RU2571712C1 - Method for preparing mastoidal cavity for mastoid repair - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: cotton swab wetted in 4% indigo carmine is immersed into a formed mastoidal cavity. The swab is supposed to fill the entire cavity. After the 10-minute exposure, the swab is removed. The remained mucous membrane coloured in blue is removed completely under control of a surgical microscope. A mastoid repair is performed.

EFFECT: more effective surgical management of chronic othelcosis, prevention of remote complications and reduced incidence of recurrence by full sanitation of the mastoidal cavity by removing the indigo carmine-coloured mucous membrane.

2 ex

Description

The invention relates to the field of medicine, namely to otorhinolaryngology, and can be used to prepare a mastoid cavity for mastoid plastics.

From the practice of otorhinolaryngology, methods of surgical treatment of chronic purulent otitis media are known. The most common of these are open methods, in which an open mastoid cavity is formed (Shpotin V.P. Clinical and functional effectiveness of the modified version of the “open” sanitizing surgery on the ear // Astrakhan Medical Journal. - 2014. - No. 2. - P. 131 -136.).

However, during the formation of open mastoid cavities with incomplete epidermis, a “operated ear disease” develops with frequent exacerbations, otorrhea, and frequent visits to an otorhinolaryngologist. (The use of biocite-elcor glass-crystal granules to reduce the volume of a trephine cavity during operations on the middle ear / F. Semenov [et al.] // Bulletin of Otorhinolaryngology. - 2005. - No. 1. - P. 32-35.).

To reduce the consequences and prevent this complication, the mastoid cavity is subjected to various plastic changes in order to reduce the cavity and improve epithelization.

Various types of mastoidoplasty are carried out with both autotissues and allogeneic and biocompatible materials. However, to achieve an optimal result and to prevent distant complications (mucocele, mucopiocele, polyps), thorough mastoid mucosal removal is necessary before mastoid surgery, which is difficult, given the anatomical features, the presence of a cellular structure. In otorhinolaryngology, methods are known for preparing bone cavities for obliteration by sterilization and removal of the mucous membrane by treating the frontal sinus with a CO2 laser. (Pat. RO 115495 (B1) Romania IPC: A61B 17/00. Method for sterilizing and filling up the frontal sinus / Leon Danaila, publ. 10.30.2000.).

The disadvantage of this method is the impossibility of carrying out this technique in conditions of pronounced pneumatization of the mastoid process and a high risk of trauma to important anatomical structures, such as the facial nerve, sigmoid sinus, dura mater of the middle cranial fossa, inner ear.

Also known is a method of preparing the frontal sinus by coagulation of the mucous membrane with an air-plasma flow (Pat. 2476171 RF., IPC A61B 17/24. Method for obliteration of the frontal sinus / Vasilenko IP, Nikolaev MP Publ. 02.27.2013).

However, this method also has drawbacks due to the risk of trauma to the air-plasma flow of the structures of the inner ear, facial nerve, sigmoid sinus.

The closest prototype method is the method of preparing the mastoid cavity for mastoidoplasty by open-type debridement with careful removal of the pathological tissue and the remaining mucous membrane from the mastoid cavity (V.F. Undrits. Diseases of the middle ear // Diseases of the ear, throat and nose. - Medgiz., 1960, S. 115-117).

The disadvantage of this method is the high probability of leaving sections of the mucous membrane in the diploetic depressions, which is a provoking moment in the formation of late complications in the form of mucocele, mucopiocele and the formation of polyps.

The invention is aimed at improving the effectiveness of surgical treatment of chronic suppurative otitis media.

The technical result in the invention is achieved by the fact that a cotton swab moistened with a 4% solution of indigo carmine is placed in the formed mastoid cavity, filling the entire volume of the cavity and, after a 10-minute exposure under the control of an operating microscope, the remaining mucous membrane painted in blue is completely removed, then mastoidoplasty is performed .

The proposed method is as follows.

After exposure of the site of the mastoid process during trepanation, autobone chips are collected from the cortical layer for subsequent mastoidoplasty. Next, a sanitation stage is carried out.

After the sanitation stage, before performing tympano - and mastoidoplasty, hemostasis is performed, blood clots are removed from the mastoid cavity, which impede the staining of the mucous membrane, after which they fill the mastoid cavity with a cotton swab moistened with 4% indigo carmine, with an exposure of 10 minutes.

During the exposure, auto-cartilage and autofascia are taken to perform tympano-and mastoidoplasty. After 10 minutes, the tampon and indigo carmine residues are removed from the mastoid cavity, while during the exposure the mucous membrane of the mastoid cavity is stained, which acquires a blue color and contrasts against the background of white bone tissue, thereby facilitating its removal. The stained mucous membrane is removed by a bone microarray in deep cells under the control of an operating microscope. Next, smoothing the walls of the mastoid cavity with boron. After thorough removal of the mucous membrane and smoothing the walls of the mastoid cavity, one or another variant of tympanoplasty is performed with the creation of a small tympanal cavity. Mastoidoplasty is performed with autobone chips obtained during trepanation of the cortical layer of the mastoid process, followed by its cover by autofascial temporal muscle. Plastic surgery of the ear canal. The surgical wound is sutured in layers.

