RU2708863C1 - Method for reconstruction of lateral wall of nasal cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to rhinosinusosurgery, and is intended for use in surgical intervention on paranasal sinuses. Method comprises endoscopic approach to maxillary sinus, removal of pathological process of involved sinus, filling the defect of an anterior wall with an allograft, above the allograft, a mucosa of the nasal wall of the nasal wall is placed. At that, the defect is repaired no more than 3 cm in diameter, the grafting allograft is used as the graft, which has a cross-shaped shape and sizes exceeding the diameter of the defect, it is installed so that two opposite protruding parts are immersed under a sinus mucosa, and two others – under a mucous membrane of a nasal cavity, thus providing dense fixation of a graft in a defect.

EFFECT: method provides higher efficiency of bone defects closure due to cartilaginous allograft properties to optimize reparative osteogenesis process that provides cartilage allograft replacement with bone tissue.

1 cl, 1 dwg

Description

The invention relates to medicine, namely to rhinosinusosurgery, and can be used for surgery on the paranasal sinuses.

The absence of one of the sinus walls is a factor in the spread of purulent process in the case of sinusitis.

It is known to use various materials for closing bone defects in the walls of the paranasal sinuses. For this purpose, an implant made of polyester-fluoron filaments is used to close the defect of the anterior wall of the maxillary sinus (RF patent 2159586, IPC A61 B 17/24, dated November 27, 2000). However, the use of any synthetic materials to make up for defects in the anterior wall of the maxillary sinus leads to the formation of an encapsulated foreign body.

Also known is a method of plasticizing a bone wall defect by using a plate, which, instead of biting and breaking, is cut whole. However, the disadvantage of this method is that the plate turned out to be smaller than the hole that arose and after replantation could fall into the sinus cavity (Pantyukhin V.P. A new modification of radical surgery on the maxillary sinus // Some questions of surgery and traumatology: Sat. Tr. - Novosibirsk, 1963 , pp. 329-331.:Yashan I.A., Masik A.F. Osteoplastic surgery in case of sinusotomy // Actual problems of otorhinolaryngology. - K .: Health, 1967, p. 146-147.; Sanderson B. Physiologiemaxllaryantrostrostomy - update // Laringoscope. - 1983. - Vo.93, N 2; 15.).

To fill the defects of the anterior wall of the frontal sinus, the use of a titanium mesh is known (Lakhani R. S. etal. Titanium mesh repair of the severely comminuted frontal sinus fracture Arch Otolaryngol Head NeckSurg 2001; 127: 665-9).

The disadvantage of this method is osseointegration of titanium structures, which leads to significant difficulties in the need to remove metal.

Closest to the proposed one is a method of plastic surgery of the walls of the paranasal sinuses with demineralized bone allografts (Bojokov A.R. Plastic surgery of bone defects of the walls of the paranasal sinuses with demineralized bone grafts: abstract of dissertation, doctor of medical sciences. - St. Petersburg, 2012. - 42 p.) .

However, this method has the following disadvantages:

- bone grafts are scarce donor material;

- expensive technology for the preparation of demineralized bone graft;

- demineralized bone graft is not resistant enough to purulent inflammatory process.

The objective of the invention is the creation of a new method of plasticity of the lateral wall of the nasal cavity, which improves the efficiency of closing a bone defect.

The specified result is achieved by the method of plastic defect of the lateral wall of the nasal cavity:

возникшего в результатеэндоскопического доступа к верхнечелюстной пазухе через нижний носовой ход для удаления патологического процесса из пораженной пазухи,

resulting from endoscopic access to the maxillary sinus through the lower nasal passage to remove the pathological process from the affected sinus,

либо длительно существующего дефекта латеральной стенки полости носа в области нижнего носового хода, включающий освежение краев дефекта.

or a long-existing defect of the lateral wall of the nasal cavity in the region of the lower nasal passage, including refreshment of the edges of the defect.

These bone defects are filled with an allograft, but if the nasal septum is corrected simultaneously, then an autograft from a quadrangular cartilage, after which a flap of the mucous membrane of the lower wall of the nasal cavity is placed over the graft.

In contrast to the prototype, a cartilage allograft is used that has a cross-shaped shape, and its dimensions exceed the diameter of the defect. It is established in such a way that two opposite protruding parts are immersed under the sinus mucosa, and the other two under the mucous membrane of the nasal cavity, thereby, as well as due to the biomechanical properties of the cartilage, the graft is firmly fixed in the defect.

The technical result of the invention is achieved due to the following. Due to the tight fixation of the cartilage allograft, its gradual (within 6 months) bone tissue replacement is ensured, due to the known properties of the cartilage allograft to optimize the process of reparative osteogenesis (Restoring the lower wall of the orbit using a cartilaginous allograft. D. Scherbakov, A.B. Nuraeva, Musina L.M .: Bulletin of the Orenburg State University. 2012, No. 12, p. 234-238). As a result, an effective repair of the defect of the lateral wall of the nasal cavity occurs.

The invention is illustrated in (figure 1), which schematically shows the installed graft in a bone defect 3 of the lateral wall of the nasal cavity 1. The lower nasal concha 2.

The method is as follows. Initially, access to the maxillary sinus is made through the lower nasal passage. Or, with a long-existing defect, the edges of the defect are refreshed. A cartilaginous allograft is placed in the formed bone defect of the lateral wall of the nasal cavity (if, however, the nose septum is corrected, then an autograft from a quadrangular cartilage), so that two opposite, protruding parts of the cruciate cartilaginous graft are immersed under the sinus mucosa, and the other two are the mucous membrane of the nasal cavity, thereby providing a tight fixation of the graft in the defect. After that, a flap of the mucous membrane of the lower wall of the nasal cavity is placed over the graft. This method is used when forming a defect in a diameter of not more than 3 cm, due to the reparative capabilities of the nasal mucosa (Musina L.M. Anatomical justification for the restoration of the alveolar process of the upper jaw by connective tissue allografts: abstract of the dissertation for the degree of candidate of medical sciences 2014.23 p. )

Thus, the advantages of this method are that the cartilage graft is resistant to a purulent inflammatory process (with the development of acute sinusitis), does not resolve, has biomechanical properties, allows the formation of organ-specific bone regeneration in the area of the defect of the lateral wall of the nasal cavity, which ensures effective closure of bone defect.

Claims (1)

A method for plastics of the lateral wall of the nasal cavity, including: endoscopic access to the maxillary sinus, removal of the pathological process from the affected sinus, filling the defect of the anterior wall with an allograft, after which a flap of the mucous membrane of the lower wall of the nasal cavity is laid over the allograft, characterized in that the defect is plasticized no more than 3 cm in diameter, a cartilage allograft is used as a graft, which has a cross-shaped shape and dimensions that exceed the diameter of the defect, its is set so that two opposing projecting portions are immersed under the sinus mucosa, and two other - under the mucous membrane of the nasal cavity, thereby providing a tight fixation of the graft into the defect.

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