MYRINGOPLASTY METHOD OF CLOSED TYMPANOPLASTY Russian patent published in 2023 - IPC A61F11/20 A61B17/00 A61F2/18 

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: postauricular approach is performed and the transmeatal route is used: the soft tissues of the postauricular region are dissected layer by layer to the bone, exposing the mastoid area. 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. Then, a square-shaped autocartilage flap with side dimensions of 1.0 cm is taken from the medial surface of the auricle in the surgical wound. Next, four square-shaped autocartilage plates 0.1 mm thick are made, then round plates with a diameter of 5.0 mm are cut out from them, after then place them in saline solution. Next, from the completed postauricular access, a round autofascial flap with a diameter of 10.0 mm is harvested from the temporal muscle. Then the fibrocartilaginous ligament of Gerlach is separated from the bone tympanic ring along the entire length corresponding to the posterior quadrants of the eardrum. After de-epithelialization of the calloused edge of the perforation of the tympanic membrane, the tympanic cavity is inspected, the stratified squamous keratinizing epithelium grown into the tympanic cavity is removed, cicatricial adhesions and adhesions are dissected, and irrigated with saline. Then five cubic fragments of a highly purified gelatin sponge with a side size of 3.0 mm are placed into the tympanic cavity, with three fragments placed in the sections of the tympanic cavity corresponding to the anterior quadrants of the eardrum, and two fragments in the sections of the tympanic cavity corresponding to the posterior quadrants of the eardrum. Next, the previously prepared four round plates of autocartilage with a diameter of 5.0 and a thickness of 0.1 mm are laid, creating a three-dimensional plane of the neotympanic membrane due to the formation of a hemispherical shape of the native tympanic membrane with the base at the bone tympanic ring with the apex in the handle of the malleus. The first plate of autocartilage is placed in the projection of the anterior-superior quadrant of the eardrum, the second plate is placed in the projection of the anterior-inferior quadrant, the third plate is placed in the projection of the posterior-inferior quadrant, and the fourth plate is placed in the projection of the posterior-superior quadrant of the eardrum. One edge of the first plate rests on the handle of the malleus, and its other edge is inserted under the bone tympanic ring by 0.5 mm. Next, each subsequent plate, namely the second and third, is placed so that one of its edges is placed on top of the previous plate, overlapping it by 0.5 mm, and its other edge is placed under the bone tympanic ring by 0.5 mm. The fourth plate is placed on top of the first and third plates and on top of the bone tympanic ring, overlapping them by 0.5 mm. Then, a previously prepared autofascial flap is placed on top of the formed autocartilaginous frame, on top of which the remains of the tympanic membrane are placed.

EFFECT: method makes it possible to increase the effectiveness of myringoplasty by ensuring the tightness of the neotympanic membrane, to restore the patient's tonal hearing and the perception of high frequencies responsible for speech intelligibility.

4 cl, 7 dwg, 1 ex