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CNAA / Theses / 2019 / May /

Improving treatment and prevention of the operated ear disease by reconstructive surgery (clinical-experimental study)


Author: Vetricean Sergiu
Degree:doctor habilitat of medicine
Speciality: 14.00.04 - Otorhinolaryngology
Year:2019
Scientific consultant: Ion Ababii
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 15 May, 2019
Approved by NCAA on the 9 July, 2019

Abstract

Adobe PDF document – 1.13 Mb / in romanian

Thesis

CZU 616.284-089.844(043.2)

Adobe PDF document 7.14 Mb / in romanian
299 pages

Keywords

total tympanomastoidian dissection, operated ear disease, mastoidoplasty, meatoplasty, meatotympanoplasty, tympanoplasty, ossiculoplasty

Summary

Thesis structure: the work is exposed on 296 pages of printed text, consists of introduction, 6 chapters, conclusions, practical recommendations, summary in Romanian, Russian, English and bibliographic index with 238 references. Illustrative material includes 106 figures, 33 tables and 6 statistical formulas. The results were published in 52 scientific papers, including 1 monograph 12 without coauthors and 12 reviewed editions.

Field of study and objectives: The purpose of the study was to improve surgical methods of treatment and prophylaxis of the „operated ear disease”. There were determined based forms of the „operated ear disease” based on clinical and morphological characteristics, argued by experimental and clinical research, the possibility of using autogenous bone graft with osteoinductive properties of Auto Oosteomatrix Forte (AOMF) in reconstructive surgery after total tympanomastoidian dissection.

Scientific novelty: It was justified, experimentally and clinically, the use of bone graft from mastoid processus cortical layer, for the preparation of AOMF prostheses, in reconstruction of the posterior wall of the external auditory canal in association with ossiculoplasty excluding the additional trauma to the patient. The method of preparation and preservation of the AOMF prosthesis from autogenous bone graft, allows their use in reconstructive interventions after different periods following sanitation surgery on the ear (from 5 days to 9 months). In addition with comparative analysis of morphological and functional outcomes of proposed reconstructive interventions along with traditional interventions results of the „operated ear disease”, there were evaluated the quality of life indices and the degree of social rehabilitation of patients after reconstructive interventions with use of AOMF autograft.

Resolved sciescientific problem:consist in determining the efficiency of using mastoid processus cortical layer for making AOMF prostheses, in experimental and clinical studies. The method is used in the reconstruction of the posterior wall of the external auditory canal and ossiculoplasty excluding additional trauma to the patient. It was developed a safe fixation of bone prostheses, that restore the posterior wall of the external auditory canal using AOMF prostheses plasticity. The method of preparation and preservation of the AOMF prostheses from autograft allows their use in reconstructive interventions after different periods following sanitation surgery on the ear (from 5 days to 9 months).

Theoretical significance and applied value of the thesis: There was evaluated and characterized the morphopatologic and microbiologic state of the cavity after radical surgery, highlighting the various forms of the „operated ear disease” and determining the surgical treatment strategy; developed different variants of using AOMF grafts for shaping ear structures destroyed by the disease process or removed in accordance with the technique of total tympanomastoidian dissection; developed the original method by application of fascial graft for membrane neoformation which allows myringoplasty in cases of total lack of tympanic membrane and the bony portion of the external auditory canal. Performing reconstructive surgery after radical operations by using AOMF prosthesis is a method of prophylaxis of the „operated ear disease”.

Implementation of scientific results: The main research results are applied in the teaching process at the Department of Otorhinolaryngology IP Medical University "Nicolae Testemitanu" and the curative activity of Otorhinolaryngology department of the Republican Clinical Hospital.