From Big Medical Encyclopedia

MYRINGOPLASTY (grech, myrinx skin, a tympanic membrane distorted by meninx a cover, a membrane + plastike sculpture, plastics) — recovery of an integrity of the tympanic membrane broken owing to inflammatory process on average to fish soup or injuries or plastic addition of its layers at the expressed atrophy. In one cases of M. carry out as independent operation, in others — as one of stages tympanoplasties (see).

Indication to M. as to independent operation permanent disturbance of an integrity of a tympanic membrane is (perforation) at the kept and functioning chain of acoustical stones, satisfactory function of the sound perceiving system. Necessary conditions — lack of carious process in tympanic cavities and allocations from an ear at least within 6 months; absence patol, changes in a nose, subordinate clauses (okolonosovy, T.) bosoms and nasopharynx; full function eustachian (acoustical, T.) pipes. The so-called prosthetic test is of great importance for the solution of a question of M.'s expediency: the flattened lump of cotton wool impregnated with any liquid oil, a piece of paper, a pellicle or the special artificial tympanic membrane is stacked on defect of a tympanic membrane; improvement of hearing after introduction of such prosthesis testifies to M. S expediency the same purpose use the so-called sound probe: if at its placement on a short shoot of a hammer hearing improves, then operation is reasonable.

Anesthesia — usually local infiltration anesthesia with use of premedication. More rare, at children and nek-ry adults, apply an anesthesia. Operation is made under control operative microscope (see) by means of tools from set for a tympanoplasty.

As a rule, use endauralny approach to a tympanic membrane. If this or that site of outside acoustical pass interferes with an opportunity to well see perforation, then the corresponding part of its wall is thinned by means of borons or mills. At very narrow and twisting outside acoustical pass of M. carry out using a zaushny section of soft tissues.

For closing of perforation of a tympanic membrane use various fabrics — skin (outside acoustical pass, zaushny area or other sites), a mucous membrane (lips), a wall of a vein from a dorsum of a brush, a fascia (e.g., a temporal muscle), a tinned firm meninx, a periosteum, etc. More and more allotransplant of a tympanic membrane is widely adopted. Apply free transplants more often, create them on the feeding leg less often.

Technique preparation of a bed for a transplant depends on on what surface of a fibrous (fibrous) layer stack a transplant. If it is stacked on an outer surface, around perforation delete a strip of epidermis 2 mm wide. Stack a transplant on a naked surface so that it reliably closed perforation, but did not cover epidermis anywhere. Sometimes edges of a connective tissue transplant enter between a fibrous layer and previously otseparovanny epidermis. The transplant is fixed the resolving sponge, a piece of foam rubber or a gauze tampon.

At regional perforation of a tympanic membrane exempt not only a fibrous and cartilaginous ring, but also adjacent departments of outside acoustical pass throughout about 3 mm then stack a transplant on a wound surface from epidermis.

Fig. 1. Myringoplasty with introduction of a fascial rag between fibrous and epidermal layers of a tympanic membrane: 1 — a tympanic membrane; 2 — the dashed line designating border of amotio of epidermis from a fibrous layer of a tympanic membrane and introduction between them a fascial rag; 3 — the fascial rag closing perforation; 4 — the resolving sponge entered into a drum cavity; 5 — edge of perforation of a tympanic membrane after amotio of epidermis; 6 — the handle of a hammer.

Nek-ry specialists consider that the transplant should be stacked on a medial surface of a fibrous layer of a tympanic membrane. For this purpose after excision of reinforced edges of perforation the tympanic membrane is partially allocated from a drum ring. Otseparovyvat a mucous membrane from a fibrous layer, fill a drum cavity with the resolving sponge and between the specified layers enter edges of a connective tissue transplant (fig. 1). At big perforation sometimes create a two-layer rag: after laying of a connective tissue transplant its outer surface is covered with a skin rag.

Fig. 2. A myringoplasty of a loose part of a tympanic membrane a rag on the feeding leg from skin of outside acoustical pass: 1 — the piece of leather of acoustical pass on the feeding leg closing perforation, 2 — the tense part of a tympanic membrane, 3 — the place of an attachment of the handle of a hammer, 4 — a short shoot of a hammer.

The rag on the feeding leg is used for closing of regional perforation of a tympanic membrane more often. It is created of skin of outside acoustical pass and moved so that it, closing perforation, densely adjoined a side to a side to its excised edges (fig. 2).

At all options M. it is extremely important to delete even the most fine particles of epidermis from an inner surface of a tympanic membrane to avoid formation of secondary cholesteatomas (see) and also rubtsovo the changed edges of perforation.

Within several days after M. sick prohibit to blow nose. In the subsequent make ear inflation (I eat.) and a pneumomassage of a tympanic membrane (see. Pneumomassage ).

Bibliography: Vulstein X. L. Slukhouluchshayushchiye of operation, a per, with it., M., 1972; Potapov I. I., 3 e r about Sunday to and I am N. V. and V. O. Timpano-plastik's Guelder-rose, M., 1963, bibliogr.: P r with about the blvd. and e of N with to and y Yu. B. Timpanoplas / the geek, M., 1973, bibliogr.; Hechinashv and - l and Page II. Questions of the theory and practice slukhovosstanovitelny hir urgiya, T biliyen, 1963.

Yu. B. Preobrazhensky.