Step by step by Dr. Irina Arechvo
In this video of the SurgSchool surgical training app, we delve into a specialized otologic surgery, presented by the Dr. Irina Arechvo, President of the Lithuanian Society of Otolaryngology. This is an endoscopic myringoplasty, a key intervention in the treatment of tympanic perforation, aggravated by a common condition: tympanosclerosis. This procedure is performed to repair the eardrum and improve hearing, offering a detailed insight into how to manage associated complications.
Clinical case: Tympanic perforation with tympanosclerosis
The patient presents a marginal inferior tympanic perforation with clear signs of tympanosclerosis, a condition where calcified scar tissue forms on the eardrum. Dr. Arechvo addresses this complexity step by step, ensuring optimal restoration of the tympanic membrane.
Procedure Details
- Infiltration of the duct: The surgery begins with infiltration of the external auditory canal, which causes a skin whitening which facilitates the intervention. The edges of the perforation are then revive to optimize tissue regeneration.
- Tympanomeatal flap: Two strategic incisions are made at six o'clock on the eardrum, connected with a Rosen scalpel. Subsequently, with the help of cotton and an aspirator, the eardrum is carefully elevated. tympanomeatal flap.
- Lifting of the annulus: During the lifting of the annulus, the dissection of the tympanic membrane is carried out from the short process of malleusThis stage is crucial to ensure clear vision and adequate access to the tympanosclerosis plaque.
- Resection of tympanosclerosis: In this case, a plaque of anterior tympanosclerosis is evident adhered to the handle of the malleus. Using delicate techniques, Dr. Arechvo removes this plaque, using microscissors to release adhesions and ensure the mobility of the ossicular chain.
- Use of grafts: Once the plaque is removed, the tympanic cavity is Fill with gelfoamFor reconstruction, chips are used tragal cartilage in the medial areas and tympanic remnants, complemented with perichondrium at the back, ensuring complete closure of the piercing.
- End of procedure: After completing the repositioning of the flaps, the procedure is carried out duct filling, which concludes the intervention with a high degree of success.
Results and Final Considerations
This procedure stands out for its precision and for Dr. Arechvo's experience in the management of tympanosclerosis, ensuring that the patient has good postoperative hearing function. endoscopic myringoplasty It allows excellent visualization of the surgical field and efficient repair of eardrum perforations, even in cases complicated by the presence of tympanosclerosis.