RU2414180C2 - Intranasal splint (versions) and method of its fixation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. Intranasal splint for surgical treatment of nasal septum deviation contains basis from elastic material, made in form of plate. Plate has heptagonal form in plan, with heptagon apexes, whose position is determined in the following way: on projection of structures of lateral wall of nasal cavity on nasal septum, obtained by computer reformation of scans of the latter, the first heptagon apex is placed on anterior nasal spine, the third point - 10 ±1.5 mm before free edge of nasal bone, the fourth point - on anterior end of middle nasal turbinate, the fifth point - in the middle of middle nasal turbinate, the sixth point - on choanal edge of hard palate, and the seventh point is determined by intersection of perpendicular, going from hard palate edge, with main bone body. Position of the second point is found by intersection of two straight lines passing through the first point at angle 105° and through the third point at angle 30°. Method of fixation lies in placement of a splint into corresponding half of nose, with thread or threads being fixed on choanal end of splint. Simultaneously with placement of splints under endoscope control threads are through over vomer onto opposite half of the nose and transseptally through splints are fixed in anterior part. Choanal end of splint is installed at the level of distal edge of nasal septum, after which additional "П"-shaped suture, fixing splints in anterior part, is applied.

EFFECT: inventions ensure increase of functional efficiency of surgical treatment of congenital and post-traumatic deformities of nasal septum.

8 cl, 2 ex, 14 dwg

Description

The invention relates to medicine, in particular to otorhinolaryngology, and can be used in the surgical treatment of diseases of the nasal cavity, namely, curvature of the nasal septum.

In the traditional method (Preobrazhensky BS, Temkin Ya.S. et al. Diseases of the ear, throat and nose. - M .: Medicine, 1968) after surgical correction of the osteo-cartilaginous skeleton of the nasal septum, the mucoperichondria sheets adapt to each other with the help of seams and tampons (latex, gauze), which ensures the fixation of the nasal septum in the established mid-position. Nasal tamponade is also aimed at preventing possible postoperative complications, such as bleeding, septal hematoma, the formation of adhesions between the septum and the lateral wall of the nasal cavity.

However, the disadvantages of this conventional method are:

- discomfort caused to the patient;

- the limited duration of the tampon in the nasal cavity due to the high probability of developing such postoperative complications as inflammation of the paranasal sinuses and necrosis of the mucous membrane;

- trauma to the mucous membrane and the possibility of displacement of the elements of the restored septum of the nose when removing the tampon.

In this regard, after surgical intervention, intranasal splints are installed on the nasal septum (splints), which, due to their rigidity, keep the nasal septum in the middle position, screening the mucous membrane of the restored septum from mechanical and chemical effects.

The closest analogue to the proposed technical solution is a tire containing a basis of elastic material made in the form of a plate (patent of the Russian Federation No. 2121309, A61B 17/24, 1996), which is fixed on the nasal septum using a special clip.

In the closest analogue, during the treatment, instead of deaf cotton-gauze swabs, nasal "ring" tires are inserted that have openings for free passage of air during breathing and the shape of a ring, half-ring, oval, semi-oval, truncated cone, half-cone with one flat side surface, or insert plate tires, or insert combinations of plate plates with "ring" tires.

The main disadvantages of this technical solution are:

- the complexity of the design, consisting of three elements, the use of which requires special training from the doctor;

- lack of clear sizes of structural elements associated with anatomical formations of the nasal cavity, which greatly complicates the modeling of tires;

- due to the fact that the nasal cavity is covered with a mucous membrane that constantly produces mucus, the fixation method presented in the closest analogue cannot be considered reliable, since the structural elements will constantly shift relative to the anatomical structures of the nasal cavity;

- “ring” tires are used only for correction of nasal passages, and their fixation in the nasal cavity is carried out due to local tissues, while the tire is installed as if opposed between the lateral wall of the nose and nasal septum. The pressure applied by the "ring" tires on the tissues of the nasal cavity, rich in nerve endings, gives the patient unpleasant sensations and discomfort. Also, the negative side of this fixation is that against the background of the treatment, the inflammation subsides, characterized by a decrease in swelling of the nasal mucosa and an increase in the lumen of the latter, which in turn leads to flotation of the nasal splint and a high probability of aspiration into the upper respiratory tract;

