RU2775936C1 - Method for laser correction of internal nasal valve - Google Patents

Abstract

FIELD: medicine; otorhinolaryngology; surgery.

SUBSTANCE: invention relates to medicine, namely to otorhinolaryngology and surgery; it can be used for the restoration of nasal breathing in the dysfunction of the internal nasal valve. In ambulatory conditions, under local anesthesia, on the interested side, a pinpoint underwing incision is made with a pointed scalpel at a distance of 5 mm from the edge of nostril. A fiber-optic holmium laser is introduced into the incision, and intratissue tunnels located fan-shaped are formed in a pulse mode. In this case, from 3 to 6 tunnels are made. The impact is performed in the pulse mode with laser radiation power of 16-18 W and frequency of 1.4-1.8 Hz, laser impact time from 10 to 20 s. Similar manipulations are additionally performed on the other lateral wall of the nasal cavity, if necessary.

EFFECT: method provides for the effective restoration of nasal breathing, fast healing, and long-term result due to an increase in the rigidity of a lateral nasal wall in the area of the internal nasal valve.

2 cl, 2 ex, 2 dwg

Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used to restore nasal breathing in case of dysfunction of the internal nasal valve, which is caused by increased flotation of its lateral wall. There are many ways to restore nasal breathing in patients with this pathology:

• "Method of reconstructing the cartilaginous skeleton of the nasal wing in case of functional insufficiency of the internal nasal valve" - RU 2276586;

• "Method of reconstruction of the external nasal valve in case of its dysfunction" - RU 2627351C1

• "Device to narrow the columella and to dilate the nasal valve" - EP 2720654;

• "Implant for splaying alar wings of the nose" - EP 1857078;

• "Nose tensioner and opener and nose tip lifter for the treatment of obstructive sleep apnoea, snoring and respiratory obstruction" - EP 2700385;

• "Nasal valve treatment method & apparatus" - US 2013178937;

• "Negative pressure nasal obstruction non-return valve" - CN 202355483;

• "A system for treating mental illness and a method of using a system for treating mental illness" - WO 200805836.

However, below we present only some of them - those that we consider closest to our invention.

A known method for the reconstruction of the cartilaginous skeleton of the wing of the nose in case of functional insufficiency of the internal nasal valve, RU 2276586. The method consists in making intercartilaginous and trans-septal incisions in the nose in the projection of the connection of the upper lateral and large alar cartilages with continuation to the nasal septum. The nasal mucosa is exfoliated upward from the incision behind the deformed area of the upper lateral and septal cartilage, followed by the installation of a replacement material. At the same time, the replacement material is made in the form of a superelastic porous plate of titanium nickelide with a thickness of 0.15-0.20 mm, a width of 3-4 mm in the form of a spacer with a bend at an angle of 17-20°, which is installed between the outer edge of the nasal septum and the inner part superior lateral cartilage. EFFECT: method allows to prevent recurrence of functional insufficiency of the internal nasal valve.

The disadvantages of the analogue are: the impossibility of using in a hospital, the use of a titanium nickelide plate makes it impossible to further carry out certain methods of diagnosis and treatment for this person, an increase in the time of surgical intervention, the employment of more equipment, and the prolongation of the treatment process.

The closest to our proposed method of restoring nasal breathing at the level of the internal nasal valve with its dysfunction is the method (prototype) "Treatment of obstruction of the nasal valve in an outpatient setting using a new bipolar radio frequency device" (Jacobowitz O, Driver M, Ephrat M. In-office treatment of nasal valve obstruction using a novel, bipolar radiofrequency device Laryngoscope Investig Otolaryngol 2019). We take this method as a prototype.

According to the prototype, a method for the treatment of internal nasal valve collapse is proposed. The authors propose a technique that consists in the following: the region of the upper lateral cartilage was anesthetized using local lidocaine 4% or tetracaine 4%. Then, to achieve complete local anesthesia, 1% lidocaine with adrenaline was administered. Next, a Vivaer handpiece from Aerin Medical with a model ORA-50S generator at a temperature of 60°C and a power of 4 W was placed intranasally on the mucosa covering the lower edge of the upper lateral cartilage, and three non-overlapping areas along the angle of the nasal valve were treated on each side. No cuts were made. The handpiece continuously provided tissue temperature feedback before, during and after treatment so that the generator could modulate the power to maintain the treatment temperature at 60°C and ensure the safety of the procedure. Each treatment cycle consisted of an 18 second treatment pulse and a 12 second cooling time with continuous upward pressure with the stylus in an outward direction perpendicular to the superior lateral cartilage at each position. A standardized approach was used, based on animal and human experimental studies, during which temperature and duration parameters were determined to ensure optimal safety and efficacy.

The disadvantage of the prototype, aimed at the treatment of internal nasal valve collapse, is the length of the recovery period (nasal congestion, swelling, crusts in the nose and pain) - up to one month, in some patients and more. The cause is RF radiation, which damages the surrounding tissue through heat, resulting in rough scarring during the healing process.

