RU2632781C1 - Device for forming cartilage transplant - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine. A device for forming a cartilage transplant for surgical correction of defects of a tympanic cavity lateral wall, including a set of hollow thin-walled cylinders of tool stainless steel, each cylinder has a length of 100 mm and the hollow part of the cylinder has a diametre of 4, or 6, or 8, or 10, or 12, or 16 mm. Cylinders are sharply ground at one end, which is intended for cutting the transplant by means of rotatory movements about its axis.

EFFECT: device is economically advantageous and easy to manufacture, facilitates and accelerates the formation of the required diametre and thickness of the cartilage transplant, shortens the duration of the operation, saves time for the reconstruction of the auditory ossicle chain with their complete or almost complete absence, and allows guaranteed restoration of the neotympanic membrane and continuity of the tympanic membrane.

2 ex, 1 dwg

Description

The invention relates to medicine and can be successfully applied in otorhinolaryngology for the formation of a cartilage graft in order to eliminate defects of the lateral wall of the tympanic cavity.

A cartilage graft is used as a support for the newly created membrane, as well as to close the perforations of the tympanic membrane.

Closest to the device we offer is a device for preparing a transplant for surgical correction of a curved nasal septum (RF Patent No. 2424775), which may be applicable in the field of surgery of the nasal cavity, mouth, larynx, bronchial ducts.

The device has plates with crossed handles. One plate is stationary and has a handle with support legs. The second plate has a hemisphere shape on the underside. A support platform is made along the hemisphere edge. The hemisphere is placed in a glass with cone-shaped inner walls and a horizontal platform along the upper edge. The glass is connected to the handle. The handle has the ability to move around the axis at the intersection of the handles. The length of the section from the axis to the end of the handles is 3.7 times the length of the section of the handles from the axis to the other end connected to the plates. A restriction ring is installed on the bottom plate with a height selected depending on the thickness of the graft, in the range from 0.1 mm to 1.0 mm, having a hole in the center in which a curved nasal septum is placed. The diameter of the hole of the restrictive ring is 2 times the size of the partition, the pressure is produced on a plate with a hemisphere. As a result, the device allows you to make a graft of the nasal septum of a given thickness by holding it during flattening in the restrictive ring of a certain height.

The disadvantages of this device are that it is not intended to form a cartilage graft in order to eliminate defects in the lateral wall of the tympanic cavity, since a device of this design cannot be used in otosurgery due to its volume and complexity in execution.

An object of the present invention is to provide a device for forming a cartilage graft for surgical correction of defects in a lateral wall of a tympanic cavity.

The inventive device is a set of hollow thin-walled cylinders of tool stainless steel, each cylinder having a length of 100 mm and a diameter of the hollow part of the cylinder 4, or 6, or 8, or 10, or 12, or 16 mm, while the cylinders are sharpened sharply from one end , which is designed to cut the graft by means of rotational movements around its axis.

The device can be made of tool sharp steel grade R-18.

The technical results of the claimed device is that:

- the proposed device is cost-effective and easy to manufacture;

- facilitates and accelerates the formation of the required diameter and thickness of the cartilage graft;

- reduces the duration of the operation;

- saves time for reconstruction of the chain of auditory ossicles with their complete or almost complete absence;

- allows you to guarantee the restoration of non-tympanic membrane and the continuity of the eardrum;

- our studies have revealed that the presence of these diameters allows you to choose a transplant of optimal shape and size for the existing defect.

The type of the claimed element of the set is shown in Fig. one.

Our proposed device works as follows:

Behind the ear or in-ear access open the middle ear cavity, including the tympanic cavity. Under the control of an operating microscope, a thorough audit of the cavities and removal of pathologically altered tissues is performed. Check the patency of the auditory tube, revise the niches of the oval and round windows. After that, the continuity and mobility of the auditory ossicles are ensured. Prepare a bed for the transplant. In the absence or forced removal of the auditory ossicles, a natural or artificial supporting structure is established. The prosthesis according to the clinical situation is installed on the foot plate or on the head of the stapes. Then, from the patient’s auricle or a plate of canned costal cartilage using the proposed device with rotational movements around its axis, a graft of the required thickness and diameter of a rounded shape is formed, depending on the task with a perichondrium or without it, and it is placed in the tympanic cavity on the supporting structure. In the absence of an eardrum, a freely transplanted fascia of the temporal muscle is placed on the outer surface of the graft. The skin of the external auditory meatus is laid in place. His lumen is plugged. The skin wound is sutured.