- when modeling nasal tires according to the "shape and size of the general nasal passage", one of the boundaries of which are the nasal septum and the roof of the nasal cavity (the latter separates the cranial cavity), when installing tires of this form, the iatrogenic injury of the sieve plate is highly likely, which leads to the development of rhinoliquorea and meningitis;

- the disadvantage of the tire-plate is that for its fixation on the nasal septum, a special clamp is required, the levers of which are located in the cavity of the common nasal passage, narrowing the lumen of the latter. The disadvantage of this mount is also that its levers, connecting near the nose (in front of the collume), in addition to the inconvenience to the patient, complicate the act of sweeping. Periodic adjustment of the compression force of the fixing clamp is also necessary, which greatly complicates the work of the doctor;

- in view of the fact that the tire plates are designed to “straighten” and “give the right shape” to the nasal septum, they are installed in a limited (curved) area. Thus, sections of the nasal septum that are not shielded by the tire remain.

The present invention is directed to solving the problem of creating a reliable device capable of increasing the functional effectiveness of surgical treatment of congenital and post-traumatic deformities of the nasal septum with the simplest possible design.

The problem for the device - the intranasal tire, is solved due to the fact that the tire contains a basis of elastic material made in the form of a plate having a heptagonal shape in plan, with heptagon vertices whose position is defined as follows: on the projection of the structures of the lateral wall of the nasal cavity on nasal septum obtained by computer reformation of the last scans, the first peak of the heptagon is set on the front nasal spine, the third peak is not reaching 10 ± 1.5 mm to the free edge of the nasal bone, four the fifth vertex is at the front end of the middle nasal concha, the fifth vertex is at the middle of the middle nasal concha, the sixth point is at the choanal edge of the hard palate, and the seventh point is defined by the intersection of the perpendicular coming from the free (choanal) edge of the hard palate with the body of the main (sphenoidal ) bone, while the position of the second point is found by crossing two lines going through the first point at an angle of 105 ° and through the third point at an angle of 30 °. The free edge of the hard palate is a constant anatomical landmark; on a computer scan, the solid sky looks like a line, its free edge is taken as a point. During the construction, generally accepted aesthetic criteria were used (G. Piskunov, “Clinical Rhinology”, M., 2002, p. 348).

In a preferred embodiment, the tire contains a basis of elastic material, made in the form of a plate with a thickness of 1-2 mm, having a heptagonal shape in plan with the vertices of the heptagon A, B, C, D, D, E, G, while the length of the sides of the heptagon is: AB = 14-16 mm, BV = 20-22 mm, VG = 16-18 mm, DG = 15-17 mm, DE = 31-33 mm, EL = 11-13 mm, JA = 49-51 mm.

For a specific intranasal splint suitable for most patients, the internal heptagon angles are ∠A = 165 °, ∠B = 75 °, ∠B = 125 °, ∠Г = 163 °, ∠Д = 169 °, ∠E = 113 ° , ∠Ж = 90 °, and the lengths of the sides are equal: AB = 15 mm, BV = 21 mm, VG = 17 mm, DG = 16 mm, DE-32 mm, ЕЖ = 12 mm, ЖА = 50 mm.

The tire in special cases of its implementation may have a hollow roll-like thickening on its surface, extending along the entire length of the intranasal tire at the level of the inferior nasal concha and oriented towards the side wall of the nasal cavity. The edges (the places where the faces converge) and the corners of the plate are blunt, mainly rounded.

A tire in a preferred embodiment may be made of silicone rubber with Shore A-60 hardness.

For the second object - the method of fixing the intranasal tire, the problem is solved due to the fact that they drive one tire into the corresponding half of the nose, while using tires, each of which has the shape of a heptagonal plate, on the choanal end of which a thread is fixed, simultaneously with the tire under endoscopic control, the threads from each tire are thrown through the opener to the opposite half of the nose and then transseptally fixed through the tires in the front section, while the choanal end of the tire is set to ur Aries of the distal edge of the nasal septum, after which an additional U-shaped suture is fixed, fixing both tires in the anterior section.

