RU2157161C1 - Method for performing meringoplastic operation using fascial double flap - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves forming the fascial double flap from the temporal muscle fascia. The flap is placed on both sides of the tympanic membrane. EFFECT: prevented degenerative transformation of the graft.

Description

 The invention relates to medicine, namely to otorhinolaryngology, and can be used for reconstructive surgery on the middle ear with total and subtotal violations of the eardrum.

 The widespread prevalence of chronic otitis media, accompanied by persistent perforation, a significant decrease in hearing, obliges otologists to look for optimal approaches, ways to close the eardrum defect. A number of methods of myringoplasty are known, in particular: the use of the mucous membrane of the middle nasal concha with the underlying bone base [1], a graft, which is a combination of an ultrathin plate of costal allochondrium and a fragment of the fascia of the patient’s temporal muscle [2]. Also known is a method of a combined tympano-ossicular graft from biological tissue - a complex of a tympanic membrane with a hammer or decalcified bone (author. Certificate. USSR N 1503804, class A 61 F 11/00, 1984). However, the disadvantage of these methods is the weak protection of the flap from external factors, the possibility of transposition outside or inside the new membrane, which entails a decrease in auditory function. The preserved antigenic structure of the homograft leads to a tissue incompatibility reaction, this is the cause of frequent diseases of the flap, its subsequent scarring or lysis and, as a result, deterioration of the functional results of the intervention.

 The aim of the invention is the prevention of degenerative changes in the transplant, transposition, reperforation.

 The essence of the invention lies in the fact that the graft replacing the missing part of the eardrum is made from fascia of the temporal muscle. Its two fragments are located respectively medially and laterally relative to the eardrum of the type of "sandwich".

 These distinctive actions in myringoplasty are unknown in medicine, therefore, their presence in the proposed method meets the criterion of "novelty." The method has significant differences, because, unlike the analogue and prototype, an autograft from the fascia of the temporal muscle is used to close the eardrum defect, which doubles over the eardrum defect, which ensures the elasticity of the graft, and its outer fragment reliably protects and creates favorable conditions for life internal fragment. This indicates the conformity of the proposed method to the inventive step.

 The method is as follows. Under local anesthesia, two fragments of the fascia of the temporal muscle 12 x 12 mm are cut out. The transplants are placed under a press, with the help of which the thickness of the fascia is regulated and excess fluid is removed. Next, the remains of the tympanic membrane are de-epidermized, a semicircular incision is made according to Lempert, the meatotympanal flap is detached and anterior. An audit of the tympanic cavity, labyrinth windows, and the chain of auditory ossicles is carried out. Then the first fascial flap is placed medially to the eardrum. With a total defect of the latter, its front edge is brought under the previously separated skin of the ear canal and is pressed with it. The meatotympanal flap is put in place, the fascia is leveled, tightly fitting to the remains of the eardrum. The second fragment is plastered on the prepared wound bed, lateral to the eardrum.

 The proposed method was tested in 18 patients. The results of myringoplasty are positive, which made it possible to restore the integrity of the eardrum in 88% of patients and to improve the functional result in 94%.

 We give examples of the use of the prototype (example 1) and the proposed method (examples 2, 3).

 Example No. 1. Patient G., 36 years old, was admitted to the ENT department with a diagnosis of right-sided dry mesotympanitis. With otoscopy, a subtotal eardrum defect was determined. According to audiometry, the threshold of air conduction was within 50 dB, the bone-air interval was 35 dB. Hearing: sh. 1.5 m, p.p. 3.5 m.

 A patient under local anesthesia with 2% novocaine solution endaurally performed myringoplasty of the mucous membrane of the middle turbinate. The difficulty was that the transplant did not have sufficient mobility, which hampered its optimal location. Morphologically, the graft is not close enough to the natural eardrum. All this led to a prolonged "disease" of the flap and subsequently to significant necrotization of the latter.

 Example No. 2. Patient V., 44 years old, was admitted to the ENT department with a diagnosis of bilateral chronic mesotympanitis. During otoscopy, a subtotal eardrum defect was installed on the left, and a total defect on the right. According to audiometry, there is a mixed form of hearing loss of the III-II stage, the bone-air interval averaged 30 dB. Hearing: right - sh. adc, p.p. 1 m, on the left - highway 1 m, p.p. 2.5 m.

 A patient under local anesthesia with a 2% solution of novocaine endaurally under a microscope was performed myringoplasty according to the proposed method.

 The postoperative period was uneventful. On the 14th day the patient was discharged from the hospital. At the control examination after a month - a pink flap, whole, sh. 3.5 m, p.p. > 5 m.

 Example No. 3. Patient S., 58 years old, was admitted to the ENT department with a diagnosis of right-sided chronic epimesotympanitis. Mixed form of hearing loss III. An otoscopy revealed a total eardrum defect. Patency of the auditory tube III. According to tonal threshold audiometry, the average hearing loss in the speech range was about 75 dB, and the bone-air interval was 30 dB. Hearing: sh. - ad conhae, p.p. 0.5 m

 A patient under local anesthesia with a 2% solution of novocaine endaurally under a microscope underwent sandwich-type myringoplasty. At the same time, auto-cartilage stapedomeringoplasty was performed. The postoperative period was uneventful. On the 15th day, the patient was discharged from the hospital. At the control examination after 1.5 months, the pink flap was thinned in the epitympanum. With audiometric control, hearing loss in the conversational frequency range was 55 dB. Hearing: sh. 0.8 m, p.p. 2.5 m.

 Thus, the application of the proposed method of myringoplasty prevents degenerative changes in the graft, transposition, reperforation.

Literature
1. Kofanov RV About the processing of the edges of the perforation and fixation of the flap with myringoplasty. - In the book: Mater. to mezh. scientific prakt. conf. ORL and departure. scientific sessions of the Research Institute of the Ear, Throat and Nose. M., 1977 .-- S. 362-363.

 2. Sitnikov V.P., Bizunkov A. B., Husam E.R. The dynamics of the acoustic properties of a two-layer graft at different times after myringoplasty // Tomsk State University Journal. otorhinolaryngology. - 1998. - N 3. - S. 21-22.

Claims (1)

 Meringoplasty with a double fascial flap, characterized in that it is formed double from the fascia of the temporal muscle, located on both sides of the perforation of the tympanic membrane.