[Assessment of the structural features of the hard palate in endonasal surgery]. / Otsenka anatomii tverdogo neba v khirurgii peregorodki nosa.

Data on the features of the anatomical structure of the hard palate are little described in the scientific literature, and therefore are not taken into account when planning surgical treatment. One of the intraoperative complications during intervention on the lower part of the nasal septum is perforation of the bottom of the nasal cavity, which can develop during a christotomy. This complication mainly depends on the features of the anatomical structure of the hard palate. OBJECTIVE: To study the anatomical structure of the hard palate from the point of view of rhinosurgery, using vector analysis of multispiral computed tomography (MSCT), and to establish anatomical features that should be taken into account when performing surgical interventions on the nasal septum. MATERIAL AND METHODS: 107 patients (30 men, 77 women) were examined without congenital cleft palate and surgical interventions on the structures of the nasal cavity and hard palate. All patients underwent MSCT of the nose and paranasal sinuses (PNS) followed by multiplanar image reconstruction. The key point relative to which the measurements were carried out was the posterior wall of the incisor canal from the side of the nasal cavity. The line corresponding to the bottom of the nasal cavity was chosen as the main vector. In the work, measurements of the thickness of the hard palate (THP) at the level of the palatal suture and the width of the palatal suture (WPS) were carried out. RESULTS: Statistical analysis of the obtained results showed that the THP is 1.74 mm [min 0.28; max 6.46], the WPS is 0.9 mm [min 0.2; max 2.51] (conditional norm). In 19 patients (17.8%), the THP was 0.82 mm, in 2 patients (1.9%) - 0.2 mm. In 3 patients (2.8%), the WPS was equal to 2.5 mm. CONCLUSION: Thus, the data obtained by us indicate that the surgical anatomy of the hard palate is characterized by significant variability, while in some patients the THP can be reduced by 8.8 times, and the WPS increased by 2.7 times compared to normal values. Such anatomical features of the structure of the hard palate should be taken into account when planning septoplasty, since this contingent of patients has an increased risk of developing iatrogenic perforation of the nasal floor during surgical intervention on the lower floor of the nasal septum.

[Chronic pharyngitis. Modern approaches to diagnosis and treatment]. / Khronicheskii faringit. Sovremennye podkhody k diagnostike i lecheniyu.

The relevance of the problem of chronic inflammatory diseases of the pharynx is due to the significant prevalence of this pathology. Among all forms of chronic pharyngitis, the most adverse effect on the quality of life is observed in chronic athrophic pharyngitis. According to the literature, in this category of patients there are no clear criteria for assessing the functional state and morphological picture of the mucous membrane of the posterior pharyngeal wall. Most of the described signs of atrophic pharyngitis are insufficienyly informative, which necessitates further improvement of existing and possible search for new diagnostic methods. Many of the modern methods of treatment do not provide a lasting effect due to the presence of only a local effect on the altered mucous membrane of the posterior pharyngeal wall, without taking into account the changes that are caused by a violation of trophic processes in the tissue, which necessitates the search for new effective methods of treating this disease.The review article outlines modern ideas about the methods of diagnosis and treatment of chronic pharyngitis, presents promising areas in the treatment of patients with atrophic pharyngitis. In foreign countries, the term «chronic tonsillopharyngitis¼ is most often used. Due to the existing difference in terminology, the predominant part of the material on the problem of chronic pharyngitis is presented by domestic literature sources.

[Rhinolith - diagnosis and treatment features]. / Rinolit ­ osobennosti diagnostiki i lecheniya.

