COMBINED ENDONASAL METHOD OF SURGICAL TREATMENT OF POST-TRAUMATIC DACRYOCYSTITIS Russian patent published in 2023 - IPC A61B17/24 A61F9/07 A61B1/02 

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: method includes performing dacryocystorhinostomy with endoscopic endonasal control, followed by washing the formed lacrimal outflow tract, intubating the outflow tract with a double silicone thread. Initially, the otolaryngologist surgeon performs endoscopic septoplasty, then vasotomy with lateralization of the inferior turbinates on both sides. After that, he performs endonasal endoscopic intervention on the paranasal sinuses with the expansion of the natural fistula of the maxillary sinus with partial resection of the uncinate process. Then he performs the formation of a prelacrimal access for an ophthalmologist surgeon, namely, he forms an access to the bone wall that separates the lacrimal sac from the nasal cavity. A mucosal flap is formed. A sickle-shaped knife is used to perform an incision of the mucous membrane at the site of the lateral wall of the nasal cavity in the area of the projection of the lacrimal sac from the place of attachment of the middle turbinate, U-shaped, 1.0x1.0 in size. This flap is separated together with the periosteum posteriorly to the maxillaris line and the area of attachment of the uncinate process. After that, the U-shaped flap is cut off horizontally below, leaving the attachment area in the upper sections, exposing the bone of the nasolacrimal canal in the projection of the lacrimal sac. The flap is placed in the middle nasal passage. After that, both surgeons jointly perform an intervention on the lacrimal ducts. After expanding the lower lacrimal punctum with a conical probe, an illuminating probe is inserted into the lower lacrimal canaliculus, and when it reaches the medial wall of the lacrimal sac, the light source is turned off on the 0-degree transnasal endoscope inserted into the nasal cavity. The place of the projection of the lacrimal sac on the lateral wall of the nose is visualized as a glow from the probe-illuminator. In this place of luminescence, the medial wall of the lacrimal sac is cut in layers, with a vertical incision, first the periosteum, then the mucous membrane of the lacrimal sac wall, after which a thread with a ball at the end is passed into the nasal cavity. Then, a bone window is formed, while most of the bone mass is removed in the lacrimal sac projection zone as far as possible upwards, to the level of the lacrimal canaliculi. After that, the otolaryngologist grabs the thread passed through the probe, brings it into the nasal cavity, pulls it out of the nasal cavity, fixes the ligature threads to the ball, and with their help conducts a double silicone thread, forming a loop between the upper and lower lacrimal openings. Then, a part of the exposed bone is covered with a flap, the ends of the thread, after tying with a ligature and tying the safety knots, are placed in the nasal cavity.

EFFECT: method allows to increase the efficiency of treatment of patients with dacryocystitis and concomitant rhinopathology by obtaining a positive functional result immediately after surgery in the form of a high-quality nasolacrimal fistula without damage to surrounding tissues, to reduce the operation time, to avoid injury to the lacrimal openings and tubules.

1 cl, 22 dwg, 1 ex