The technical result from the use of the invention is to simplify the design of the tire while ensuring high reliability of fixation and preservation of new breath in the patient. The specified technical result is achieved due to the fact that the intranasal tire, the shape and dimensions of which are determined in accordance with the method proposed above, has a simple structure - in the form of a heptagonal plate, while reliable fixation of the tire on the nasal septum is performed without the use of additional devices. In addition, this embodiment of the tire allows you to save nasal breathing in the patient. As a result of statistical analysis, no reliable pattern was found between gender and age. Therefore, if necessary, if the tire with the specific dimensions indicated above is not suitable, it is possible to individually select the shape and size of the intranasal tire according to the above method for both children and the adult patient population.

This method can be used to calculate the spatial relationship and shape of both intranasal structures and other anatomical structures of the ENT organs.

The above specific numerical values of the plate thickness, the lengths of the sides of the heptagon and the values of its internal angles are average. The implementation of intranasal tires according to these sizes allows them to be used for most patients. A swell-like thickening further facilitates the patient's nasal breathing. Injury to the nasal mucosa is excluded due to the selection of the shape and size of the tire, as well as due to the fact that the angles of convergence of the faces and the angles at the vertices of the heptagon are made blunt (rounded). The execution of tires made of silicone rubber with a shore hardness of A-60 provides sufficient rigidity of the plate when fixing the nasal septum, and also eliminates mucosal injury.

The indicated sizes of tire elements were obtained as a result of studies of tire samples made from special grades of medical silicone rubber. These studies have shown the sufficiency of the above essential features, not only to achieve the technical result of the invention in particular cases, which are illustrated by the following examples, but also in other cases of the invention.

The invention is illustrated by drawings:

On figa shows a side view of the nasal cavity (nasal septum).

On figb - frontal (coronary) view of the nasal cavity.

On figv - top view (axial) of the nasal cavity.

Figure 2 - the first step in the implementation of the method - the establishment of the first tire with the transfer of thread at the choanal ends through the opener to the opposite half of the nose (a - side view, b - front view, c - top view).

Figure 3 - the second stage of the method - the installation of the first tire (a - side view, b - front view, c - top view).

Figure 4 - the third step in the implementation of the method - the establishment of the second tire with the transfer of thread at the choanal ends through the opener to the opposite half of the nose (a - side view, b - front view, c - top view).

Figure 5 - the fourth stage of the implementation of the method is the installation of the second bus (a - side view, b - front view, c - top view).

Figure 6-9 is a step of fixing the tires with a U-shaped seam.

Figure 10 is a plan view of the intranasal tire.

On figa and 11B - computer reformation of the lateral wall of the nasal cavity and nasal septum, respectively.

On Fig - view of the intranasal tire in plan with a hollow roller-like thickening.

In Fig.13 is a section aa from Fig.12.

On Fig - building a bus computer.

The intranasal splint for surgical treatment of curvature of the nasal septum contains a basis of elastic material, for example, silicone rubber with a shore hardness of A-60. The basis is made in the form of a plate 1 mainly with flat faces, i.e. in the form of a prism, with a thickness (height of the prism) of 1-2 mm.

In figure 1, the positions shown: 1 - nasal septum; 2 - nasal concha; 3 - opener; 4 - choans; 5 - the main sinus; 6 - nasal bone; 7 - front nasal spine; 8 - nasopharynx; 9 - common nasal passage; 10 - roof of the nose (sieve-like plate); 11 - the cavity of the skull.

The plate in the plan has the shape of a heptagon with the vertices A (first vertex), B (second vertex), C (third vertex), D (fourth vertex), D (fifth vertex), E (sixth vertex), F (seventh vertex). The shape of the intranasal splint in the form of a heptagonal plate is determined on the basis of a statistical analysis of computer reformation of nasal septum scans and the structures of the lateral wall of the nasal cavity projected onto the latter in a large group of patients. The starting point (A) for measurement was the anterior nasal spine, from which the measurement was taken to the key places (points) of intranasal surgery. At work, a computer was used. Each line was represented by a computer in the form of a vector, the angle of which was measured relative to a conditional line passing through point A, using the drawn vectors, the angle and distance to key places of intranasal surgery were measured, namely: point B - not reaching 10 ± 1.5 mm to free the edges of the nasal bone, the front end (point G) and the middle (point D) of the middle nasal concha, the choanal edge of the hard palate (point G) and the point (E) of the intersection of the perpendicular line from the edge of the hard palate with the body of the main bone. Point B is found by crossing two lines going through point A at an angle of 105 ° and through point B - 30 °, which correspond to normal aesthetic criteria for the shape of the nose.