Exogenous foreign bodies enter the nasal cavity through the nostrils or in some cases through the choana and usually get stuck in the lower or middle nasal meatus. An alien body that has been in the nasal cavity for a long time serves as a nucleus around which calcium and magnesium salts, organic components, are deposited from the nasal secretions, and contributes to the formation of rhinolith (nasal stone, from Greek rhino - nose, lithos - stone). Endogenous material (thick mucous secret or a blood clot drying into the crusts, desquamated epithelium, an atypically located tooth, products of cellular lysis and necrosis of the mucous membrane) can also serve as a potential nucleus for salt deposition. Narrowing of the nasal passages due to the curvature of the nasal septum, hypertrophy of the nasal conchae, violation of mucociliary transport and inflammatory changes in the mucous membrane in chronic rhinitis or rhinosinusitis can lead to a delay in the mucous discharge in the nasal cavity, pH changes, excessive saturation of the secretion with crystalloids, initiate crystallization around the nucleus and deposition of salts. This article presents the results of clinical examination and surgical treatment of a patient with rhinolith formed by prolonged inhalation of construction dust.

[Comprehensive assessment of the respiratory function of nasal packs with airway tubes]. / Kompleksnaya otsenka respiratornoi funktsii «dyshashchikh¼ vnutrinosovykh tamponov.

Intranasal packs with breathing tubes are one of the possible methods of postoperative management of patients after endonasal surgery. The role of these devices is to provide the possibility of nasal breathing of patients to facilitate the course of the postoperative period. However, the possibility of providing proper nasal breathing with these devices has not been studied. The aim of the work is to study the calculated and clinical possibilities of nasal breathing when using intranasal packs with breathing tubes after endonasal surgical interventions. MATERIAL AND METHODS: We studied packs with air tubes from two manufacturers: Medtronic and Spiggle & Theis. During the experimental part, measurements of the air tubes and their study using acoustic rhinometry were carried out. In the clinical part, there were two groups of patients with different types of tampons and control group of volunteers with normal nasal breathing, the total number of participants was 45 people. All patients of groups 1 and 2 underwent septoplasty, bilateral lower partial conchotomy. In the postoperative period, rhinomanometry, rhinoflowmetry, a study of the duration of nasal breathing, and a subjective assessment of nasal breathing were performed. RESULTS: According to measurements and acoustic rhinometry, the airway tubes of the tampons have a cross-sectional area that is more than 4 times smaller than the narrowest part of the nasal cavity in healthy volunteers. According to the results of a clinical study, the tampons in question are not able to provide a level of nasal breathing comparable to normal, even after clearing the lumen by a doctor. Medtronic packs provide somewhat better airway function due to the larger internal diameter of the tubes, but also do not create conditions for satisfactory nasal breathing. CONCLUSION: Improving the respiratory function of tampons in the future can be achieved by increasing the internal lumen of the breathing tubes while maintaining comfort of use.

[Surgical interventions on the pharynx in the structure of otorhinolaryngological care to the population of the city of Moscow]. / Khirurgicheskie vmeshatel'stva na glotke v strukture otorinolaringologicheskoi pomoshchi naseleniiu Moskvy.

The authors studied the reporting documentation of otorhinolaryngological hospitals of the city of Moscow on the surgical treatment of pharyngeal pathology in adults from 2002 to 2017. It was found that for 16 years surgical treatment of 290 362 patients with ENT-diseases was performed: 181.206 (62.4%) patients with diseases of the nose and paranasal sinuses, 24.981 (8.6%) patients with ear pathology, 60.346 (20.8%) patients with diseases of the pharynx and 23.829 (8.2%) - with diseases of the larynx. The assessment of the overall dynamics of the studied indicators was carried out on the 'trend lines'. For the considered period, the number of patients with surgical pathology of the pharynx increased by 33.2%. The proportion of tonsillectomies increased by 1.85 times to 56.5%, drainage of peritonsillar abscesses and abscesses-tonsillectomies decreased by 19%, uvulopalatoplastic increased 4.1 times, removal of neoplasms of the pharynx increased 2.2 times, adenotomies decreased by 2.4 times. Analysis of the data allowed to establish that, against the background of an ever-increasing number of surgical interventions for diseases of the pharynx in adults, a descending trend was noted only in the treatment of complicated forms of chronic tonsillitis and hypertrophy of the pharyngeal tonsil.