The disadvantages of the methods known from the prior art (aesthetic dissatisfaction with the result, a long recovery period, the need for wide access, the use of auto- and allografts), including the prototype, led to the emergence and development of an effective, technically simple, reliable, structured, as well as cosmetically and an aesthetically pleasing procedure to restore nasal breathing at the level of the internal nasal valve, compared to other available alternative treatments.

The objective of the claimed invention is to eliminate these shortcomings of the prototype in the correction of dysfunction of the internal nasal valve, i.e. in creating a simple, reliable way to improve nasal breathing at the level of the internal nasal valve, while maintaining the cosmetic function of the external nose.

The technical result of the proposed method consists in the effective restoration of nasal breathing by increasing the rigidity of the lateral wall of the nose in the region of the internal nasal valve, while the surgical intervention is technically simple, cosmetically expedient, can be performed on an outpatient basis, provides rapid healing and long-term results.

The method of laser correction of the internal nasal valve by increasing the rigidity of the lateral wall of the nose in the region of the internal nasal valve consists in the fact that in the region of the vestibule of the nose, after additional infiltration of the soft tissues of the tip and back of the nose on the interested side, after a point marginal incision, a holmium (Ho :YAG) laser. In a pulsed mode with a laser radiation power of 16-18 W and a frequency of 1.4-1.8 Hz, the laser exposure time is from 10 to 20 seconds, the formation of interstitial tunnels arranged in a fan-like manner is performed. The tunnels eventually become overgrown with scar tissue and stiffen the lateral wall of the nose in the region of the internal nasal valve.

Common features of the prototype and the claimed invention are: the same purpose - correction; point of application of the method - the level of restoration of nasal breathing, the internal nasal valve; the place of impact is the internal nasal valve; the ability to perform the operation on an outpatient basis.

Distinctive features of the claimed invention from the prototype are:

1) in the nature of the impact - a holmium laser, which more gently affects the surrounding tissues, in contrast to radio frequency radiation;

2) in the direction of impact - a fan-shaped orientation, which creates a more stable structure in contrast to linear notches.

Due to the sparing effect of the holmium laser on the surrounding tissues, nasal congestion, swelling, crusts in the nose and pain disappear in the early postoperative period. The result of surgical treatment is more stable due to the more anatomical and structurally stable location of the scar tissue. The fan-shaped scar tunnels provide ample support for the internal valve area.

Thus, the proposed method is an effective, technically simple, reliable, structured, as well as cosmetically and aesthetically appropriate procedure.

This procedure has proven to be an effective technique, as well as other alternative correction techniques. Improved nasal breathing of patients at the level of the internal nasal valve with its dysfunction.

The method of reconstruction of the external nasal valve in case of its dysfunction is illustrated by the figures, where:

in fig. 1 shows the location of the dot marginal incision;

in fig. 2 shows the fan-shaped direction of a holmium laser.

Designations:

1 - the angle of the internal valve of the nose;

2 - nasal septum;

3 - the anterior edge of the inferior turbinate;

4 - triangular cartilage of the nose;

5 - lateral leg of the alar cartilage of the nose;

6 - the place of the dot marginal incision;

7 - nasal bones;

8 - frontal process of the upper jaw;

9 - sesamoid cartilage;

10 - fan-shaped direction of the holmium laser.

Implementation of the invention

The method of laser correction of the internal nasal valve in case of its dysfunction is as follows.

After infiltration anesthesia of the soft tissues of the lateral wall of the vestibule, tip and back of the nose on the interested side with a local anesthetic solution (for example, Sol. Norapini 2% 2.0 ml), using a pointed scalpel, a point underwing incision is made at a distance of 5 mm from the edge of the nostril. An optical fiber of a holmium (Ho:YAG) laser is introduced into the incision and, in a pulsed mode, the formation of interstitial tunnels arranged in a fan-like manner is performed. The number of tunnels and parameters of laser exposure are selected individually, based on the degree and area of collapse of the lateral wall of the nose in the region of the internal nasal valve during inspiration. In a particular embodiment, the laser radiation power is 16-18 W, the frequency is 1.4-1.6 Hz, the total laser exposure time is 10-20 seconds. Usually perform from 3 to 6 interstitial tunnels. Similar manipulations, if necessary, are carried out on the other lateral wall of the nasal cavity. The postoperative area does not require any additional manipulations, such as suturing, shielding with silicone splints, etc. The operation is performed on an outpatient basis.

GBUZ "NIKIO them. L.I. Sverzhevsky" DZM operated on 9 patients according to the claimed technique.

Clinical example 1

Patient B., 49 years old, with dysfunction of the nasal valve on the right, was offered surgery in the form of laser correction of the internal nasal valve on the right.

The patient was examined by anterior rhinoscopy, endoscopic examination with a 0-degree endoscope and referred for surgical treatment.

Preoperative assessment: analysis of the medical history, including subjective sensation of stuffiness and obstruction of the nasal passages, fiber optic nasopharyngoscopy, acoustic rhinometry, computed tomography of the paranasal sinuses.

