Новый метод хирургического лечения пациентов с врожденной аплазией окна преддверия

Abstract

Aplasia of the oval window is an extremely rare developmental anomaly of the middle ear. Previously, many authors proposed various methods of surgical treatment of this pathology, but in most cases it was not possible to achieve a stable satisfactory functional result. At this stage, an idea was formed about the main reason for the unsatisfactory results, namely, the overgrowth of the formed vestibulostomy, which is accompanied by fixation of the prosthesis. The solution of this problem is one of the priority tasks of surgery for malformations of the middle ear at this stage. This paper presents a new developed and patented method of surgical treatment of patients with congenital aplasia of the vestibule window. The method consists in modeling a complex titanium prosthesis, consisting of an f-element and an m-element. The f-element is installed in the neo-oval window and has the function of a protector that prevents fixation of the prosthesis as a result of bone-cicatricial obliteration processes. Further, the plunger part of the f-element is installed in the m-element. The developed method of stapes prosthetics in case of anomalies in the development of the vestibule window, based on the results of this study, has proven its high efficiency. Installation of a modified endo-lymphatic shunt into the formed neo-oval window, pressing the fascial flap previously placed on the neo-oval window, followed by the insertion of the K-piston prosthesis, prevents overgrowing of the neo-oval window in the postoperative period, prevents the development of fixation of the prosthesis and prevents the development of perilymphatic fistula. A comparative assessment of the effectiveness of the proposed method and method with the formation of a neo-oval window and the installation of a stapedial prosthesis (as in piston stapedoplasty) was carried out. The effectiveness of the developed method has been proven – 89% of the functional efficiency in the long-term postoperative period, which is close to the indicators of the effectiveness of piston stapedoplasty in otosclerosis (the frequency of a stable satisfactory functional result when performing piston stapedoplasty in otosclerosis is about 95%).