The authors studied the age-related features of the vascular organization of the adenoid tissue. A total of 46 subjects (n=46) were examined; they were divided into two groups one of which included subjects at the age from 7 to 12 years (n=25) whereas the other group was comprised of 21 subjects at the age from 18 to 42 years (n=21). 29 participants of the study were men (63%) and 17 (37%) women. The histological examination of the adenoid tissue revealed the characteristic changes in the adenoid vasculature in the subjects of either age-group. The subjects above 18 years of age were shown to have developed sclerosis and hyalinosis of the vascular walls with the formation of cavernously dilated plethoric veins having the thickened rigid walls. The morphological changes in the connective tissue (basal) layer were documented responsible for the manifestation of the phenomenon of 'immersion' of the lymphoid tissue with the well developed microcirculatory bed. It is concluded that the results of the histological examination can serve as one of the indicators for the use of electrophysical methods to perform adenotomy in the patients older than 18 years.
The objective of this review is to summarize and systematize the data concerning the modern laser and laser-based systems, their characteristics, and possible applications in various spheres of medicine including otorhinolaryngology. The application of laser technologies in medical practice gains ever increasing popularity. Lasers have been successfully used during a long period for the diagnostic and therapeutic purposes. At present, they are just as actively applied in different fields of the surgical practice. Otorhinolaryngology makes the most extensive use of neodymium, CO2, and holmium lasers. The latter has the most universal characteristics and is operated in a relatively short wavelength range (λ=2.01 mcm); moreover, its radiation penetrates as deep as 0.4 mm into the biological tissues. In other words, the holmium laser not only combines the advantages of the CO2 and neodymium lasers but is also devoid of their shortcomings. The holmium laser is considered to be the most promising source of laser radiation for the application in otorhinolaryngological surgery with a potential encompassing the most wide spectrum of surgical manipulations needed to treat pathological changes in the ears, nose, and throat. The application of this instrument in medical practice opens up new prospects for the development of otorhinolaryngology.
The objective of the present work was to study syntopy of the large neck vessels in relation to the capsule of palatine tonsils with the use of the MRI technology. A total of 109 patients (218 palatine tonsils) presenting with chronic tonsillitis were available for the examination including 64 women and 45 men at the age varying from 15 to 54 years. All of them underwent MRI-guided vascular visualization in the paratonsillar region together with the measurements of the vessels extending to the capsule of the palatine tonsils at the level of the upper and lower poles, and also close to the mid-third of each palatine tonsil. The distance from the external carotid artery to the upper and lower poles of the palatine tonsils was found to be 17.1±1.01 mm and 10.3±0.18 mm respectively and in the mid-third the palatine tonsil 10.7±0.12 mm; the distance from the internal carotid artery to the upper and low poles of the palatine tonsil amounted to 14.5±0.84 mm and 16.8±0.77 mm respectively while that to the mid-third of the palatine tonsil was 15.3±0.07 mm. The branches of the external carotid artery feeding the palatine tonsils are the most frequent sources of bleedings; the following measurements were obtained: the maxillary artery 16.4±0.43 mm (17.4%) - the upper pole 9.6±0.02 mm (46.2%), the mid-third of the palatine tonsil 18.5±0.74 mm (29.5%) - the lower pole; the lingual artery 4.7±0.02 mm (6.8%) - the mid-third of the palatine tonsil, 6.2±0.82 mm (56.8%) - the lower pole; facial artery: 4.2±0.01 mm (0.76%) - the mid-third of the palatine tonsil; the occipital artery 25.6±0.12 mm (19%) - the upper pole; 14.8±0.11 mm (18.9%) - the mid-third of the palatine tonsil 9.56±0.12 mm (3.8%) - the lower pole; the tonsillar artery 1.88±0.01 mm (9.8%) - the upper pole; 2.51±0.01 mm (23%) - the mid-third of the palatine tonsil; 2.12±0.01 mm (11%) - the lower pole. The distance from the internal jugular vein to the capsule of the palatine tonsils in the region of the upper pole of the palatine tonsil was 28.3±1.01 mm, in the lower pole region 26.6±1.54 mm, and in the region of the mid-third of the palatine tonsil 22.7±1.24 mm. It is concluded that the results of the present study may be useful for the planning of the surgical strategy for the treatment of the patients presenting with chronic tonsillitis and for the prevention of hemorrhagic complications of tonsillectomy.
научно-исследовательский клинический институт оториноларингологии им. Л.И. Свержевского» департамента здравоохранения москвы, москва, россия; 2 ГБоУ впо «российский национальный исследовательский медицинский университет им. н.И. пирогова» минздрава россии, москва, россия Цель-изучить распространенность хронического кистозного верхнечелюстного синусита и частоту применяемых хирургических доступов к пораженной пазухе при лечении данной патологии. Материал и методы. проанализирован архивный материал, включающий 12 094 истории болезни пациентов, проходивших хирургическое лечение в пяти крупных Лор-клиниках москвы в течение 2014 г. Результаты. Установлено, что за год было проведено 659 хирургических вмешательств по удалению кисты верхнечелюстной пазухи, что составляет 34,1% от общего числа операций по поводу хронического верхнечелюстного синусита и 4,1% от общего числа хирургических вмешательств на Лор-органах. применялись следующие хирургические доступы: эндоназальный (через средний носовой ход)-в 188 (28,5%) наблюдениях, экстраназальный (через переднюю стенку пазухи)-у 454 (68,9%) пациентов, комбинированный-в 17 (2,6%) случаях. Вывод. отмечена целесообразность разработки рекомендаций по выбору оптимального хирургического доступа при кистах верхнечелюстной пазухи. Ключевые слова: киста верхнечелюстной пазухи, хронический гайморит, медицинский стандарт лечения.
The article provides the study of anatomomorphological features of ostiomeatal complex structures condition based on complex examination of 102 patients with chronic cyst sinusitis. The vector analysis of paranasal sinuses СT with the measurement of the ethmoidal infundibulum gleam and diameter of natural anastomosis of the maxillary sinus is made, and histologic research of a mucous membrane of ostiomeatal complex structures is provided. As a result of the research it was determined that the damage of mucous membrane in the area of ethmoidal infundibulum and the natural anastomosis of the maxillary sinus had chronic nature with sclerosis of the genuine plate of mucous membrane and, quite often, hyperplasia and hypersecretion of mucous glands. The gleam of the complex system of the sinus communication with the nasal cavity remains over the whole perios constituting 1.31±0.03 mm – in the area of ethmoidal infundibulum, and 2.09±0.02 mm – in thearea of natural anastomosis of the maxillary sinus (p < 0.01).
The authors carried out a detailed analysis of various methods of physical exposure to tissues during surgical treatment of patients with chronic tonsillitis. Removal of palatal tonsils in their chronic inflammation has been carried out since ancient times. Today modern medical technologies allow performing this intervention using various technologies, whether – classic „cold“ tools or one of the variants of „hot“ methods of tonsillectomy. In the article, the authors analyzed the advantages and disadvantages of semi-surgical treatments for chronic tonsillitis, when most of the palatal tonsil remains intact, and also compared the effectiveness of possible surgical methods of radical tonsillectomy: using an electrocoagulator, harmonic or ultrasonic scalpel, surgical laser or cold plasma; frequency of intra- and postoperative hemorrhagic complications is estimated.
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