Результаты исследования клинико-морфологических особенностей послеоперационных перфораций перегородки носа

Abstract

The literature provides many ways to close perforations of the nasal septum (NS), there is no differential approach to the choice of technique depending on the etiological factor. Objective: to study the clinical and morphological features of tissues at the edges of postoperative nasal septum perforations (PNSP) to substantiate the choice of the optimal surgical technique. Materials and methods. 52 patients are divided into 3 groups in accordance with the area (S) of PNSP: 1st S < 1 cm2 (10%); 2nd S 1–2 cm2 (75%), 3rd S > 2 cm2 (15%). In group 2, the subgroups are: 2A – PNSP without curvature of the NS (CNS) (52%); 2B – PNSP with CNS (48%). The state of the mucous membrane (MM) and supporting tissues at the edges of the PNSP, the results of a cytological study from the edges of the PNSP, and specific complaints of the patients were evaluated. Results: In group 1 and 2 at the edges of the PNSP, there was a significant decrease in tissue elasticity compared with group 3, indicating a deficit in supporting tissues (p < 0.05). The ratio of the area of the defect of supporting tissues and PNSP in group 1 was 1 to 3.5, in group 2 – 1 to 1.5, in group 3 – 1 to 1.1. A high degree of elasticity of the posterior edge of PNSP is accompanied by pronounced clinical manifestations, regardless of the size of PNSP, and is confirmed by the cytological picture of inflammation (p <0.01). The presence of CNS enhances the clinical manifestations of PNSPI (p < 0.05). Conclusion: the structure of the edges of PNSP forms the clinical picture of the disease. When choosing a closure method for PNSP, the surgeon must solve the following problems: the size of the NS defect required for replacement is determined not so much by the dimensions of the PNSP as the area of the defect in the supporting tissues of the NS; with a deficit of local tissues, it is advisable to additionally use grafts; MM in the area of the posterior and lower edges has pronounced signs of inflammation, these tissues should be removed during the operation.