RU2477988C2 - Method for restoring lachrymal duct accompanying lower lid rupture from medial angle - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly ophthalmology and may be used for surgical management of lower lid rupture with an injured lachrymal duct. Lachrymal passages are probed through an upper lachrymal opening by a Johnson's needle and a filament. A needle out matches with an internal portion of the injured lower lachrymal duct. The Johnson's needle is removed with the brought filament left in the duct lumen. Through a lower lachrymal opening, the Johnson's needle is brought in the similar way; a free segment of the filament is brought out from an injury area through the lower lachrymal opening. The free ends are brought out through the lachrymal openings of the upper and lower eyelids. A probe is put on a free end of the filament passing through the lower lachrymal opening, and the filament is bent and brought back to form a loop. The wound is closed in layers so that the injured region of the lower lachrymal opening can be visually controlled. The filament brought through the upper lachrymal opening is tightened; the probe is brought into the lower lachrymal opening. The immersion procedure lasts until a tube completely penetrates into the lower lachrymal opening to the loop level. The filament within the upper lachrymal opening is dissected away within the upper lachrymal opening. The probe together with the filament is removed one month later.

EFFECT: invention provides a cosmetic effect of the lower lachrymal opening position and lachrymal passage patency and formation of delicate scar tissue.

2 cl, 1 ex

Description

The invention relates to medicine, in particular ophthalmology, and can be used for surgical treatment of lower eyelid abruption with damage to the lacrimal tubule.

A known method of restoring the lacrimal tubule with temporary intubation of its lumen with a silicone tube [R. Gundorova Department of Traumatology, Reconstructive, Plastic Surgery and Eye Prosthetics of the Moscow Research Institute of Eye Diseases named after Helmholtz - the last 40 years / R.A. Gundorova // Bulletin of Ophthalmology. - 2000. - No. 5. - S.5-8]. In this method, the lumen of the damaged tubule is filled with a silicone tube, which is passed through the intact upper lacrimal tubule using special tools. A similar silicone stent remains in the lumen of the tubule for a month. Defect repair through scarring processes occurs with a lesser degree of coarse stricture formation. The degree of scar stricture in the postoperative period depends on the intensity of scarring and the width of the scar. For this reason, during the entire period of healing and scarring, an implant should be in the area of the anastomosis, filling the lumen of the tubule. The disadvantage of this method is the technical complexity and the availability of special tools. This technique uses an expensive stent, which is not always possible to put in an emergency.

A known method of restoring the lacrimal tubule using a Johnson needle [Dzhaliashvili OA First aid for diseases and injuries of the eye / O.A.Dzhaliashvili, A.I. Gorban. - SPb .: Hippocrates Publishing House, 1999. - 137 p.]. As an intubation component, a non-absorbable thread is used, installed in the lower lacrimal tubule for 1 month. Before conducting the thread, the lacrimal ducts are probed with conical probes to expand their lumen. The thread is passed through the upper lacrimal opening, the upper lacrimal canaliculus, under the internal adhesion using a Johnson needle. The thread is output through the damaged part. Similarly, the thread is removed through the damaged part of the lower lacrimal tubule. After the initial surgical treatment, the thread remains in the lacrimal tubules as an implant. This method is taken as a prototype. The disadvantage of this technique is the formation of strictures in the area of the scar of the lower lacrimal tubule, which leads to a subsequent violation of patency.

The objective of the invention was the development of a universal method for repairing a damaged lower lacrimal canaliculi when the lower eyelid is torn from the inner corner.

The technical result when using the invention is to improve the aesthetic effect of the position of the lower lacrimal opening and patency of the lacrimal openings due to the restoration of the lumen of the tubule and the formation of delicate scar tissue.

The proposed method is as follows: under local anesthesia, the lacrimal ducts are probed through the upper lacrimal opening with a Johnson needle and thread (nylon 4/0). The exit of the needle coincides with the inside of the damaged lower lacrimal tubule. Johnson's needle is removed, leaving the thread held in the lumen of the tubules. Through the lower lacrimal opening, Johnson’s needle is similarly drawn, a free part of the thread through the lower lacrimal opening is removed from the wound area. The free ends exit through the lacrimal openings of the upper and lower eyelids. From the injection needle of a disposable syringe, a part is broken off with a clamp more than 3 mm longer than the length of the damaged tubule, and a steel tube — probe — of cylindrical shape is obtained. A probe is put on the free edge of the thread passing through the lower lacrimal opening, and, bending the thread, it is held back with the formation of a loop. The wound is sutured in layers so that the damaged area of the lower lacrimal tubule can be visually inspected. The lower lacrimal tubule is sewn with 2 interrupted sutures 10/0. Pull the thread through the upper lacrimal tubule, conduct the probe to the lower lacrimal opening. Immersion is carried out until the probe completely enters the lower lacrimal tubule to the level of the loop. The thread in the region of the superior lacrimal tubule is cut off in the region of the superior lacrimal opening. The probe is removed with the thread after one month.

