RU2394510C1 - Allotransplantation technique of deformed nasal septum - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology and can be used in surgical treatment of patients with nasal septum deviations. Said technique consists in transplantation of deformed nasal septum with Perfoost bone allograft by resection of deviated segments of the nasal septum. An allograft plate is laid in a bed of the formed defect and modelled so that plate size exceeds the defect area of the nasal septum by 5-6 mm on each side whereto the allograft contacts. Along the whole length of its lateral surface, penetrating incisions are made along the midline at a depth to 4-5 mm on anterior, posterior and superior surfaces to place the allograft in the defect area and fix to the remained segments of the osteochondrous skeleton of the nasal septum.

EFFECT: use of the given invention allows recreating the nasal septum skeleton with eliminated allograft displacement due to its reliable fixation, application of the demineralised bone graft prevents transmission of an infectious agent.

2 ex, 2 dwg

Description

Surgical treatment of nasal septum deformities remains one of the urgent problems of modern otorhinolaryngology. It is known that one of the most optimal methods of treatment for curvature of the nasal septum is septoplasty, which consists in the surgical removal of deformities followed by plastic surgery of the skeleton of the nasal septum [1]. Unfortunately, with significant curvature of the nasal septum, septoplasty is not possible, and in such situations, surgeons are limited to submucosal resection of the nasal septum according to Killian [2]. As a result of this, the mucous membrane of the nasal septum remains without a solid skeleton, which in the future often leads to such undesirable consequences as atrophy of the mucous membrane, formation of perforations, flotation of the nasal septum due to the loss of its rigidity. Cosmetic defects such as saddle deformity of the nasal dorsum, retraction of the columella and a change in the shape of the tip of the nose are also possible [3]. To eliminate the above defects with a lack of autotissues, it becomes necessary to use various types of transplants. Allografts can serve as an alternative to autografts, the valuable qualities of which depend on the methods of conservation and sterilization.

In the last decades of the last century in otorhinolaryngology, allografts preserved in various ways were used for plastic surgery of defects of the nasal septum. The most common method in our country is the preservation of grafts in weak solutions of aldehydes [4, 5]

The disadvantages of performing plastic surgery of the defects of the nasal septum skeleton using canned allografts in aldehyde solutions are the possibility of transmission of an infectious agent through the allograft, difficulties encountered during transportation and storage, undesirable saturation of the allograft with a preservative solution, reduced osteoinductive and osteoconductive properties, which increases the likelihood of rejection.

However, when performing septoplasty using allografts, their reliable fixation to the remaining parts of the bone-cartilage skeleton of the nasal septum is necessary. Often in the postoperative period after septoplasty, due to the lack of fixation, the graft is displaced, as a result of which the effectiveness of the operation decreases.

The use of a new plastic material devoid of the above drawbacks with its reliable fixation in the field of implantation will increase the effectiveness of surgical treatment of defects of the skeleton of the nasal septum.

1) The method of plastics of the cartilage of the nasal dorsum. RU 2090115, 1997

2) A way to restore the nasal dorsum with its saddle retraction. 2167620, 1999

3) A method for treating curvature of the nasal septum. RU 2136230, 1997

4) A method for closing subtotal perforations of the nasal septum in children. RU 2246910, 2003

The closest solution is:

Makashev V.E., Gorbachevsky V.N., Minin V.Yu. A method for the treatment of curvature of the nasal septum using demineralized allosty (bone matrix) - Information letter. - Kiev. - 1991. - 12 p.

We take it as a prototype. The method involves the removal of curved sections of the nasal septum, followed by implantation and fixation in the area of the resulting defect of the plate from a demineralized bone alloimplant (DKA), preserved in a 0.5% formaldehyde solution. Allograft fixation is carried out in the following way: a plate 0.5-0.6 mm thick is modeled from a demineralized bone graft. In the middle part of the front and rear edges of the graft, two horizontal cuts cut rectangular flaps 7-8 mm long, with which the graft is fixed in front and behind to the remaining parts of the bone-cartilage skeleton of the nasal septum. In this case, sections of the skeleton are placed between the graft and the cut flap.

