RU2591546C1 - Method of treating contact laryngeal granuloma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and surgery. Removing contact granuloma larynx with guttural Cordes forceps. Introducing in both surface layers of vocal cords at a depth of 2 mm biopolymer "Kolost" in amount of up to 0.3 ml in each fold. Operation is performed under local anaesthesia with indirect microlaryngoscopy. During manipulation subjective control of voice is carried out.

EFFECT: method enables to recover voice in treating contact granuloma of larynx and reduces probability of recurrences in given pathology.

1 cl, 2 ex, 4 dwg

Description

The invention relates to medicine, in particular to otorhinolaryngology, and can be used to restore voice quality and reduce the number of relapses of contact granulomas of the larynx.

Currently, in otorhinolaryngology, various methods of treating patients with contact granulomas of the larynx are known and widely used. So, the most common surgical methods for removing contact granulomas of the larynx using both a cold instrument and various types of lasers. But despite the proposed large number of methods, the recurrence rate of contact laryngeal granulomas remains high.

Given the above, there is a need to develop a method that would significantly reduce the recurrence rate of contact granulomas due to the effect on the mechanism of their formation.

Closest to our proposed method is the "method of treatment of benign neoplasms of the larynx" proposed by D. Mustafayev et al., in which the authors use the radiation of a YAG-holmium laser to remove neoplasms greater than 2 mm. In this case, access to the laryngeal cavity is carried out with direct support laryngoscopy. Pre-created zone of tension of the underlying mucous membrane by delaying the neoplasm by clamping. Then the end of the fiber is introduced into the submucosal layer to a depth of 1-5 mm under the base of the neoplasm. The end face is moved along the base and 5-7 pulses of laser radiation are sent so that the wound from each subsequent pulse matches the wound from the previous pulse. Neoplasms of less than 2 mm are contacted by a KTP laser with 1-8 pulses. Coagulation of the bases of the neoplasms and their residues is carried out by a defocused beam of a KTP laser, which is installed above the neoplasm surface at a distance of 1-2 mm. The method is carried out with direct support laryngoscopy using high-frequency jet artificial lung ventilation through a double-lumen catheter.

This method is published in the article "Endolaryngeal laser microsurgery of benign neoplasms of the larynx and an objective assessment of its functional results" D.M. Mustafaev, Z.M. Ashurov, V.G. Zenger, E.V. Osipenko, V.V. Massarygin, O.O. Kopchenko - J. Herald of Otorhinolaryngology. - M., 2008, No. 5, p. 14-17.

The disadvantages of this method are:

1. Surgical access for endolaryngeal intervention, which causes the patient to be anesthetized, which in turn increases the risk of complications.

2. The inability to control voice quality during the intervention due to the fact that the intervention is carried out under general anesthesia.

3. The lack of impact on the main factor in the formation of contact granulomas, namely the excessive collision of the arytenoid cartilage, which leads to the development of relapses.

To eliminate these shortcomings, we propose a method we developed for the treatment of contact laryngeal granulomas, which includes the simultaneous removal of the contact larynx granuloma and introducing into the surface layers of both vocal folds a 2 mm absorbable Kollost biopolymer in a volume of up to 0.3 ml in each voice fold with indirect microlaryngoscopy using a laryngeal mirror and a microscope. In this case, the patient is conscious and the method is performed under local anesthesia, which makes it possible to control the quality of the voice in the process of manipulation.

The technical result of the proposed method is that there is not only the removal of the contact granuloma of the larynx, but also the prevention of trauma to the operated area by increasing the horizontal size of the vocal folds. This leads to an improvement in the closure of the vocal folds and a decrease in the trauma of the arytenoid cartilage on which the granuloma is formed, as well as ensuring complete tissue regeneration at the site of the removed granuloma, which in turn reduces the likelihood of relapse. This reduces the risk of complications due to the lack of the need for the patient to be anesthetized.

The method is as follows.

