RU2793651C1 - Method for surgical correction of c-shaped curvature of the quadrangular cartilage of the nasal septum in septoplasty - Google Patents

Abstract

FIELD: medicine; otorhinolaryngology; maxillofacial, reconstructive and plastic surgery.

SUBSTANCE: incision is made in the mucous membrane with the perichondrium along the anterior caudal edge of the cartilage on the side of the curvature, followed by access to the opposite side and bilateral separation of the mucous membrane of the nasal septum in the subperichondrial and subperiosteal layers. Then, posterior chondrotomy is performed at a distance of 4 mm anteriorly from the caudal edge of the perpendicular plate of the ethmoid bone. At the same time, the cartilage incision is not brought to 5 mm to its dorsal edge and back of the nose. Next, the curved bone fragment of the nasal septum is removed. At the same time, the skeleton of the C-shaped curved quadrangular cartilage is maintained and its mobilized upper part is moved to the side opposite to the curvature. The mobilized upper cartilage is then fixed in a new straightened position with two polydioxanone sutures on a 5/0 stabbing needle. The nodes are located on the side opposite to the curvature of the cartilage.

EFFECT: method allows to improve the results of surgical treatment of patients with C-shaped curvature of the quadrangular cartilage of the nasal septum, to perform the operation while preserving the cartilaginous framework of the nasal septum, to ensure functional efficiency and safety in relation to aesthetic complications.

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Description

The invention relates to medicine, namely to otorhinolaryngology, maxillofacial, reconstructive and plastic surgery, and concerns a low-traumatic method for surgical correction of a C-shaped curvature of the quadrangular cartilage of the nasal septum during septoplasty.

Deviated septum continues to be one of the urgent problems of modern otorhinolaryngology, and its surgical correction (septoplasty) is one of the most common reasons for surgical interventions in ENT hospitals. During preventive examinations, the curvature of the nasal septum is detected in 68% of the adult population (Piskunov G.Z., 2003) (1). A displaced nasal septum often leads to a violation of the aerodynamics of the air stream in the nasal cavity, which is the cause of the development of acute and chronic diseases of the paranasal sinuses.

Currently, there are only surgical methods for the treatment of a deformed nasal septum. All methods of correction of the nasal septum can be divided into resections of the type of submucosal resection of the nasal septum (Killian's operation), and septoplasty with the possible preservation or restoration of intranasal structures due to reimplantation of cartilage and bone (the methods of Voyachek and Cottle) (1). Due to low trauma and fewer complications, septoplasty is currently preferable. At the same time, the curvature in the cartilaginous part of the septum is a greater problem, since cartilage resection can lead to unfavorable aesthetic consequences.

A known method of surgical treatment of a deviated nasal septum according to the Cottle method, which consists in a wide maxillo-premaxillary approach to the nasal septum with the removal of only the deviated parts of the nasal septum and maintaining the support complex (2). With this technique, access occurs along the anterior caudal edge of the quadrangular cartilage, and mucosal separation is performed from two sides for better visualization and more space for surgical maneuver.

There is a known method of surgical treatment of a deviated nasal septum, described by Piskunov G.Z., which consists in making a semi-penetrating incision along the caudal edge of the quadrangular cartilage, one-sided separation of the mucous membrane of the nasal septum by the method of tunnels or channels, followed by removal of the curved bone and cartilaginous part of the septum (3). The fundamental difference between the method and the Cottle technique is a one-sided approach with the preservation of all connections on the side opposite to the curvature.

A known method of surgical treatment of horizontal curvature of the cartilage of the nasal septum, which occurs as a result of through or almost through horizontal parallel incisions along the entire length of the cartilage (1). Despite the fact that with this method there is almost complete preservation of the cartilage framework, the method is not reliable in terms of stable correction of cartilage deformity, as well as a significant decrease in the support capacity of the cartilage during its multiple incisions.

