METHOD OF SURGERY FOR CHRONIC EPITYMPANOANTRAL PURULENT OTITIS MEDIA Russian patent published in 2024 - IPC A61F11/20 A61B17/00 A61F2/18 A61B18/12 

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: infiltration of the soft tissues of the postauricular area and the posterior surface of the auricle and the skin of the posterior wall of the external auditory canal is performed with saline solution. A 5.0 cm long skin incision is made along the entire length of the postauricular fold from top to bottom. Traction of the soft tissue mass of the posterior edge of the incision is performed, including the skin, soft tissues and periosteum posteriorly. Separation of the skin, soft tissues and periosteum of the anterior edge of the incision anteriorly are performed. 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. The tympanic cavity is inspected, specifying the condition of the chain of auditory ossicles, mucous membrane, and the degree of spread of cholesteatoma. The bone stage of the Zaufal-Levin operation is performed, corresponding to the extent of the pathological process in the cellular structure of the mastoid process, in the attic. The tympanic segment of the trepanation cavity is inspected and ossiculoplasty is performed. After this, the placement of the graft used for plastic replacement of the defect of the tympanic membrane is controlled, forming a neotympanic membrane. Next, the surgical approach is closed by placing sutures on the incision along the postauricular fold. After making an incision in the skin of the postauricular fold, the soft tissues of the postauricular area are dissected layer by layer to the bone using a monopolar electrosurgical instrument with a needle-type electrode, exposing the mastoid area. After separating the skin to the tympanic ring, a vertical incision is made in the skin of the posterior wall of the external auditory canal in the middle of the membranous-cartilaginous section of the external auditory canal, 1.0 cm long. A silicone strip 30.0 cm long, 0.5 cm wide is passed through the auditory canal and the incision with a loop. Traction of the auricle is performed along with the skin of the posterior wall of the external auditory canal anteriorly, fixing the free ends of the silicone strip with a clip on the surgical linen used to drape the surgical wound. Then a circular incision is made in the skin of the bony part of the external auditory canal, retreating 2.0 mm from the tympanic ring from 6 to 1 o'clock position clockwise for the right ear, or from 6 to 11 o'clock position counterclockwise for the left ear. Longitudinal incisions are made in the skin of the external auditory canal, connecting the lower point of the vertical incision in the membranous cartilaginous section to the lower point of the circular incision made at the eardrum. Similarly, the upper point of the vertical incision in the membranous cartilaginous section is connected to the upper point of the circular incision, and the resulting trapezoidal section of skin, facing outwards with its wide base, is removed. Next, using a power instrument, the spine of Henle, the protruding ridges of the tympanomastoid and tympanosquamosal sutures, as well as the cortical layer of the bony posterior wall of the external auditory canal are removed until the anterior meatotympanic angle is visualized, creating a remodeled plane of the posterior bony wall of the external auditory canal. After performing the bone stage according to Zaufal-Lewin, the implementation of surgical access is recorded — visualization of the entire plane of the trepanation cavity — the tympanic and mastoid segments, the remnants of the tympanic membrane, the auditory ossicles, the tympanic mouth of the auditory tube. After the formation of the neotympanic membrane, a round silicone protector with a diameter of 1.0 cm is placed on top of it. Then the trepanation cavity is tamponed with fragments of gelatin sponge. Next, in the middle of the posterior wall of the membranous-cartilaginous section of the external auditory canal, a horizontal incision 0.5 cm long is made in the direction from the inside to the outside with a transition to the surface of the cup of the auricle. A compression fragment of a gelatin hemostatic sponge measuring 2.0×2.0×1.0 cm is inserted into the external auditory canal as a spacer.

EFFECT: method allows to increase the effectiveness of treatment and subsequent rehabilitation of patients with suppurative otitis media.

1 cl, 3 dwg, 2 ex