A silicone stent is placed in the ear canal and tamponade is performed with a hemostatic sponge. Removal of tampons and a silicone stent is performed 3 weeks after surgery.

The proposed method was successfully tested on 28 patients in the Astrakhan branch of the FSBI NKTSO FMBA of Russia in 2013 and 2014.

Below are the results of testing.

Example No. 1. Patient K., was admitted with a diagnosis of Right-sided chronic epithympanitis.

Complaints upon admission for hearing loss, constant discharge from the right ear with a scorching odor. These complaints have been troubling for over 5 years. With otoscopy in the external auditory canal, a purulent discharge with an ichoric odor, the eardrum is infiltrated, an edge defect in the unstretched part of the eardrum up to 2 mm in diameter is determined.

With a CT study of the temporal bones against the background of the sclerotic process, a destructive cavity up to 3 cm in size is determined.

On the audiogram - hearing loss in the right ear according to the type of sound conduction with a bone-air interval at colloquial frequencies of 20-30 dB. Whispering speech on the right is 0 m, conversational speech is 3 m. Based on objective data, a CT scan of the temporal bones performed a sanitizing operation on the right middle ear with mastoid and tympanoplasty with the preparation of a mastoid cavity by placing a cotton swab moistened with a 4% solution of indigo carmine in the mastoid cavity, filling the entire volume of the mastoid cavity, and after a 10-minute exposure under the control of an operating microscope, the tampon was removed and the remaining mucous membrane painted in blue was completely removed, then mastoidoplasty was performed with autobone chips obtained during trepanation of the cortical layer of the mastoid process, which is covered by autofascia of the temporal muscle.

The postoperative period is smooth, the sutures are removed on the 7th day after the operation, healing by primary intention. Tampons and a silicone stent from the ear canal were removed 3 weeks after surgery. Perforation of the tympanic membrane is closed, the residual mastoid cavity after mastoidoplasty is completely epidermized.

On the audiogram, hearing improvement in conversational frequencies by 15-20 dB, whispering 1.5 m, colloquial speech 5 m, with a control CT of the temporal bones, there were no signs of destructive phenomena and inflammation in the mastoid process.

Example No. 2. Patient T., was admitted with a diagnosis of Right-sided chronic epithympanitis.

Complaints at admission for hearing loss and noise in the right ear, constant discharge from the right ear with a scorching odor.

These complaints concern the patient for about 3 years.

With otoscopy in the external auditory canal, a purulent discharge with an ichoric odor, the eardrum is hyperemic, an edge defect in the unstretched part of the eardrum, obturated by a polypoid formation, is determined. During CT examination of the temporal bones against the background of the sclerotic process, the destruction of the temporal bone with a roof defect in the area of the antrum up to 1.0 cm is determined.

On the audiogram - mixed hearing loss in the right ear with a bone-air interval at colloquial frequencies of 20-25 dB. Whispering speech to the right 0 m, conversational speech 2 m.

Based on objective data, a CT scan of the temporal bones performed a sanitizing operation on the right middle ear with mastoid and tympanoplasty with the preparation of a mastoid cavity by placing a cotton swab moistened with a 4% solution of indigo carmine, filling the entire volume of the mastoid cavity, and after 10 minutes exposure under the control of an operating microscope, the swab was completely removed and the remaining mucous membrane, painted in blue, was removed, then mastoidoplasty was performed with shavings a tokosti obtained during craniotomy mastoid cortical layer, which is covered autofastsiey temporal muscle.

The postoperative period is smooth, the sutures are removed on the 7th day, healing by primary intention. Tampons and silicone stents from the ear canal are removed 3 weeks after surgery.

Perforation of the tympanic membrane is closed, the mastoid cavity is completely epidermal. On the audiogram, hearing improvement in colloquial frequencies by 10-15 dB, whispering 0.5 m, colloquial speech 4 m. During control CT of the temporal bones, there were no signs of destructive phenomena and inflammation in the mastoid process.

The proposed method improves the treatment of chronic suppurative otitis media:

- complete rehabilitation of the mastoid cavity;

- prevention of distant complications in the form of mucocele, polyps, granulations of the mastoid cavity;

- a decrease in the recurrence rate of the disease.

Claims (1)

A method of preparing a mastoid cavity for mastoidoplasty by open-type debridement with careful removal of pathological tissue and the remaining mucous membrane from the mastoid cavity, characterized in that a cotton swab moistened with a 4% solution of indigo carmine is placed in the formed mastoid cavity, filling up the entire volume of the cavity, after 10 -minute exposure, the tampon is removed and, under the control of an operating microscope, the remaining mucous membrane painted in blue is completely removed, then oidoplastiku.