RU2467734C1 - Method for engraftment of neotympanic flap following tympanoplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can find application in engraftment of a neotympanic flap following tympanoplasty. A method involves application of the flap to borders of a tympanic perforation and physical effect on the flap. The flap is exposed to a gas flow containing 0.1-0.3% nitrogen monoxide at temperature 18-20°C with exposition of 1 min. 30 sec. A manipulator tip is introduced in an external auditory canal for max. 1 cm with its output placed at 45°C to a plane of a posterior wall of the external auditory canal. The treatment is conducted once a day for 5-10 days.

EFFECT: use of the given invention enables providing effective engraftment of the neotympanic membrane due to stimulation of repair processes, as well as avoiding attachment of a secondary infection.

2 ex

Description

The invention relates to medicine, in particular to otorhinolaryngology, and can be used to reduce the risk of reperforation after tympanoplasty.

One of the complications of tympanoplasty is the occurrence of reperforation. Various methods are used to prevent the occurrence of reperforation, including the fixation of a tympanal flap.

A known method of fixing a tympanal flap with tympanoplasty, including strengthening the tympanal flap in the tympanic orifice of the auditory tube with a strip of auto-cartilage (US Pat. RF No. 2332193, class A61F 11/00, 2008).

The disadvantages of this method are:

1. The possibility of reperforation due to the lack of reparative processes in the postoperative period.

2. The possibility of displacement of the strip of cartilage in the tympanic cavity and, as a result, the deterioration of sound conduction.

3. The ability to block the mouth of the auditory tube due to the formation of scar tissue.

Closest to the proposed method is the engraftment of a non-tympanic flap after tympanoplasty, including applying a flap to the edges of the perforation of the tympanic membrane and physical impact on the flap (US Pat. RF No. 224094, class A61F 11/00, 2004).

In this method, a thin layer of 10% Sintomycin emulsion is applied to the tympanic membrane along the edge of the perforation hole after it is depapitalized before laying the graft from the dura of the human fetus to better adhere the graft to the edges of the perforation of the tympanic membrane. Additionally, the graft was fixed to the eardrum by laser "biological" welding (LBS). Fixing is carried out by the distal part of the end of the fiber of the AKTUS-15 semiconductor laser by the contact method in a pulsed mode with a pulse duration of 600-700 ms and an output laser radiation power of 8.5 watts. Welding was carried out at 6-8 points.

However, it should be noted that the engraftment of the flap is not effective enough due to:

1. The possibility of transplant necrosis due to its secondary infection.

2. The possibility of reperforation due to insufficient formation of one's own connective tissue.

3. Possibilities of excessive coagulation of the tympanic membrane at the site of application of the end of the fiber.

In accordance with this, the task was set to improve engraftment by stimulating reparative processes in the region of a non-tympanic membrane by blowing it with an air stream containing nitrogen monoxide (NO).

This task is achieved by the fact that in the method of engraftment of a non-tympanic flap after tympanoplasty, including applying a flap to the edges of the perforation of the tympanic membrane and physical impact on the flap, it is proposed that the flap be exposed to a stream of gas stream containing 0.1-0.3% nitrogen monoxide, at a temperature of 18-20 ° C with an exposure of 1 min 30 sec, while the tip of the manipulator is inserted into the external auditory meatus by no more than 1 cm and its outlet is placed at an angle of 45 ° with respect to the plane wall of the external auditory meatus days, and treatment is to carry out one time a day for 5-10 days.

Nitric oxide (NO) has a pronounced biostimulating effect, manifested in accelerated healing of wounds, trophic ulcers.