The closest technical solution is a method for correcting the displacement of the nasal septum according to Oganesyan S.S. and Yanov Yu.K. (patent RU 2253383 C1, 2003) (4). In the known method of nasal septum plasty, including separation of the mucous membrane on both sides, mobilization of the nasal septum by making incisions in the caudal, dorsal and cranial sections of the nasal septum, a restrictive incision is made in the cartilage of the nasal septum in the ventral section perpendicular to the incision line in the cranial section, departing from ventral edge of the cartilage of the nasal septum by 5-6 mm.

The disadvantage of this method is a significant reduction in the support capacity of the cartilaginous section of the nasal septum due to its partial resection, as well as dissection of the cartilage in all directions (ventral, dorsal and cranial). This disadvantage can adversely affect the aesthetic appearance of the external nose in the event of its saddle deformity.

The technical result of the invention is to improve the results of surgical treatment of patients with C-shaped curvature of the quadrangular cartilage of the nasal septum.

The goal is achieved by modifying the septoplasty method, in which, due to the mobilization and angular incision of the quadrangular cartilage, it is moved and fixed in a straight position.

With this method of surgical treatment of patients with C-shaped curvature of the quadrangular cartilage of the nasal septum, at the first stage, after infiltration of a local anesthetic solution with a vasoconstrictor, access to the quadrangular cartilage is performed through an incision in the mucous membrane with the perichondrium along the anterior caudal edge of the cartilage on the side of the curvature, followed by access to the opposite side and bilateral separation of the mucous membrane in the subperichondreal layer, followed by a transition to the subperiosteal layer in the bony part of the nasal septum. Thus, there is a wide access to all departments of the nasal septum. Next, a posterior chondrotomy is performed (Fig. 1 (1)) at a distance anteriorly approximately 4 mm from the caudal edge of the perpendicular plate of the ethmoid bone, without bringing the upper border of the cartilage incision by 5 mm to its dorsal edge and back of the nose. At the next stage, according to the septoplasty technique (3), the deformed bone and posterior cartilaginous fragments of the nasal septum are removed using chisels, bone scissors and nasal forceps. Further, after eliminating the existing bone curvature of the nasal septum with a scalpel with a No. 15 blade, a lower chondrotomy is performed (Fig. 1 (2)) from the anterior edge of the quadrangular cartilage to the connection with the incision during posterior chondrotomy. In this case, the incision is made at an angle to the septal cartilage perpendicular to the edge of the premaxilla on the convex side of the C-shaped cartilage, as shown in Fig. 2. In this way, the cartilaginous section of the septum is mobilized and fixed from above in the dorsal section. Next, the upper fragment of the quadrangular cartilage is thrown over the lower one to its opposite side and fixed in a new straightened position with two sutures of a polydioxanone thread on a 5/0 stabbing needle with the knots located on the side opposite to the curvature (Fig. 3). Next, the incision of the mucous membrane is sutured and the nasal cavity is tamponade with tampons made of glove rubber and foam rubber for 24 hours. Thus, there is a correction of the C-shaped deformity of the quadrangular cartilage of the nasal septum, while maintaining the entire cartilaginous framework of the nasal septum, located in front of the posterior chondrotomy. This method of surgical correction of the displaced quadrangular cartilage of the nasal septum during septoplasty allows not only avoiding unwanted deformation of the external nose associated with cartilage resection, but, on the contrary, allows eliminating a slight lateral displacement of the external nose.

Brief description of drawings:

1 - posterior chondrotomy,

2 - lower chondrotomy.

