RU2312624C1 - Method for submucous conchotomy of inferior concha - Google Patents

Abstract

FIELD: medicine, surgical otorhinolaryngology.

SUBSTANCE: the present innovation deals with treating patients with hypertrophy of inferior conchae. The innovation deals with mechanical reduction of inferior concha. Moreover, before reduction it is necessary to perform bipolar coagulation of anterior edge of inferior concha followed by tunneling the inferior concha along inferior edge of osseous spine. Mechanical reduction should be fulfilled with the help of a surgical high-rate cutting with reciprocation while withdrawing the instrument out of the developed early tunnel. The innovation enables to avoid the development of hematomas, hemorrhages, nasal septum's perforation, cicatricial and atrophic phenomena in postsurgical period.

EFFECT: higher efficiency.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to surgical otolaryngology, and can be used in the surgical treatment of patients with lower turbinate hypertrophy.

There is a method of surgical reduction of the volume of the lower nasal concha with hypertrophic rhinitis ("Handbook of otolaryngology" edited by A.G. Likhachev, 1981, pp. 103-105).

The known method consists in the fact that after anesthesia with a nasal loop and scissors, the hypertrophied part of the lower or middle nasal conch is cut off in its anterior, middle, and posterior sections. Due to significant bleeding during surgery, hemostasis is performed with bilateral anterior nasal tamponade.

The number of complications in the postoperative period with this method is from 18 to 25%, due to the invasiveness of the operation, a large amount of blood loss and the development of cicatricial and atrophic phenomena in the nasal cavity. Complications are associated with excessive trauma to tissues in the nasal cavity, a significant reduction in the cavernous tissue of the nasal concha and nasal septum, the development of atrophy and subatrophy of the mucous membrane, often with the formation of perforation of the nasal septum, nosebleeds, and persistent cephalgia.

The invention is aimed at rapid rehabilitation of patients, reducing the morbidity of the operation and reducing the number of complications in the postoperative period.

The novelty of the claimed method consists in creating a new low-traumatic intervention on the lower turbinates to reduce their volume. The use of a high-speed surgical cutter to implement this method required the creation of a new sequence of techniques and an anatomical method for their implementation in the submucosal layer of the nasal concha. The most preferred anatomical site for introducing a cutter into the thickness of the nasal concha is the front end of the lower nasal concha, since it is there that the capillary network has fewer anastomoses. This is important in preventing bleeding during surgery.

A new technical result that can be achieved by the invention is the prevention of hematoma formation, bleeding, as well as perforation of the nasal septum, cicatricial and atrophic phenomena in the postoperative period.

The technical means for implementing the claimed method is the well-known high-speed drill "BS-3" with a set of diamond cutters 7 cm long for work in the nasal cavity. The most convenient for surgical intervention is a diamond mill with a diameter of 3 mm. The best working moment is determined by the return direction of the cutter with its small lateral movements for tactile control of the process of reduction of the bony skeleton of the lower turbinate. In this case, there is no excessive bleeding, soft tissues are not injured by a diamond mill, bone dust is easily removed by an aspirator from the wound canal.

The miniature dimensions of the drill motor, mounted on a standard collet tip, and the working part of the burs, increased to 7 cm, provide a sufficient overview of the surgical field without restricting the surgeon's actions.

The method is implemented in the operation of submucosal milling conchotomy and is performed as follows. After bipolar coagulation, a mucous membrane of the anterior end of the inferior nasal conch is dissected with a scalpel. Then it is tunneled along the lower edge of the bone skeleton.

Then, a cutter with a diameter of 3 mm is inserted into the formed tunnel to the end of the lower nasal concha in the idle state and the cutter is turned on (Figure 1), and upon returning with slight swaying from side to side, sensing the lower bony edge of the nasal concha, the nasal concha is reduced. Visual control of the process of reduction of the nasal concha is carried out endoscopically. In one cycle, no more than 1 mm of bone tissue is removed. Repeatedly carry out 3-4 cycles.

The operation is completed by installing a Surgicell hemostatic sponge in the nasal cavity.

Example. Patient D-s, 26 years old. Complaints of difficulty in nasal breathing for about 5 years, resulting from a nose injury. When endoscopy revealed hypertrophy of the lower nasal concha. On a computer tomogram of the nose and paranasal sinuses, the true bone hypertrophy of the lower nasal concha is determined.

General condition is satisfactory. A pulse of 80 beats per minute, blood pressure of 135/80 mm Hg, pathology from the cardiovascular system, parinchymal abdominal organs, chest organs were not found.

Preparation for the operation is traditional. After anesthesia and bipolar coagulation of the mucous membrane of the anterior end of the inferior nasal turbinate, a 3 mm long incision was made on the right, followed by tunneling of the lower margin of the turbinate with a narrow raspator 3 mm wide. Then, a diamond mill with a diameter of 3 mm and a length of 7 cm inoperative was introduced into the tunnel formed to the end of the lower nasal concha. Further, the milling cutter was set in motion and was withdrawn by reciprocating movements, touching the lower edge of the bone skeleton of the lower nasal concha, on the right. The procedure was repeated twice until the bone skeleton was reduced by 3 mm along its lower edge. Bleeding is minor, stopped on its own. Similarly, a milling conchotomy on the left was performed. The nasal passages as a result of the operation are wide. Nasal breathing restored.

The operation ended with tamponade of the nasal passages with the Surgicell hemostatic sponge.

According to this method, 19 people were operated on, complications in the form of bleeding, adhesions, perforations of the nasal septum were not observed.

The combination of methods of the claimed operation allows for quick rehabilitation of patients. Studies have shown that the patented method provides a significant reduction in the number of complications.

Claims (1)

The method of submucosal conchotomy of the inferior nasal concha, including its mechanical reduction, characterized in that before the reduction, bipolar coagulation of the anterior end of the inferior nasal concha is performed, the lower nasal concha is tunneled along the lower edge of the bony skeleton, and the mechanical reduction is performed by surgical high-speed milling cutter with reciprocating movements tool from a previously created tunnel.