Statistical analysis showed that for the bulk of adult patients, the length of the sides of the base is: side AB = 14-16 mm, side BV = 20-22 mm, side HH = 16-18 mm, side HD = 15-17 mm, side DE = 31-33 mm, side ЕЖ = 11-13 mm, side ЖА = 49-51 mm. The ribs and vertices of the heptagon are rounded to prevent trauma to the nasal mucosa. On the surface of the tire, a hollow roll-like thickening can be performed, extending along the entire length of the intranasal tire at the level of the inferior nasal concha and oriented towards the side wall of the nasal cavity, which further facilitates nasal breathing in the patient. The most commonly used intranasal tires with sides of the heptagon length: AB = 15 mm, BV = 21 mm, VG = 17 mm, DG = 16 mm, DE - 32 mm, EF = 12 mm, JA = 50 mm and the inner corners of the heptagon: ∠ A = 165 °, ∠B = 75 °, ∠B = 125 °, ∠Г = 163 °, ∠Д = 169 °, ∠E = 113 °, ∠Ж = 90 °.

The method of fixing intranasal tires is as follows. After septoplasty and surgical correction of intranasal structures (radio wave disintegration of the inferior nasal concha), both sides of the nose are guided along one bus with fixed threads at the choanal ends of the bus (side hedgehog). Simultaneously with the establishment of the tires, the threads under endoscopic control are thrown through the opener to the opposite half of the nose and transseptally fixed through the tires in the front section, while the choanal end of the tire (side of the hedgehog) is installed at the level of the distal edge of the nasal septum. Also impose an additional U-shaped seam, fixing the tires in the front. Thus, tight fixation of the intranasal splint is achieved along the entire length of the nasal septum. Tamponade of the nasal cavity after surgery is not performed. Postoperative care is carried out according to the generally accepted technique (daily toilet of the nasal cavity, irrigation or application with antibacterial and antiseptic drugs). Intranasal tires are removed 7 days after surgery.

Intranasal tires were tested in 22 patients with congenital and post-traumatic curvature of the nasal septum in combination with chronic vasomotor rhinitis from the age of 25 to 57 years.

2 case histories can illustrate the effectiveness of the use of intranasal tires in the surgical treatment of congenital and post-traumatic deformities of the nasal septum.

1) Patient B., 23 years old, was admitted with a diagnosis of curvature of the nasal septum, chronic vasomotor rhinitis for planned surgical treatment, with complaints of difficulty in nasal breathing. In connection with the above pathology, the patient underwent septoplasty and microwave disintegration of the lower nasal concha, while the nasal septum is fixed in the manner described above by the claimed intranasal splints. The postoperative period was characterized by a smooth course, the temperature reaction returned to normal on the second day, and there was no headache. Intranasal tires did not impede medical procedures (toilet of the nasal cavity, application of medicinal substances), screening the nasal septum along the entire length (data of endoscopic examination). Nasal breathing is satisfactory during the entire time the intranasal tires are in the nasal cavity. On day 7 after surgery, the tires are removed. Intranasal picture: nasal septum in the midline; the mucous membrane of the nasal septum is pale pink, with no signs of inflammation; the nasal passages are free, there are no adhesions between the septum and the lateral wall of the nose. Nasal breathing is free. On the 8th day after the operation in satisfactory condition, the patient was discharged from the hospital.