Example No. 1. Patient O., aged 28, came to the clinic with complaints of difficulty in nasal breathing. From the anamnesis it was found out that these complaints have been disturbing for 10 years, during which the patient has been using vasoconstrictor drugs in the nose. On examination, the external nose is correct in shape. During rhinoscopy, the nasal septum is C-shaped and evenly curved to the left, the inferior turbinates are hypertrophied. On computed tomography of the paranasal sinuses, their pneumatization was not disturbed. Diagnosis: deviated septum, chronic hypertrophic rhinitis. The patient under general anesthesia underwent surgery - septoplasty according to the above method with turbinoplasty. The patient was discharged in a satisfactory condition after 4 days. When viewed after 1 year, the shape of the nose is satisfactory, nasal breathing is free.

Example No. 2. Patient M., aged 32, came to the clinic with complaints of difficulty in nasal breathing. History of sports trauma to the nose. On examination, a slight curvature of the cartilaginous pyramid of the nose to the right with subluxation of the quadrangular cartilage to the right is determined (Fig. 4). On rhinoscopy, the nasal septum is C-curved to the right with a bony crest on the left. The lower nasal conchas are edematous. On computed tomography of the paranasal sinuses, their pneumatization was not disturbed. Diagnosis: deviated septum, chronic rhinitis. The patient under general anesthesia underwent surgery - septoplasty according to the above method (Fig. 5, 6, 7) with turbinoplasty. The patient was discharged in a satisfactory condition after 5 days. When viewed after 8 months, the shape of the nose is satisfactory, nasal breathing is free.

In GBU RO "OKB named after N.A. Semashko, Ryazan, on the basis of the ENT department, for the period from 2020 to 2021, 10 patients with a diagnosis of deviated septum, chronic rhinitis were treated, who underwent septoplasty according to the above method. No complications were observed in the postoperative period. During the follow-up period from 6 to 18 months, patients maintain a stable functional and cosmetic result.

This method of surgical correction of the C-shaped curvature of the quadrangular cartilage of the nasal septum is an effective method of septoplasty that allows you to perform the operation with maximum preservation of the cartilaginous framework of the nasal septum, ensuring functional efficiency and safety in relation to aesthetic complications, allow you to use it in hospitals involved in surgical treatment of the nose .

Information sources:

1. Piskunov G.Z. Clinical rhinology / G.Z. Piskunov, S.Z. Piskunov. - 3rd ed., add. - Moscow: LLC "Medical Information Agency", 2017. - 750 p.; ill.

2. Cotlle M.N., Loring R.M. Surgery of the nasal septum - New operative procedures anole indication // Ann. Otol. Rhinol. Laringolog. - 1948. - vol.57, # 3. - p.703-713

3. Piskunov G.Z. Surgery for curvature of the nasal septum: practical aspects. Russian rhinology. 2018;26(2):54-57.

4. The method of plastic surgery of the nasal septum: Pat. RU 2253383 C1 Russian Federation: IPC A61B 17/24, A61B 17/00 / S.S. Oganesyan, Yu.K. Yanov; applicants and patent holders: State institution St. Petersburg Research Institute of Ear, Throat, Nose and Speech of the Ministry of Health of the Russian Federation (NII ENT) (RU). - No. 2003135522/14; dec. 11/27/2003; publ.: 10.06.2005.

Claims (1)

A method for surgical correction of a C-shaped curvature of the quadrangular cartilage of the nasal septum during septoplasty, including an incision in the mucosa with the perichondrium along the anterior caudal edge of the cartilage on the side of the curvature, followed by access to the opposite side and bilateral separation of the mucous membrane of the nasal septum in the subperichondrial and subperiosteal layer, followed by posterior chondrotomy at a distance of 4 mm anteriorly from the caudal edge of the perpendicular plate of the ethmoid bone, without bringing the cartilage incision 5 mm to its dorsal edge and back of the nose, and further removal of the curved bone fragment of the nasal septum, characterized in that the skeleton of the C-shaped curved quadrangular cartilage is preserved and move its mobilized upper part to the side opposite to the curvature, and fix it in a new straightened position with two sutures of polydioxanone thread on a 5/0 stabbing needle with the knots located on the side opposite to the curvature of the cartilage.

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