Возникновение ретракционного кармана тимпанальной мембраны (барабанной перепонки) влечет за собой нарушение звуковой проводимости среднего уха. Хирургическое удаление фиксированных ретракционных карманов приводит к появлению перфораций, на место которых устанавливается хрящевой трансплантат. Целью работы являлось определение геометрических параметров хрящевого трансплантата, обеспечивающих звуковую проводимость колебательной системы среднего уха, соответствующую слуховым функциям среднего уха в норме. Определение геометрических параметров трансплантата осуществлялось на основании соответствующей конечно-элементной модели. В качестве величин, характеризующих слуховую проводимость колебательной системы среднего уха, рассматривались собственные частоты свободных колебаний. На основании сравнительного анализа спектров собственных частот свободных колебаний среднего уха в норме и среднего уха с хрящевыми трансплантатами различной толщины установлено, что толщина трансплантата, накладываемого на задневерхний квадрант после удаления фиксированного ретракционного кармана, составляет 0,193 ± 0,031 мм. Полученные результаты могут быть использованы при планировании хирургических операций по восстановлению целостности барабанной перепонки и улучшению слуховой проводимости.
Relevance: The problem of graft choosing to close the eardrum defect in chronic purulent otitis media remains relevant today. In the literature there are few scientific studies that examine the graft nutrition mechanisms.
The purpose of this study was to study water flow features in the free lying fragmented cartilage graft used by us in myringoplasty.
Materials and methods: The mass of fragmented cartilage autotransplants prepared for tympanoplasty, having the same area, was measured using electronic scales before immersing them in a physiological solution and after immersion. An increase of the transplant mass wasafter wetting it in a physiological solution. Morphological and immunohistochemical studies were carried out in 30 cases grouped into three groups: native cartilage, crushed (fragmented) cartilage and crushed cartilage hydrated by physiological solution. The histological material was 90 tissue samples. The histological preparations were made from all the pieces to assess the morphological characteristics of the cartilage. An immunohistochemical study was also conducted with antibodies to aquaporins (AQP 1, AQP 3 and AQP 8) to identify the localization of endogenous water channels in the auricle cartilage and to identify the role and transport function of aquaporins.
Results: It is proved that the nutrition of loosely lying fragmented cartilage improves due to the capillary effect after crushing it, the adsorption of fluid by cartilage tissue increases due to the activation of aquaporins. For the first time, the localization of aquaporin AQP8 in the auricle cartilage was determined.
Relevance: It is noted that the condition of the skin, the external auditory canal bone, the eardrum residues, that is, the tissues, from which the graft must first receive nutrition, largely determine the myringoplasty result.
Purpose: to assess the regenerative ability of the external auditory canal and tympanic membrane tissues in patients with chronic otitis media.
Materials and Methods: The migration ability of the external auditory canal and tympanic membrane tissues study was carried out in 98 patients with acute tympanic membrane perforation using a tissue staining test. In patients with chronic otitis media the staining test was performed before the operation. The external auditory canal skin in the bone part and the tympanic membrane residues were taken in patients of all groups in myringoplasty for immunohistochemistry.
The quantitative assessment of the biomolecular markers expression was performed by the digital image analyzing. It was obtained by a Leica DMLS microscope with software (Germany) and a JVC digital camera (the magnification of 200 times and a minimum number of view fields 5 in each microslide) using «positive pixel count» and morphometry software Aperio Image Scope.
Results: It was noted that in cases where the perforation was not closed, the migration ability of the tissues was impaired. A correlation was established between the regenerative ability of the epithelium by determining tissue biomarkers and migration ability. A high EGF level indicates a good regenerative ability and a positive test with staining. A low EGF level is noted in a negative test with staining. The state of the migratory ability of the external auditory canal epithelium and the tympanic membrane epithelium may indirectly indicate the regenerative ability of tissues and affect the tympanoplasty result. The staining test can serve as a prognostic criterion for the myringoplasty result, because it evaluates the regenerative ability state of the external auditory canal epithelium and eardrum epithelium.
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