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

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: behind-the-ear approach is performed using the transmeatal route to reach the tympanic cavity. Afterwards, an oval-shaped autofascial flap measuring 10.0×15.0 mm is harvested from the surface of the temporal muscle. Then a tympanotomy is performed. The tympanic cavity is inspected, scars, ingrown epidermis, foci of tympanosclerosis, and polypous mucosa are removed. The bone stage of the surgical intervention is carried out using the Zaufal-Lewin technique, preserving the facial nerve spur. Next, the anvil affected by the inflammatory process is removed, and the remains of the eardrum are separated from the handle of the malleus. Then, when the superstructures of the stapes are destroyed, their remains are removed, the foot plate of the stapes is cleaned of cicatricial adhesions, foci of tympanosclerosis and epidermization loci. Next, an ossicular prosthesis is installed, a complete one on the foot plate of the stapes when the superstructures of the stapes are destroyed, a partial one on the head of the stapes if it is intact. A previously prepared autofascial flap is placed, the mastoid segment and the external auditory canal are tamponed to the formed tympanic cavity. The access is closed by placing sutures on the postauricular incision. After harvesting the autofascial flap from the medial surface of the auricle, a square-shaped autocartilaginous flap with a side of 15.0 mm is harvested from the surgical wound. Then autocartilaginous plates with the following characteristics are made from it: three round plates with a diameter of 6.0 mm, a thickness of 0.1 mm, and one triangular plate with a thickness of 0.6 mm, and the triangle of the said plate is rectangular with legs 10.0 mm long and 4.0 mm. After separating the remnants of the tympanic membrane from the handle of the malleus, the tendon of the tensor tympanic membrane muscle is cut and the malleus is removed. After cleaning the foot plate of the stapes, deepithelialization of the anterior epitympanic sinus is performed, the epitympanic tooth is removed, and deepithelialization of the medial wall of the attic is carried out. Then, one fragment of the hemostatic material Surgicel measuring 2.0 mm³ is placed in the deepithelialized epitympanic sinus, and two of these fragments are placed on the deepithelialized medial wall of the attic. Next, a triangular autocartilaginous plate is placed on top of the specified material, placing it with a 10.0 mm long catheter parallel to the horizontal segment of the facial nerve canal, and with a 4.0 mm long catheter in the anterior epitympanic sinus. After installing the ossicular prosthesis, its position is fixed using two Spongostan hemostatic sponges measuring 3.0 mm³, and three fragments of the said sponge are placed in the anterior sections of the tympanic cavity. Then the previously prepared three plates of autocartilage with a diameter of 6.0 mm and a thickness of 0.1 mm are laid, creating a three-dimensional plane of the neotymapanal membrane by forming a hemispherical shape of the native eardrum. The apex is in the center of the cap of the ossicular prosthesis, and the base has three support elements in the sections of the neotympanic membrane: at the bone tympanic ring in the anterior and lower sections, the spur of the facial nerve in the posterior section, and the triangular autocartilaginous plate in the upper section. The first autocartilage plate is placed in the projection of the anterior superior quadrant of the tympanic membrane so that one of its edges rests on the cap of the ossicular prosthesis, and the other on the triangular autocartilage plate, namely, on its part with a leg 10.0 mm long. The second plate of autocartilage is placed in the projection of the center of the eardrum so that one of its edges overlaps the first plate by 0.5 mm. The third plate of autocartilage is placed in the projection of the posteroinferior quadrant of the tympanic membrane so that one of its edges overlaps the second plate by 0.5 mm, and its other edge is placed on the spur of the facial nerve. The autofascial flap is placed on top of the formed autocartilaginous frame so that its anterior and lower segments are placed under the remnants of the tympanic membrane supported by the hemostatic sponge Spongostan. The posterior segment covers the spur of the facial nerve along with the third plate of autocartilage, and the upper segment covers the triangular autocartilage plate. Then the remains of the eardrum are placed on top of it.

EFFECT: method makes it possible to increase the effectiveness of tympanoplasty, ensure the transmission of high-frequency sounds by the ossicular prosthesis, which are responsible for speech intelligibility, and at the same time prevent the retraction of the formed eardrum and maintain a pressure equal to atmospheric pressure in the formed tympanic cavity.

3 cl, 2 dwg, 2 ex