Thus, in the proposed method creates the conditions for the full restoration of the tubule. As a result, when scar tissue is formed, the stricture diameter is limited by the diameter of the probe, which is the basis on which the repair process is based.

The developed method was tested in 23 patients operated on for the separation of the lower eyelid with damage to the lower lacrimal tubule. All operated patients received a satisfactory aesthetic effect and complete patency of the lower lacrimal tubule.

The proposed method is illustrated by the following clinical example.

Patient Kalashnikov V.P., b. 1976

Diagnosis: Separation of the lower eyelid of the right eye with damage to the lacrimal tubule.

Operation: Suturing the lower eyelid separation with the restoration of the lower lacrimal tubule.

Under local anesthesia (novocaine 2%), lacrimal ducts were probed through the upper lacrimal opening with a conical probe. After the expansion of the lacrimal tubules, a Johnson needle with a thread (nylon 4/0) was performed. The exit of the needle coincided with the inside of the damaged lower lacrimal tubule. A needle was passed through the lower lacrimal opening, a free section of the thread through the lower lacrimal opening was removed from the wound area. The free ends exited through the lacrimal openings of the upper and lower eyelids. From the injection needle of a disposable syringe (20 ml), a portion was broken off with a clip 3 mm longer than the length of the damaged tubule. Received a steel tube - probe. A probe was put on the free edge of the thread passing through the lower lacrimal opening, and, bending the thread, they carried it back. Imposed a U-shaped seam. The wound was sutured in layers so that the damaged area of the lower lacrimal canaliculi succumbed to visual inspection. The lower lacrimal canadian was sutured with 2 interrupted sutures 10/0. Pulling the thread held through the upper lacrimal tubule, a probe was carried out to the lower lacrimal opening. Immersion was carried out until the probe completely entered the lower lacrimal tubule to the level of the loop. The thread in the region of the superior lacrimal tubule was cut off in the region of the superior lacrimal opening.

After 1 month, the metal probe was removed beyond the nylon loop from the lower lacrimal opening. When washing the lacrimal passages revealed full patency.

Thus, when using the new universal method for the restoration of the lacrimal ducts, a significant improvement in the aesthetic effect of the position of the lower lacrimal opening and patency of the lacrimal ducts was revealed, which shows its promise in primary surgical treatment. The simplicity of the method and the absence of additional specific tools are noteworthy. In the proposed method, the steel probe is the basis on which the repair process is based.

Claims (2)

1. A method of restoring the lacrimal canaliculi when the lower eyelid is torn off from the inner corner, including probing the lacrimal canaliculi with a Johnson needle and passing a thread through their lumen, introducing a metal probe, suturing the wound, removing the thread after a month, characterized in that the lacrimal ducts are probed through the upper lacrimal a point with a Johnson needle with a thread, the exit of the needle coincides with the inside of the damaged lower lacrimal tubule, the Johnson needle is removed, leaving the thread drawn in the lumen of the tubule; through the lower lacrimal opening, Johnson's needle is similarly drawn, a free section of the thread through the lower lacrimal opening is removed from the wound area; the free ends lead through the lacrimal openings of the upper and lower eyelids; a probe having a cylindrical shape and a length greater than the length of the damaged tubule by 3 mm is put on the free edge of the thread passing through the lower lacrimal opening and the thread is drawn back to form a loop, the wound is sutured in layers, the lower lacrimal tubule is sutured with two interrupted sutures, and then tightened the thread passed through the upper lacrimal tubule, conduct the probe to the lower lacrimal opening; immersion is carried out until the probe enters the lower lacrimal tubule; the thread in the region of the upper lacrimal tubule is cut off in the region of the upper lacrimal opening; the probe is removed with the thread after one month. 2. The method according to claim 1, characterized in that the probe is made from an injection needle of a disposable syringe.