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Otorhinolaryngology
INVENTION
Patent of the Russian Federation RU2074688

METHOD OF MASTODOPLASTICS

METHOD OF MASTODOPLASTICS

The name of the inventor: Kozlyuk Anatoly Stepanovich
The name of the patent holder: Kozlyuk Anatoly Stepanovich
Address for correspondence:
The effective date of the patent: 1992.08.26

The invention relates to the field of medicine and can be used in the surgical treatment of diseases of the middle ear and mastoid process. The purpose of the invention is to increase the efficiency of engraftment of plastic material. It is proposed to use as an plastic material for mastoidoplasty an autologous bone marrow-rich spongy bone treated with a suspension of activated "in vitro" autologous lymphocytes. Application of the proposed method allows to achieve effective engraftment of the autograft and rapid healing of the surgical wound.

DESCRIPTION OF THE INVENTION

The invention relates to the field of medicine, and in particular to methods of mastoidoplasty. There are well-known methods of mastoidoplasty (Tarasov DI Fedorova OKK Bykova VP Diseases of the middle ear, M. Medicine, 1988. pp. 153-180), in which the plastic material is used for muscle and periosteal flaps, fascia , Bone shavings, canned auto- and allogeneic cartilage, xenocarp, polymeric synthetic materials, ceramics, etc.

The most applicable at present are plates from the cartilage of the nasal septum (auto- or allogeneic), costal cartilage, xenocardia and canned allogeneic bone, and a combination of autosteal plate with autochondria and fascia.

Disadvantages of these methods of mastoidoplasty is that the graft transplanted to reduce the trepanation cavity does not always effectively survive, as soft tissue materials often wrinkle and thin, forming large cavities, foreign tissue is rejected because of incompatibility, often occurs infection followed by purulent decomposition of plastic material, and chemical Substances used to preserve the graft (formalin, etc.), can have toxic effects on surrounding tissues.

The proposed method for the technical essence is closest to the described types of mastoidoplasty.

The purpose of the invention is to increase the efficiency of engraftment of plastic material.

The goal is achieved thanks to the found opportunity to use as an plastic material an autologous spongy bone rich in bone marrow, together with a suspension of in vitro activated autologous lymphocytes and products of their vital activity.

The proposed method increases the efficiency of engraftment of plastic material, contributes to the rapid healing of the surgical wound.

To carry out the proposed method, the day before the operation, autologous lymphocytes are isolated, for which the patient is taken from the vein 10 ml of blood into a sterile test tube with heparin (25 units per 1 ml of blood). Then, mononuclear cells are isolated in the density gradient of ficollveregraine (density of the solution is 1.077 g / cm 3 ). After isolation and washing with Hanks solution, the cells are resuspended in Eagle's medium and adjusted to a concentration of 5 × 10 6 cells / ml with a culture medium containing 10% autologous serum.

At the second stage, cells are cultured with zinc glycinate. For every 4 ml of the culture medium with mononuclears (concentration 2 million / ml) 0.1 ml of zinc glycinate (containing 5 μg of zinc) is added. After 12-16 hours of incubation of cells in a thermostat (37 ° C), lymphocytes under the influence of zinc glycinate are activated, becoming larger (the stage of preprophase). The cells are then pelleted by centrifugation, and the supernatant is placed in a sterile vial. The precipitates are adjusted with Eagle's medium to a cell concentration of 5 million / ml and zinc glycinate is added at a rate of 1 μg zinc per milliliter. Activated cells and a supernatant containing (interleukins and interferon) secreted by lymphocytes in the blast-transformation reaction are used in mastoidoplasty.

During the operation, the patient after a local anesthetic of the soft tissues of the behind-the-ear region, 1% solution of novocaine, cuts the tail fold to the bone. Then, the temporal bone is cut off in the area of ​​planum mastoidea and trepanation of the bone in the antrum projection area, opening the antrum and removing the pathologically altered tissue, pus and granulations. After this, aditusad antrum expands. Trepanation cavity and middle ear are washed with saline. Then go to the fence of the plastic material. In the anterior-superior crest of the iliac bone, 1% solution of novocaine is anesthetized with soft tissues, followed by a cut of the skin, subcutaneous tissue (4-5 cm), bone separation in the anterior-superior crest area, a chisel splintered 1-2 mm 3 and take spongy bone tissue. The wound is sutured layer by piece tightly. In the wound for a day left polymer drainage (prevention of hematoma). The resulting autologous bone marrow-rich autograft is chopped into small fragments, which are irrigated with a suspension of activated autologous lymphocytes, after which they are used to fill the trepanation cavity. Then the wound is layer-by-layer closed tightly, and 1.0 ml of a suspension containing activated autologous lymphocytes is injected subcutaneously into the BTE area. In the external ear canal, a turunda moistened with a supernatant containing mediators of immunocompetent cells (interleukins, interferon) is injected.

The suitability of the method is based on the results obtained, indicating that the proposed variant of mastoidoplasty promotes effective engraftment of the graft and rapid healing of the surgical wound.

Example. Patient Michalaki T.K. 15 years old, was admitted to the ENT department of the 4th City Clinical Hospital in the city of Chisinau 7 / V 1992 with the diagnosis "Exacerbation of right-sided chronic purulent mesotympanitis". He suffers from a middle ear disease since childhood. Periodically, conservative treatment was conducted. Given the frequent exacerbations of the disease, the ineffectiveness of conservative treatment, on 12.05.1992, an operation "Antromastoidotomy with a mastoid autologous spongy bone with bone marrow treated with a suspension of autologous activated lymphocytes" was performed. The operation was carried out as described above. In the pre- and postoperative period, the introduction of a suspension of activated autologous lymphocytes into the BTE area was used, and in the postoperative period of the turunda moistened with a supernatant containing mediators of immunocompetent cells.

The postoperative period proceeded smoothly. Wounds healed with primary tension. In addition to vitamin therapy, the patient did not receive any additional treatment. On the 11th day after the operation, the patient was discharged home in a satisfactory condition.

According to the proposed method, another 5 patients with the same result shown in the example were operated.

Thus, the proposed method of mastoidoplasty leads to an effective engraftment of the graft and rapid healing of the postoperative wound.

CLAIM

A method of mastoidoplasty by closing the trepanation cavity with an ileal graft, characterized in that the trepanation cavity is filled with a graft from the iliac crest that is irrigated with a suspension of activated autologous lymphocytes, then the wound is layer-by-layer closed tightly, and 1 ml of the same suspension is injected subcutaneously into the BTE The external auditory meatus is injected with a turunda moistened with a supernatant containing mediators of immunocompetent cells.

print version
Date of publication 06.01.2007gg