In cases of elimination of perforation of the tympanic membrane, the graft is placed from the inside from the side of its inner surface, with small perforations it is no longer necessary to cover it with fascia of the temporal muscle.

The invention is illustrated by the following examples:

Example 1

Patient G., 28 years old, was hospitalized in the ENT department from 01/08/2012 to 02/10/12. Clinical diagnosis: Chronic bilateral purulent otitis media (mesotympanitis), without exacerbation.

Concomitant diseases: no.

Complaints at admission: hearing loss, more on the left ear, frequent discharge from the ears.

Anamnesis: Chronic purulent otitis media has been sick since childhood, exacerbations about 1 time per month, was repeatedly treated conservatively. Over the past 2 years, there has been a sharp decrease in hearing. Directed to KB No. 86 for surgical treatment.

The condition at admission is satisfactory. Heart sounds are muffled, the rhythm is correct, heart rate = Ps = 74 min, blood pressure 100/60 mm Hg. In the lungs, vesicular breathing, no wheezing. The abdomen is soft, b / w. Physiological administration is normal. No swelling.

Otoscopy: AS: Auricle of the correct shape. The area of the mastoid process is not changed, painless on palpation. The external auditory meatus is wide, free, there is no pathological discharge. Mt - subtotal perforation of the stretched part, the mucous membrane of the tympanic cavity is pale pink, there is no pathological discharge. Patency of the auditory tube 2 tbsp.

AD: the auricle of the correct form. The area of the mastoid process is not changed, painless on palpation. The external auditory meatus is wide, free, there is no pathological discharge. Mt-subtotal perforation of the stretched part. The mucous membrane of the tympanic cavity is pale pink; there is no pathological discharge. Ventilation function of the auditory tube 2 tbsp.

On the audiogram from 01/10/12 - bilateral mixed hearing loss, right 2 tbsp., Left 3 tbsp.

Other ENT organs within the age norm.

Treatment: 01/16/2012. under m / a, an operation of tympanoplasty of type 1 auto-cartilage with perichondrium on the left was performed.

The progress of the operation. Soft tissue was peeled off under an infiltration anesthesia through an incision along the transitional fold of the right auricle, and the skin of the posterior wall of the external auditory meatus was transversely cut. The edges of the perforated eardrum were refreshed. The skin of the posterior wall of the external auditory meatus was longitudinally cut at 6 and 12 hours, a meatotympanic flap was formed and it was thrown anteriorly.

The chain of auditory ossicles was preserved, mobile; the mucous membrane of the tympanic cavity is somewhat thickened.

On the handle of the malleus and under the remnants of the tympanic membrane, a cartilage fragment was laid outside with a perichondrium, which was cut out in the form of a circle from the patient’s auricle using the inventive device. The skin of the external auditory meatus was laid back and pulled over the perichondrium of the cartilage graft. A plastic swab was placed in the external auditory meatus. Hemostasis was performed during the operation. The behind-the-ear wound was sutured. An aseptic dressing. Blood loss was up to 20 ml. The patient is in satisfactory condition transferred to the ward.

The operation suffered satisfactorily. The postoperative period was calm. In the p / o period received: ceftriaxone at 1.0 × 1 r / d / m - 7 days, dicinone 2 ml × 1 r / d / m - 1 day, ketonal 2 ml × 2 r / d / m - 5 days, omez 20 mg × at night - 10 days, nystatin 500 thousand units × 4 r / d - 9 days, exercises for the auditory tubes, daily toilet p / o wounds. Polyethylene swabs removed on the 21st day.

On the day of discharge: General condition is satisfactory. Subjectively, hearing has improved. The neothympanic membrane is wealthy, moderate transparent wound discharge.

Control audiogram from 02/09/12: positive dynamics in the form of a decrease in the bone-air interval from 40 dB to 20 dB.