The patient is conscious in a sitting position in the operating chair. After local application anesthesia with a 10% lidocaine solution, the posterior wall of the larynx is visualized using a laryngeal mirror and an operating microscope (indirect microlaryngoscopy). In case of indirect microlaryngoscopy, a larynx cutter of Cordes is introduced into the laryngeal cavity and the laryngeal contact granuloma is removed. Then, a Brunnings syringe with Kollost gel is injected into the lumen of the larynx and gel is injected into the surface layers of both vocal folds to a depth of 2 mm in a volume of up to 0.3 ml per fold, achieving an increase in the horizontal size of the vocal folds while maintaining voice quality, for which the patient asking to utter various words and singing sounds.

On average, the volume of the introduced gel is up to 0.3 ml, which is determined by us on the basis of experimental studies.

The method is illustrated by the following examples.

Example 1

Patient B., aged 40, was admitted to the hospital with complaints of hoarseness, a sensation of a foreign body in the throat, pain when swallowing with radiation to the left ear. He underwent 3 surgical interventions for contact granuloma of the larynx, the last of which took place 1 month ago under anesthesia.

When examining the larynx:

the entrance to the larynx is free, the vestibular folds are pink, moist. The vocal folds are white, symmetrical, shiny. When breathing, the gap is up to 15 mm, during phonation there is an incomplete closure of the vocal folds in the middle and back sections, signs of a decreased tone of the vocal folds. On the vocal process of the left arytenoid cartilage there is a contact granuloma that prevents the complete closure of the vocal folds (Fig. 1). The lining of the larynx is free.

The patient was diagnosed with contact granuloma of the larynx on the left, relapse.

The operation was performed - removal of the contact larynx granuloma, the introduction of the Kollost biogel into both vocal folds under local anesthesia with indirect microlaryngoscopy using a Brunnings laryngeal syringe.

When examining the larynx after 6 months:

the entrance to the larynx is free, the vestibular folds are pink, moist. The vocal folds are white, shiny, symmetrical. Glottis during breathing up to 15 mm, with phonation complete closure of the vocal folds. The lining of the larynx is free (Fig. 2).

The patient notes the absence of relapse, improved voice quality, the absence of complaints of a foreign body sensation in the throat.

Example 2

A 35-year-old patient R. was admitted to the hospital with complaints of hoarseness, sore throat with radiation to the left ear. The patient underwent 2 operations for contact granuloma of the larynx, the last 2 months ago under anesthesia.

When examining the larynx:

the entrance to the larynx is free, the vestibular folds are pink, moist. The vocal folds are white, symmetrical, shiny. When breathing, the gap is up to 13 mm, with phonation there is an incomplete closure of the vocal folds in the posterior sections. On the vocal process of the left arytenoid cartilage there is a contact granuloma that prevents the complete closure of the vocal folds (Fig. 3). The lining of the larynx is free.

The patient was diagnosed with contact granuloma of the larynx, relapse.

The operation was performed - removal of the contact granuloma of the larynx, the introduction of the Kollost biogel in a volume of 0.3 ml into each vocal fold under local anesthesia with indirect microlaryngoscopy using a Brunnings laryngeal syringe.

When examining the larynx after 6 months:

the entrance to the larynx is free, the vestibular folds are pink, moist. The vocal folds are white, shiny, symmetrical. Glottis during breathing up to 13 mm, with phonation complete closure of vocal folds. The mucous membrane of the arytenoid cartilage without pathological changes. The lining of the larynx is free (Fig. 4).

The patient notes an improvement in voice quality, the absence of relapse within 6 months.

Claims (1)

A method for treating laryngeal contact granulomas, including removal of the larynx contact granuloma, characterized in that the operation is performed under local anesthesia and after the granuloma is removed, the absorbable “Kollost” biopolymer is introduced into the surface layers of 2 mm to a depth of 2 mm in a volume of up to 0.3 ml each vocal fold, subjective voice quality control.

Images