2) Patient R., 29 years old, was admitted with a diagnosis of an open fracture of the nasal septum, a fracture of the nasal bones with post-traumatic deformation of the external nose and nasal septum, abrasion of the nasal bridge, and alcohol intoxication. In connection with an open fracture of the nasal septum, an open reposition of the nasal septum with septoplasty elements and a finger-instrumental reposition of the nasal bones were performed. The nasal septum is fixed by the claimed method with intranasal splints, the nasal bones are fixed with intranasal swabs. Due to the presence of skin lesions, the external plaster cast did not overlap. On the 2nd day, the intranasal tampons were removed, the shape of the nose was correct, the nasal septum was in the midline, the intranasal splints were consistent, and the nasal breathing was satisfactory. When examining the nasal cavity with a rigid endoscope, intranasal tires block the nasal septum along its entire length, separating the latter from the inflamed side wall of the nasal cavity. On the 4th day after surgery, the patient has a deformation of the external nose. On the 7th day, after abrasions of the nasal dorsum of the nose were epidermized, repeated finger-instrumental reposition of the nasal bones was performed, with fixation of bone fragments by an intranasal swab and an external plaster cast. The intranasal swab was removed on the 2nd day after repeated surgery, the external gypsum string and the intranasal splints were removed on the 4th day. Objectively: the shape of the nose is correct, nasal breathing is free. Midline nasal septum, pink, with no signs of inflammation. The nasal passages are free, there is no pathological discharge and adhesions. On the 13th day of inpatient treatment, the patient was discharged in satisfactory condition.

Claims (8)

1. An intranasal splint for surgical treatment of curvature of the nasal septum, containing a base of elastic material made in the form of a plate, characterized in that the plate has a heptagonal shape in plan with heptagon vertices, the position of which is defined as follows: on the projection of the structures of the lateral wall of the nasal cavity on nasal septum obtained by computer reformation of the last scans, the first peak of the heptagon is set on the front nasal spine, the third point is not reaching (10 ± 1.5) mm to free nasal bone, the fourth point is on the front end of the middle nasal concha, the fifth point is on the middle of the middle nasal concha, the sixth point is on the choanal edge of the hard palate, and the seventh point is determined by the intersection of the perpendicular coming from the edge of the hard palate with the body of the main bone, in this case, the position of the second point is found by the intersection of two lines going through the first point at an angle of 105 ° and through the third point at an angle of 30 °. 2. The intranasal tire according to claim 1, characterized in that the heptagonal plate is made flat with a hollow roller-like thickening on its surface, running along the entire length of the intranasal tire at the level of the lower nasal concha and oriented towards the side wall of the nasal cavity, and the ribs and tops of the plate are made rounded. 3. The intranasal tire according to claim 1 or 2, characterized in that the tire is made of silicone rubber with a shore hardness of A-60. 4. An intranasal splint for surgical treatment of curvature of the nasal septum, containing a basis of elastic material in the form of a plate, characterized in that the basis is made in the form of a plate 1-2 mm thick, having a heptagon in plan with the vertices indicated by A, B, C, G, D, E, G, while the length of the sides of the heptagon is: side AB = 14-16 mm, side BV = 20-22 mm, side VG = 16-18 mm, side DG = 15-17 mm, side DE = 31-33 mm, side ЕЖ = 11-13 mm, side ЖА = 49-51 mm. 5. The intranasal tire according to claim 4, characterized in that the inner angles of the heptagon are: ∠A = 165 °, ∠B = 75 °, ∠B = 125 °, ∠G = 163 °, ∠D = 169 °, ∠E = 113 °, ∠Ж = 90 °, and the lengths of the sides are equal: AB side = 15 mm, BV side = 21 mm, VG side = 17 mm, DG side = 16 mm, DE side - 32 mm, EZ side = 12 mm side ЖА = 50 mm. 6. The intranasal tire according to claim 4 or 5, characterized in that the heptagonal plate is made flat with a hollow roller-like thickening on its surface, running along the entire length of the intranasal tire at the level of the inferior nasal concha and oriented towards the side wall of the nasal cavity, and the ribs and vertices the plates are rounded. 7. The intranasal tire according to claim 4 or 5, characterized in that the tire is made of silicone rubber with a shore hardness of A-60. 8. The method of fixing the intranasal tire, which consists of inserting the tire into the corresponding half of the nose, characterized in that the tires are used, each of which has the shape of a flat heptagonal plate with a thickness of 1-2 mm, while a thread or threads are fixed at the choanal end of the tire, simultaneously with the introduction of the tires, the threads under endoscopic control are thrown through the opener to the opposite half of the nose and transseptally fixed through the tires in the front section, while the choanal end of the tire is set at the level of the distal edge of the nose howl partitions, after which impose additional U-shaped seam, which connects both the tires and the tire locking anterior.

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