This effect is achieved by the following mechanisms:

1) direct or indirect (through the formation of peroxynitrite) bactericidal effect;

2) the induction of phagocytosis of bacteria and necrotic detritus by neutrophils and macrophages;

3) inhibition of free oxygen radicals that have a pathogenic effect, as well as the possible activation of antioxidant protection;

4) normalization of microcirculation due to regulation of vascular tone, antiplatelet and anticoagulant properties of NO, which improves vascular trophism and tissue metabolism, increased angiogenesis;

5) improvement of nerve conduction;

6) regulation of immune disorders characteristic of wound pathology;

7) secretion by activated macrophages of cytokines that enhance the growth of fibroblasts (IL-1β, TNF-α, IL-8 and others), angiogenesis factors, chemokines, in particular monocytic chemoattracting peptide (MCP-1), G-protein, nuclear factor kV ( NFkB) and other biologically active factors that regulate the wound and inflammatory process;

8) direct induction of fibroblast proliferation and protein synthesis, enhancement or regulation of collagen synthesis;

9) regulation of apoptosis during remodeling of granulation-fibrous tissue;

10) the effect on the proliferation of keratinocytes and, therefore, epithelization of a wound defect.

The implementation of the method is shown in specific examples.

Example 1

Patient Sh. 41 years old. Medical history 20525.

Diagnosis: bilateral mesotympanitis, remission. Performed tympanoplasty type 1 on the right. On the 12th day after the operation, after removing tampons from the external auditory canal and rubber pads from the tympanic membrane, a neotympal flap was daily blown with a gas stream containing 0.1-0.3% nitrogen monoxide at a temperature of 18-20 ° C with an exposure of 1 min 30 sec once a day for 5 days (5 sessions).

The tip of the manipulator was introduced into the external auditory canal by no more than 1 cm, its outlet was positioned at an angle of 45 ° relative to the plane of the posterior wall of the external auditory canal, so that the gas stream was directed along the rear wall of the external auditory canal, which prevents damage or displacement of the tympanal flap.

The result was monitored by cytological examination, as well as microotoscopy.

When conducting otomicroscopy on the second day of conducting NO-therapy, there was a lack of wound discharge, regional vascularization of the tympanum graft.

In a cytological study on the 4th – 5th day of conducting NO-therapy, large numbers of fibrocytes and the absence of bacterial flora were noted in fingerprint smears.

In the long-term postoperative period (7 months), reperforation of the tympanic membrane was not observed.

Example 2

Patient K., 60 years old.

Diagnosis: right-sided mesotympanitis without exacerbation. Performed myringoplasty on the right.

NO therapy was carried out starting from the 11th day of the postoperative period after removal of tampons from the external auditory meatus and rubber pads from the surface of the tympanic membrane.

The exposure was carried out similarly to that described in example 1. However, due to the presence of punctate perforation of the non-tympanic membrane, it was decided to conduct 10 sessions of NO-therapy.

After conducting NO-therapy, the perforation spontaneously closed.

With otoscopy, the non-tympanic membrane is located correctly, almost completely vascularized.

When conducting a cytological examination on the 11th day after the operation, a pronounced leukocyte infiltration, a moderate amount of the bacterial flora was found in smear prints from the surface of the non-tympanic membrane.

On the 5th day of conducting NO-therapy, leukocyte infiltration was practically absent, isolated cocci were found. Fibrobrasts were found in smears, which indicates the reparative phase of the wound process.

In the long-term follow-up period (1 year), reperforation of the tympanic membrane was not observed.

Conducting NO-therapy in the postoperative period after tympanoplasty avoids the attachment of a secondary infection, enhances reparative processes, which helps to improve the engraftment of the non-tympanic membrane.

The use of this invention will provide effective treatment by stimulating reparative processes.

Claims (1)

The method of engraftment of a non-tympanic flap after tympanoplasty, including applying a flap to the edges of the perforation of the tympanic membrane and physically affecting the flap, characterized in that the flap is exposed to a stream of gas stream containing 0.1-0.3% nitrogen monoxide at a temperature of 18- 20 ° C, with an exposure of 1 min 30 s, while the tip of the manipulator is inserted into the external auditory meatus by no more than 1 cm and its outlet is positioned at an angle of 45 ° relative to the plane of the posterior wall of the external hearing Vågå passage, and the treatment is carried out one time a day for 5-10 days.