony hole in the anterior wall of the paranasal sinus will exceed the size of the endoscope by 1 mm. With the consistent use of two drills of increasing diameter, small bone chips are formed, they are easier to remove when washing the sinus with medicinal solutions, and this eliminates the development of such a complication as sequestral osteomyelitis. The formation of a hole with a drill of increasing diameter requires less effort pressing the tool and is easier to carry by patients. A large drill requires a lot of mechanical pressure on the bone. Drilling a large hole immediately, without preceding entering the sinus with a thin drill, is undesirable, since bone chips will be large and will require additional manipulation to remove them. In addition, when trying to drill a large diameter drill at the same time on a convex surface of the frontal bone, the drill glides, resulting in spilled periostitis and displacement of the hole from the calculated location, the second negative circumstance will be the appearance of large bone shavings, because it is known that the larger the drill, the larger chips left.

The proposed method for introducing an endoscope into the paranasal sinuses was tested during 2004-2005. in the State Institution “Alexandro-Mariinsk Regional Clinical Hospital” of Astrakhan for 7 patients with exacerbation of chronic purulent-productive or productive sinusitis.

The following is the result of testing.

Example: Patient S., born in 1972, medical history No. 1067, was admitted to the otorhinolaryngological department of AIOCB No. 1 on February 9, 04 with a diagnosis of Exacerbation of chronic left-sided purulent-productive frontal sinusitis. He considers himself sick for about 5 years. The last worsening of the condition was about 3 days, when after acute respiratory infections there were complaints of sharp pain in the left eyebrow radiating to the temple, intensification of the pain symptom when the head was tilted forward. Nasal breathing is sharply difficult on the left, notes purulent discharge from the nasal cavity on the left. From the anamnesis it is known that due to purulent left-sided frontal sinusitis, the patient was repeatedly treated on an outpatient basis only with antibacterial agents, trepanopuncture of the frontal sinus was not performed.

An X-ray examination of the paranasal sinuses in 2 projections revealed a subtotal decrease in pneumotization of the left frontal sinus with suspected polyposis of the mucous membrane in the area of the natural anastomosis. The remaining paranasal sinuses without impaired airiness.

The patient underwent endoscopic examination of the left frontal sinus. The zone of the planned intervention was determined taking into account the location of the inter-axial septum and the depth of the left frontal sinus, after which, under local Sol anesthesia anesthesia. Novocaini 0.5% - 3 ml with a device for trepanopuncture of the frontal sinuses created a hole in the soft tissues in the area of the anterior wall of the left frontal sinus with a cutter with a diameter of 2.6 mm (7), followed by drilling a bone with a drill with a diameter of 2.5 mm (9). After penetration into the sinus, the probe was examined with its depth, then around the primary trepanation hole, the diameter of the created hole was increased in soft tissues with a cutter with a diameter of 6.1 mm (10) and a first narrow bone hole was drilled with a second drill with a diameter of 6 mm (12), as a result, conditions were created for introducing an endoscope into the paranasal sinus.

An endoscopic examination of the left frontal sinus revealed a sharp swelling of the mucous membrane, the presence of polypous tissue in the area of the natural anastomosis of the fronto-nasal canal, as well as a small amount of purulent exudate.

The patient was offered surgery on the left frontal sinus taking into account purulent-productive changes. 02/12/04, an operation on the left frontal sinus was performed under endotracheal anesthesia, and the surgical findings were consistent with endoscopic findings. Over the next 7 days, the patient underwent anti-inflammatory treatment and was discharged from the hospital in satisfactory condition on 02/19/04. Relapse and exacerbation of the disease for 2 years of outpatient monitoring was not.

Thus, the proposed method of introducing a device for trepanopuncture into the left frontal sinus was accompanied by minimal trauma to the soft tissues and bony wall of the sinus. Complications during and after the intervention were not observed. There were no reactive phenomena from the side of soft tissues. The performed manipulation allowed to perform endoscopy to accurately determine the nature of purulent-productive changes in the paranasal sinus.

The proposed object of the invention allowed to achieve the following positive result: the introduction of a device for trepanopuncture in both the maxillary and frontal sinuses was accompanied by minimal injuries to the soft tissues and bony walls of the sinuses, and no complications during and after the intervention were observed. Reactive phenomena from the soft tissues disappeared after 1-2-3 days. There were no iatrogenic complications. The results of treatment were traced up to 6 months.

Claims (2)

1. The method of introducing a device for trepanopuncture into the paranasal sinuses by creating an opening in the anterior wall, characterized in that the area of the planned intervention is radiologically determined, after which, under local infiltration anesthesia, a hole in soft tissues is created in the area of the anterior wall of the paranasal sinus with a trepanopuncture of the frontal sinuses with a diameter of 2.6 mm, followed by drilling a bone with a drill with a diameter of 2.5 mm, the probe is examined with a probe of the sinus depth, then around the primary trepanation operate on the hole diameter increase created hole in soft tissue by a cutter diameter of 6.1 mm and the first narrow bone reaming second drill hole diameter of 6 mm. 2. A device for trepanopuncture of the frontal sinuses, including a cylindrical body, in which there is a roller-chuck for drill, buffer and spring, characterized in that it contains two interchangeable cutters with a diameter of 2.6 and 6.1 mm, as well as interchangeable cylindrical spiral drills with a diameter of 2.5 and 6 mm.

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