Discharged from the hospital with improvement. Disability reduced.

3 months after surgery. Follow-up examination: AS - the ear is dry, the hearing is good, the graft is integrated, its periosteum is rebuilt. Appointed turnout in 2-3 months to resolve the issue of surgery on the right ear.

Example 2

Patient K., 27 years old,

Diagnosis: Mesothympanitis on the right.

Concomitant diseases: VVD with hypertension syndrome.

Complaints on admission: hearing loss on the right.

Anamnesis: the above complaints for 13 years, exacerbation 2 times a year for 10 years.

The condition at admission is satisfactory. For other organs and systems without features.

Objectively: AD - an auricle without features, the external auditory meatus is wide, free, central perforation (d - up to 4 mm) of the eardrum. The mucous membrane of the tympanum is pale pink. The auditory ossicles are preserved.

AS - without features.

Accuracy: ShR on the right 5 m, on the left more than 6 m

The ventilation function of the auditory tubes of art.

Survey Results:

CT of the temporal bones (11/3/11): signs of right-sided chronic purulent otitis media without exacerbation.

R-gram PPN (03.11.11): the paranasal sinuses are pneumatized.

Audiogram (11/7/11) - conductive hearing loss on the right with a bone-air interval of up to 20 dB.

Treatment:

10/10/11. under m / a tympanoplasty was performed on the right, without complications.

The progress of the operation. Under infiltration anesthesia, an incision was made along the transitional fold in the left behind the ear region, soft tissues were separated, a transverse incision was made of the skin of the posterior wall of the external auditory meatus. The edges of the perforation of the eardrum are refreshed. Longitudinal skin incisions were made in the skin of the posterior wall of the external auditory meatus at 6 and 12 hours, a meatotympanal flap was formed and folded anteriorly. Revision of the tympanic cavity: the chain of auditory ossicles is preserved, the mobile, mucous membrane of the tympanic cavity is pale, slightly thickened, the tympanic orifice of the auditory tube is free, the round window is free. Myringoplasty was performed: the auto-cartilage plate was mounted on the handle of the malleus under the remnants of the eardrum, and a meatotympanal flap was placed on top. The graft in the form of a circle is cut using the inventive device from the cavity of the ear of the patient. Fragments of glove rubber were laid on top of the meatotympanal flap, the external auditory meatus was plugged with polyethylene tampons. The wound in the behind-the-ear area is stitched in layers. External aseptic dressing.

He underwent the operation well, there were no vestibular phenomena at the end of the operation, his face was symmetrical, and in satisfactory condition he was taken to the ward.

The patient received: Flixonase, 2 doses of 2 r / d in each half of the nose; clarithin 10 mg 1 r / d - 9 days; ceftriaxone at 1.0 v / m 1 r / d - 7 days, ketonal at 2 ml 2 r / d / m - 6 days; 4 ml dicinone 2 r / d - 3 days, normax drops in the ear on the right for 2-3 drops. 3 r / d - 7 days, blowing of the auditory tubes according to the Politzer, gymnastics of the auditory tubes, daily toilet of the ear,

On the day of discharge: general condition satisfactory, hearing improved.

Otoscopically: AD the external auditory meatus is wide, Neo Mt is wealthy, pink, perforation is not. The ventilation function of the auditory tubes I Art. Control audiogram (12/05/11) - the bone-air interval was completely reduced.

It is discharged with improvement. Disability is temporarily lost.

The proposed device was used during surgery in 16 patients, while it was noted that it accelerates the formation of the required diameter and thickness of the cartilage graft, which reduces the duration of the operation, saves time for reconstruction of the auditory ossicle chain in their complete or almost complete absence and allows guaranteed restore non-tympanic membrane and continuity of the tympanic membrane.

Claims (1)

A device for forming a cartilage graft for surgical correction of defects of the lateral wall of the tympanic cavity, comprising a set of hollow thin-walled cylinders of instrumental stainless steel, each cylinder 100 mm long and the diameter of the hollow part of the cylinder 4, or 6, or 8, or 10, or 12, or 16 mm, while the cylinders are sharpened sharply from one end, which is intended for cutting the transplant, by means of rotational movements around its axis.

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