MYRINGOPLASTY METHOD OF CLOSED TYMPANOPLASTY WITH OSSICULOPLASTY Russian patent published in 2024 - IPC A61F11/20 A61B17/00 A61F2/18 

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: postauricular approach is performed using the transmeatal route. The soft tissues of the behind-the-ear region are dissected in layers to the bone, exposing the site of the mastoid process. 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 the fibrocartilaginous ligament of Gerlach is separated from the bone tympanic ring along the entire length corresponding to the posterior quadrants of the eardrum. Then the remains of the tympanic membrane are separated from the lateral process and the handle of the malleus. The calloused edge of the perforation of the tympanic membrane is de-epithelialized, and the tympanic cavity is inspected. The stratified squamous keratinizing epithelium that has grown into the tympanic cavity is removed. Scar adhesions and adhesions are dissected. Next, in the projection of the stapes, with the superstructures of the stapes intact, a partial prosthesis is installed on the head of the stapes. If the superstructures of the stapes are lost, a complete prosthesis is installed on the footplate of the stapes, and the remains of the tympanic membrane are placed. The external auditory canal is tamponade and a bandage is applied. After separating the skin of the external auditory canal from the medial surface of the auricle, a square-shaped autocartilage flap with side dimensions of 1.0 cm is taken from 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 of them. One of them is made with a triangular cutout emanating from the centre, which is 1/8 of its circumference. Then the autocartilage plates are placed in a physiological solution. Next, from the completed postauricular access, a round autofascial flap with a diameter of 10.0 mm is harvested from the temporal muscle. After dissection of cicatricial adhesions and adhesions of the tympanic cavity, the malleus and incus are removed, and in case of defects of the stapes, the superstructures of the stapes are removed. Next, the tympanic cavity is irrigated with saline solution. Then five cube-shaped fragments of a highly purified gelatine sponge with a side size of 3.0 mm are placed into it. Three fragments are placed in sections of the tympanic cavity corresponding to the anterior quadrants of the eardrum, and two fragments are placed in sections of the tympanic cavity corresponding to the posterior quadrants of the eardrum. After installing the ossicular prosthesis, four previously prepared round plates of autocartilage with a diameter of 5.0 mm and a thickness of 0.1 mm are laid. A three-dimensional plane of the neotymapanal membrane is created due to the formation of a hemispherical shape of the native tympanic membrane with the base at the bone tympanic ring and the apex in the centre of the cap of the ossicular prosthesis. 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 one, is placed so that one of its edges are 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 with a cutout is placed on top of the first and third plates and on top of the bone tympanic ring, overlapping the edges of all these elements by 0.5 mm. Its centre is located in the projection of the stapes, namely in the head of the stapes — when installing a partial prosthesis, in the footplate of the stapes — in the case of installing a complete prosthesis. The socket of the cutout is directed to the geometric centre of the formed neotympanic membrane. Then, a previously prepared autofascial flap is placed on top of the formed autocartilaginous frame.

EFFECT: ensuring contact and reliable fixation of the distal part of the prosthesis used to replace the lost elements of the auditory ossicular chain, to achieve tightness of the neotympanic membrane while simultaneously restoring the patient's perception of both speech and high frequencies responsible for speech intelligibility.

4 cl, 7 dwg, 2 ex