RU-2861500-C1 - METHOD FOR REMOVING METAL FERROMAGNETIC FOREIGN BODIES IN GUNSHOT PENETRATING WOUNDS OF NASAL CAVITY, PARANASAL SINUSES, PHARYNX OR LARYNGEAL VESTIBULE

RU2861500C1RU 2861500 C1RU2861500 C1RU 2861500C1RU-2861500-C1

Abstract

FIELD: medicine; emergency otorhinolaryngology. SUBSTANCE: endoscopic video visualisation of the injury zone is performed. When the location of the foreign body - a metal penetrating projectile - is identified, a magnetic extractor is introduced through the common nasal passage, or the oral cavity, or the inlet of the wound channel. The magnetic extractor is used to search for and fix the metal ferromagnetic foreign body in the operating field. Tissues around the metal ferromagnetic foreign body are dissected. Then the metal ferromagnetic foreign body is removed, and haemostasis is performed. The magnetic extractor contains two neodymium magnets of cylindrical shape, each 5 mm in diameter and 6 mm in length, placed in a hollow tube made of combined latex, obtained from a part of the additional injection port of an infusion set. A nasal probe with winding, 140 mm long, is inserted into the lumen of a polyvinyl chloride tube 125 mm long located on the opposite side of the infusion set. EFFECT: possibility of simple and rapid search and removal of metal ferromagnetic foreign bodies in gunshot penetrating wounds of the nasal cavity, paranasal sinuses, pharynx or laryngeal vestibule after tissue dissection around the foreign body through nasal or oral approaches using endoscopic video visualisation. 1 cl, 10 dwg, 1 ex

Inventors

Onishchenko Dmitrii Iurevich
Chechko Artem Nikolaevich

Dates

Publication Date: 20260505
Application Date: 20251003

Claims (2)

1. A method for removing metallic ferromagnetic foreign bodies in penetrating gunshot wounds of the nasal cavity, paranasal sinuses, pharynx or vestibule of the larynx, characterized in that after endovideoscopic visualization of the injury zone and identification of the localization of the foreign body - a metallic wounding projectile, a magnetic extractor is inserted through the common nasal passage, or the oral cavity, or the entrance opening of the wound channel, the magnetic extractor is used to search for and fix the metallic ferromagnetic foreign body in the surgical field, tissue preparation is performed around the metallic ferromagnetic foreign body, after which the metallic ferromagnetic foreign body is removed, hemostasis is performed; wherein the magnetic extractor contains two neodymium magnets of cylindrical shape, 5 mm in diameter and 6 mm in length each, placed in a hollow tube made of combined latex, obtained from a part of the unit for additional injections of the infusion system, and a nasal probe with a winding 140 mm in length is inserted into the lumen of the polyvinyl chloride tube 125 mm in length, located on the opposite side of the infusion system.
2. The method according to paragraph 1, characterized in that, if necessary, the magnetic extractor is removed from the surgical field, the nasal probe with winding is bent without removing it from the cavity of the polyvinyl chloride tube of the infusion system, giving the magnetic extractor the shape of an anatomical bend, after which the magnetic extractor is again placed in the surgical field, tissue preparation is carried out around the metallic ferromagnetic foreign body, the metallic ferromagnetic foreign body is removed.

Description

The invention relates to the field of medicine, in particular to emergency otolaryngology, and can be used to remove ferromagnetic foreign bodies in penetrating gunshot wounds of the nasal cavity, paranasal sinuses, pharynx and vestibule of the larynx. Ferromagnetic foreign bodies in the upper respiratory tract pose a risk of respiratory distress, which can occur when they migrate from the nasal cavity and pharynx into the larynx and trachea. Purulent-inflammatory complications are also possible [1, 2]. The primary method for examining the localization of ferromagnetic foreign bodies in the ENT cavity is radiography [1, 2, 3]. Nasal/laryngeal forceps and clamps are most often used to remove them from the above-mentioned areas [1, 2, 3, 4]. The use of the latter may be difficult when endoscopic visualization of the ferromagnetic foreign body is impossible in cases where it is located within the soft tissue. Methods for removing ferromagnetic foreign bodies in ophthalmology are known, described in patent RU2181274C2 and adopted at the “First meeting of military ophthalmologists in Moscow in 1943” - “Diascleral method for removing foreign bodies from the eye with a magnet.” A disadvantage of the first method is the combination of the endoscope and magnet, which is only advantageous for examinations in the anterior chamber of the eyeball. In the nasal cavity, paranasal sinuses, pharynx, and vestibule of the larynx, a ferromagnetic foreign body located deep within the tissues, especially in cases of gunshot wounds, will become magnetized to the endoscope during the examination and contaminate it, hindering visualization of the surgical field. This will increase the surgical time. The disadvantages of the second method include the large size of the electromagnet, its high cost of manufacture, and its inability to be used in body cavities. Magnetic extractors are known for removing ferromagnetic foreign bodies from hollow organs (SU 1748802 A1) and from the brain and spinal cord (RU 220893 U1). Their disadvantages include complexity of manufacture and the lack of a guide wire. In the latter case, the extractor's bulkiness also prevents its placement deep within body cavities. Endoscopic magnetic probes have been developed for removing ferromagnetic foreign bodies from hollow organs, as described in patent RU203097U1. Its advantage is the ability to bend the guide wire. However, it has disadvantages such as being bulky for examining ENT cavities and being expensive. Magnetic surgical instrument sets designed for removing metal fragments from wounds are known [5]. This technical solution has a rigid rod-like structure, which complicates endoscopic surgical intervention. The closest method for removing a ferromagnetic foreign body is RU2825952C1. It involves videothoracoscopic visualization of the area of damage to the internal organs of the chest and the suspected location of the foreign body within the chest. A magnetic extractor is inserted into the chest cavity, containing two cylindrical neodymium magnets, 10 mm in diameter and 10 mm in length, or one 20 mm magnet, attached to one end of a 25 cm long PVC drainage tube with a diameter of 6–8 mm. An endovideosurgical clamp is then inserted into the lumen of the tube. The metallic ferromagnetic foreign body is then located, identified, and secured. After tissue preparation, the foreign body is removed, and hemostasis and aerostasis are achieved. Disadvantages of this method include the large diameter of the magnet, which complicates examination of the ENT cavity, and the rigidity of the guide wire (endovideosurgical clamp). The latter feature prevents the removal of a ferromagnetic foreign body located deep within the ENT cavities. These cavities have anatomical peculiarities, including a deviated nasal septum, curved paranasal sinus ducts, the presence of turbinates in the common nasal meatus, and non-linear access from the nasal cavity or oral cavity to the vestibule of the larynx. Also, in cases of combined pharyngeal and mandibular injuries, severe trismus may occur, preventing examination with direct access to the pharynx through the oral cavity. We took this method as a prototype. The claimed invention is aimed at solving the problem of developing a method for removing metallic ferromagnetic foreign bodies from penetrating gunshot wounds of the nasal cavity, paranasal sinuses, pharynx or vestibule of the larynx. To achieve the above result, the invention contains the following essential features. Following endovideoscopic visualization of the injury site in the nasal cavity, paranasal sinuses, pharynx, or laryngeal vestibule, as well as the suspected location of the foreign body (a metallic projectile), a magnetic extractor is inserted through the common nasal passage, the oral cavity, or the wound entry port. The magnetic extractor contains two cylindrical neodymium magnets, 5 mm in diameter and 6 mm long, housed in a hollow composite latex tube obtained fro