Ultrasonic septocorrection of traumatic deformities of the nasal septum in the acute period

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Ultrasonic septocorrection of traumatic deformities of the nasal septum in the acute period

Traumatic deformity of the back and septum of the nose is a frequent result of domestic, sports, and traffic accidents today. Deformation of the nasal septum entails an impaired function of nasal breathing. The nose is an important anatomical formation of the face, the correct ratio of the anatomical structures of the nose, the main condition for free nasal breathing. The normal functioning of the nose is one of the basic conditions for the physical and mental development of a person. Dysfunction of the nose negatively affects the activity of vital organs and functions. The tactics of managing patients with acute trauma to the nose and nasal septum are still controversial.

Among patients with nasal dorsum injuries, we paid special attention to the condition of the nasal septum. During rhinoscopic and endoscopic examinations, we found signs of a fracture and deformation of the nasal septum: ruptures of the mucous membrane, submucosal hemorrhages, pathological mobility, pronounced curvature of the cartilaginous and bone sections of the nasal septum. It was the fracture of the nasal septum that was leading to the development of persistent difficulty in nasal breathing.

Deformation of the bones of the nasal dorsum and the nasal septum (deviated nasal septum) is often the result of domestic, sports, and road traffic injuries.

Elimination of deformities of the nasal septum is almost impossible with the routine finger-instrumental reduction of the nasal bones. We perform surgical intervention: ultrasonic septocorrection in the acute period, aimed at previously restoring impaired respiratory function, preventing the development of post-traumatic scars and synechia. Sparing surgical treatment of deformities of the nasal septum with obstruction of nasal breathing has been developed.

As a result, nasal breathing is restored when the nasal septum is aligned with the device for low-frequency ultrasonic septocorrection. Under endotracheal anesthesia, infiltration anesthesia of the nasal mucosa (1% solution of lidocaine 5 ml) is performed in the premaxil area and along the nasal septum on both sides. On the left, hemitransfication incision is performed with a scalpel, the dissection of the mucoperichondria of the quadrangular cartilage is performed on both sides, the zones of pronounced cartilaginous and bone deformation of the nasal septum are exposed. The branches of the device are inserted into the mucoperichondrial tunnels into the cartilaginous and bony deformation zones. A fundamentally new approach to straightening the nasal septum during its deformation is proposed - low-frequency ultrasonic septocorrection. Through the choke, low-frequency ultrasonic vibrations are transmitted to the working branches and the deformed section of the septum, in which, under the influence of these vibrations, the tissue is dispersed, after which it lends itself to soft physiological straightening.

Applied instrumentation for endoscopic operations in the treatment of diseases of the nasal cavity and its paranasal sinuses from Karl Storz.

Correction of the nasal septum with this device is convenient for the patient, painless, does not cause atrophic and cicatricial changes in the mucous membrane.

The septocorrection with low-frequency ultrasonic vibrations flattens the nasal septum without complications. Nasal breathing is restored completely immediately after the intervention. The device for ultrasonic compression correction straightens curved areas of the cartilaginous and bony parts of the nasal septum. After that, the sheets of the mucous membrane come together and the correct location of the septum and the degree of restoration of the lumen of the common nasal passage are monitored. Suture for incision and suture for thin silicone splints installed on both sides of the partition to prevent synechia and displacement. Further, the lumen of the general nasal passage is restored to normal to eliminate obstacles in the path of the airflow, leading to a impaired aerodynamics. Anterior oil tamponade with Levomekol for a day.

There were no complications during surgery and subsequent treatment. None of the patients developed synechiae, and nasal breathing was fully restored. The patients were discharged on average 5-7 days after the operation. According to this technique, we operated on 517 patients aged 10 to 15 years from 2009 to 2020.

The diagnostic algorithm included: clinical examination, endoscopic examination of the nasal cavity, radiography of the paranasal sinuses, clinical and laboratory examination.

The technology of minimally invasive compression ultrasonic septocorrection developed by us is the key to a stable positive clinical effect. There is considerable disagreement on the merit of today's commonly performed destructive surgical techniques. In our opinion, the most sparing, functionally justified technology is the method of choice.