Physical examination included assessment of the appearance of the nose, Cottle technique, anterior rhinoscopy without anemization and with anemization of 0.05% oxymetazoline. Fiber optic nasopharyngoscopy was performed after topical application of 0.5% lidocaine and 0.5% oxymetazoline.

The course of the surgical intervention. After infiltration anesthesia of the soft tissues of the lateral wall of the vestibule, tip and back of the nose with a local anesthetic solution, using a pointed scalpel, a point underwing incision is made at a distance of 5 mm from the edge of the nostril. In a pulsed mode with a laser radiation power of 16 W and a frequency of 1.6 Hz, a laser exposure time of 10 s (the minimum exposure time was selected for this patient due to the small area and degree of medialization of the lateral wall of the nose), 3 interstitial tunnels are formed, arranged in a fan-like fashion.

The result of treatment was evaluated after 1, 3 and 6 months. After surgery, the patient's nasal breathing improved according to the sensory analog scale. Acoustic rhinometry indicators increased. A reliable increase in the rigidity of the lateral wall of the nose was provided, which is a reliable practice for restoring nasal breathing at the level of the internal nasal valve, in case of its dysfunction. The formed scar tissue provides sufficient support for the internal nasal valve area.

The results of the surgical intervention were assessed as excellent after the operation.

Clinical example 2

Patient K., 41 years old, with obstruction of the internal nasal valve on the left, surgery was proposed for laser correction of the internal nasal valve on the left.

The patient was examined using anterior rhinoscopy, endoscopic examination with a 0-degree endoscope and referred for surgical treatment.

Preoperative evaluation included analysis of the medical history, including subjective feeling of congestion and obstruction of the nasal passages, fiber optic nasopharyngoscopy, acoustic rhinometry, computed tomography of the paranasal sinuses.

Physical examination included assessment of the appearance of the nose, Cottle technique, anterior rhinoscopy without anemization and with anemization of 0.05% oxymetazoline. Fiber optic nasopharyngoscopy was performed after topical application of 0.5% lidocaine and 0.5% oxymetazoline.

The course of the surgical intervention. After infiltration anesthesia of the soft tissues of the lateral wall of the vestibule, tip and back of the nose with a local anesthetic solution, using a pointed scalpel, a point underwing incision is made at a distance of 5 mm from the edge of the nostril. In a pulsed mode with a laser power of 18 W and a frequency of 1.6 Hz, a laser exposure time of 20 seconds (the maximum exposure time was selected for this patient due to the large area and degree of medialization of the lateral wall of the nose), 6 interstitial tunnels are formed, arranged in a fan-like fashion.

The result of treatment was evaluated after 1, 3 and 6 months. After surgery, the patient's nasal breathing improved according to the sensory analog scale. Acoustic rhinometry indicators increased. A reliable increase in the rigidity of the lateral wall of the nose was provided, which is a reliable practice for restoring nasal breathing at the level of the internal nasal valve, in case of its dysfunction. The formed scar tissue provides sufficient support for the internal nasal valve area.

The results of surgery were assessed after the operation as a significant improvement.

Sources of information

• Jacobowitz O, Driver M, Ephrat M. In-office treatment of nasal valve obstruction using a novel, bipolar radiofrequency device. Laryngoscope Investig Otolaryngol. 2019 Feb 4;4(2):211-217. doi: 10.1002/lio2.247. PMID: 31024989; PMCID: PMC6476263 (prototype);

• "Method of reconstructing the cartilaginous skeleton of the nasal wing in case of functional insufficiency of the internal nasal valve" - RU 2276586;

• "Method of reconstruction of the external nasal valve in case of its dysfunction" - RU 2627351C1;

• "Device to narrow the columella and to dilate the nasal valve" - EP 2720654;

• "Implant for splaying alar wings of the nose" - EP 1857078;

• "Nose tensioner and opener and nose tip lifter for the treatment of obstructive sleep apnoea, snoring and respiratory obstruction" - EP 2700385;

• "Nasal valve treatment method & apparatus" - US 2013178937;

• "Negative pressure nasal obstruction non-return valve" - CN 202355483;

• "A system for treating mental illness and a method of using a system for treating mental illness" - WO 200805836.

Claims (2)

1. A method for correcting the internal nasal valve in case of its dysfunction, characterized in that on an outpatient basis under local anesthesia on the interested side with a pointed scalpel, a point underwing incision is made at a distance of 5 mm from the edge of the nostril, a fiber-optic holmium laser is introduced into the incision and the formation is performed in a pulsed mode interstitial tunnels arranged in a fan-like manner, while performing from 3 to 6 tunnels, and the impact is carried out in a pulsed mode with a laser radiation power of 16-18 W and a frequency of 1.4-1.8 Hz, a laser exposure time of 10 to 20 s. 2. The method according to p. 1, characterized in that additionally similar manipulations, if necessary, are carried out on the other lateral wall of the nasal cavity.

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