METHOD OF SURGICAL TREATMENT OF CHRONIC TUBOTYMPANIC PURULENT OTITIS MEDIA Russian patent published in 2023 - IPC A61F11/20 A61B17/00 

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: skin incision is made along the entire length of the behind-the-ear fold from top to bottom. The soft tissues of the behind-the-ear region are dissected in layers to the bone, exposing the site of the mastoid process. Separation of the skin, soft tissues and periosteum of the anterior edge of the incision anteriorly are performed. Then, in the upper corner of the wound, an autofascial free graft 1.0 cm in diameter is taken from the fascia of the temporal muscle. The skin of the posterior, upper and lower walls of the external auditory canal is cut off anteriorly along the entire length until the tympanic ring is reached. After that, the meatotympanic flap is mobilized by dissecting the tympanic ring from 6 to 1 hour clockwise for the right ear, or from 6 to 11 hours counterclockwise for the left ear. The implementation of surgical access is fixed, namely, the full volume of visualization of the tympanic cavity, auditory ossicles, tympanic mouth of the auditory tube. Then the malleus handle is separated from the tympanic membrane throughout. The keratinized edge of the tympanic membrane defect is removed. The preparation of the receiving bed is performed. The epidermis is separated and removed from the inner surface of the remnants of the tympanic membrane. Then the auricle is returned to its original position. The skin wall of the external auditory canal is straightened out. After that, the surgical access is closed. After removal of the epidermis from the inner surface of the remnants of the tympanic membrane, fragments of an absorbable gelatin sponge with sizes from 1.0 to 3.0 mm are placed in the tympanic cavity, completely filling the mesotympanum and hypotympanum under the plane of the native tympanic membrane. After that, medial laying of the autofascial free graft is performed in such a way that its edges adjoin the bone tympanic ring in all areas. After the auricle returns to its original position and the skin wall of the external auditory canal is straightened, a polyethylene plate 1.0 cm in diameter and 10.0 μm thick is placed on the surface of the formed neotympanic membrane. Then, fragments of an absorbable gelatin sponge are plugged layer by layer into the external auditory canal, performing mechanical fixation of the formed neotympanic membrane. Fragments with a larger diameter are used than with tamponade of the tympanic cavity.

EFFECT: method makes it possible to securely fix the autofascial flap, provide diffuse nutrition of the autograft, increase the efficiency of treatment of patients with chronic otitis media.

1 cl, 6 dwg, 1 ex