In our opinion, the disadvantages of this method of septoplasty are the following:

1) Fixation of a plate from a demineralized bone allograft in the implantation bed occurs only in limited areas using rags cut in front and back, which does not provide reliable fixation of the graft.

2) With prolonged conservation in formaldehyde solution, the allograft is inevitably saturated with formaldehyde, which negatively affects the processes of osteoinduction and osteoconduction in the implant bed.

3) Preservation (DKA) in formaldehyde solutions does not ensure the complete sterility of the plastic material, as a result of which the possibility of transmitting dangerous infectious diseases through an allograft is not ruled out.

4) Storage of the transplant in formaldehyde solutions requires finding it at low temperatures, a change of formaldehyde solution must be carried out every 3 months, the shelf life of the transplant does not exceed 9 months.

It is also necessary to take into account the fact that formalin is banned in the USA and Western Europe as a solution used for preserving biological transplants and is a carcinogenic chemical substance with a cytotoxic effect [6, 7, 8, 9].

To eliminate these shortcomings, we propose a method of nasal septum plasty developed by us using a demineralized bone allograft, made and sterilized according to a new technology in the Russian Federation under the trade name "Perfoost" (RF Patent for invention No. 2147800 dated 02.17.99).

This plastic material is produced in a tissue bank CITO them. Priorova in full accordance with international requirements [14]. The following valuable qualities are inherent in a demineralized bone allograft: in the process of obtaining the material, donor tissues are tested for the presence of viral and bacterial infections, mechanically and chemically treated to remove blood elements and the myeloid component. Bone tissue is demineralized with weak hydrochloric acid solutions. After freezing, the preforms are lyophilized, placed in a standard double plastic package and sterilized by a stream of fast electrons with a radiation absorption dose of 20-25 kGy, which completely excludes the transmission of the infectious agent through an allograft. The shelf life of the Perfoost allo-implant is 3 years from the date of manufacture under conditions that do not require special equipment at room temperature.

The purpose of the invention: the reconstruction of the skeleton of the nasal septum by implanting a plate from a demineralized bone allograft "Perfoost" and its reliable fixation in the field of implantation.

This goal is achieved by the fact that under local anesthesia with a 1% solution of novocaine or under ETN anesthesia, mucoperichondria and mucoperiostis are hydrotissed on both sides, and deformed sections of the skeleton of the nasal septum are resected. Next, an allotransplant is modeled, the dimensions of which exceed the area of the defect in the nasal septum by 5-6 mm on each side with which the allograft is in contact. Then, throughout the lateral surface of the graft in the midline, a penetrating incision is made up to a depth of 4-5 mm (Fig. 1). This incision is made on the front, back and upper surfaces of the allograft, with which the allograft is fixed to the remaining parts of the bone-cartilage skeleton of the nasal septum (figure 2). Mucoperechondria and mucoperiost are placed on top of the allotransplant. The operation ends with anterior nasal tamponade with elastic latex tampons, which are removed after 48 hours.

The advantages of the proposed method are:

- eliminates the possibility of displacement of the allograft due to its reliable fixation of the front, rear and upper surfaces;

- when using a demineralized bone allograft, the possibility of transmission of an infectious agent is excluded;

- optimal time for restoration of the bone-cartilaginous skeleton at the implantation site due to the presence of osteoinductive and osteoconductive properties in (DFA) Perfoost.

Case Study 1

Patient G., 31 g., Medical history No. 4402. Diagnosis: curvature of the septum of the nose.

Received in the ENT department for surgical treatment. The patient was performed septoplasty using (DKA) "Perfoost". From the anamnesis: difficulty in nasal breathing notes since childhood, frequent colds. With anterior rhinoscopy: the pink mucosa, the nasal septum is S-shaped, the nasal concha are moderately swollen, and there is a slight mucous discharge in the nasal cavity. When conducting anterior active rhinopneumatometry - difficulty in nasal breathing on both sides. The patient in the department under local anesthesia performed septoplasty with the Perfoost allograft according to our method. The postoperative period was uneventful; antibacterial and antihistamine therapy was performed. Tampons from the nasal cavity were removed on the second day, a daily toilet of the nasal cavity was carried out. On the 10th day the patient was discharged from the hospital. On examination, the nasal septum along the midline, the mucous membrane of the nasal septum is moist, there are no residual perforation reactive phenomena. In the control anterior rhinopneumometry: nasal breathing within normal limits on both sides.

Case Study 2

Patient I., 42 years old, medical history No. 1907. Diagnosis: curvature of the septum of the nose.

I entered the department for surgical treatment - septoplasty.

Difficulty in nasal breathing has been noted over the past 15 years, after a nose injury.

With anterior rhinoscopy: the mucous membrane of the nasal cavity is slightly hyperemic, the nasal concha are not enlarged, the test with adrenaline is positive.

The nasal septum is S-shaped curved, in the bony part on the right there is a crest running along the bottom of the nasal cavity.

When conducting anterior active rhinopneumatometry, there is a pronounced bilateral obstruction of nasal breathing, more to the right.

A patient in the department under local anesthesia performed septoplasty according to our method using a demineralized bone allograft "Perfoost".

The postoperative period was uneventful; antibacterial and antihistamine therapy was performed. Tampons from the nasal cavity were removed on the second day, a daily toilet of the nasal cavity was carried out. On the 9th day the patient was discharged from the hospital, the nasal septum in the midline, the mucous membrane of the nasal septum is moist, there are no residual perforation reactive phenomena. In control rhinopneumometry: nasal respiration within normal limits on both sides.

List of references

1. Makashev V.E. Experimental substantiation and clinical use of demineralized bone tissue for nasal septum plasty: Abstract. diss. ... Candidate of Medical Science. - Kiev, 1992.

2. Killian G. Die submucose fenestreresktion der Nasenscheidwang. // Arch. Laringol. Rhinol. 1904. Vol.16. S.362-387.

3. Prosekin AS, Septoplasty using biocompatible elastic permeable implants: Abstract. diss ... cand. honey. sciences. - Novosibirsk, 2004.

4. Parfentieva V.F., Rozvadovsky V.D., Dmitrienko V.I. The effect of formalin on antigenic activity / Proceedings of Chisinau honey. in-that. - Chisinau: B. and., 1967. - p.126-127.

5. Makashev V.E. Experimental substantiation and clinical use of demineralized bone tissue for nasal septum plasty: Abstract. diss ... cand. honey. sciences. - Kiev, 1992 .-- 36 p.

6. Govallo V.I. Tissue transplantation in the clinic. - M., "Medicine", 1979. - 288 p.

7. Panshin A.G., Sokolova L.I., Fridlyanskaya I.I. et al. Cytotoxic properties of weak formaldehyde solutions // Sat. scientific tr .: "Transplantation of biological tissues sterilized and preserved by formalin." - L., 1980, p. 26-34.

8. Skripnyuk P.A., Krivenko V.M., Dmitrienko M.V. The use of vacuum in the preparation and use of demineralized bone grafts // Sat. scientific tr .: "Demineralized bone grafts and their use in reconstructive surgery." - SPb., 1996. - P.106-109.

9. Feigelman S.S. On the visibility of saving life in tissues preserved in weak formalin solutions // Ortoped., Traumatol. - 1980. - No. 12. - S. 45-50.

Claims (1)

Method for plastic surgery of a deformed nasal septum using the Perfoost demineralized bone allograft by resecting the curved sections of the nasal septum, characterized in that a plate of demineralized bone allograft is placed in the defect bed and its modeling is performed, while the plate dimensions exceed the area of the defect of the nasal septum defect 5 -6 mm on each side with which the allograft is in contact; penetrating incisions up to 4-5 mm deep along the front, back and top surfaces are made along the entire length of its lateral surface along the midline, with their help the allograft is placed in the defect area and fixed to the remaining parts of the bone-cartilaginous skeleton of the nasal septum.

Images