Method for prevention of recurrent oroantral communications. RU patent 2510246.
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| Method of physiotherapy and conservative treatment of pleurisy / 2478391 Invention relates to medicine, namely to traumatology, oncology, pulmonology and surgery, and can be applied for treatment of pleurisy. For this purpose immediately after removal of exudate from pleural cavity into it introduced is wide-spectrum antibiotic and intravenously introduced is amikacin, after 10 minutes patient does 5 forced inhalations and exhalations with 3-minute intervals. After 10 minutes chest is subjected to electrophoresis with potassium iodide solution, which after day is alternated with solution of calcium chloride, with anode being placed into the space between scapular and midaxillary line at the level of 4-th rib to lower edge of rib arc. After finishing each session strips of capsicum plaster are stuck on back around shoulder-blades from both sides for one day, not less than 3 times. |
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FIELD: medicine.
SUBSTANCE: invention refers to medicine, namely to surgical dentistry and maxillofacial surgery, and is applicable in maxillary sinusotomy with fistula repair. A mucous membrane is incised to a bone under an intubation narcosis after a two-fold preparation of a surgical area. A D-shaped flap is cut out within an alveolar socket of an extracted tooth to be extended along a mucobuccal fold of an upper jaw on one side to a second incisor, and on the other side - to a third molar. The flap together with the periosteum is separated and retracted upwards with exposing a canine fossa and the alveolar socket of the extracted tooth. A hole is created within the canine fossa. Pathologically changed tissues or all sinus mucosa is scooped with a bone curette through the created hole. The alveolar socket of the extracted tooth is inspected. After the cavity has been scooped, an artificial hole is created towards a nasal cavity through an inferior nasal meatus. The sinus cavity is packed with a iodoform cotton swab; an end of the cotton swab is laid thoroughly on a sinus bottom, namely within the defect; the end of the cotton swab is brought out into a nose. A mucoperiosteal flap is mobilised within the alveolar socket of the extracted tooth, laid on the alveolar socket; the wound is closed completely. In the postoperative period, the cotton swab is removed from the sinus on the 9-10th day. The sutures are removed on the 10-11th day.
EFFECT: method enables reducing an incidence of recurrent oroantral communications in the postoperative period ensured by a compact packing of the sinus, and the antiseptic and regeneration effect of iodoform on the maxillary sinus.
2 ex
The invention relates to medicine, namely to the surgical stomatology and maxillofacial surgery, and can be used at carrying out of hamartoma with the plastic fistula.
There is a classical method of surgical treatment and postoperative management odontogenic sinusitis with a large orientalniho messages, which after appropriate processing operating fields and production of anesthesia, an incision of mucosa to the bone, vykraivaya trapezoid flap in the field of the alveolus tooth, which extend for transition to fold lateral incisor and to the third molar. Flap with the periosteum usepreview pulled up, exposing the scope of the dog fossa and the hole of the extracted tooth.
With a chisel and a hammer or chisel, Wojciecha in the field of dog dimples create a hole. Pliers or forceps skyiwwt bone plate in the area of the front wall, and then through the appeared window carefully scraped sharp spoon diseased tissue or all of sinus mucosa. - Audits the wells of the extracted tooth. After scraping cavity create an artificial hole in the side of the nasal cavity through the lower nasal passage. Shirt loose plugging iodoform turundas, the end of turunda taken out into the nose, mucoperiosteal flap in the field of the alveolus tooth mobilize, stack on the hole of the extracted tooth, and wound tightly sewn up [4].
In the postoperative period turundas from sinus remove only for 2-3 days, and operating the sutures are removed on 9-10 day.
The disadvantage of this method is that in the postoperative period, especially if there are significant defect of the bottom of the sinuses, there is always the risk of relapse orientalniho messages. According to various authors, this risk is from 4% to 27% [1, 2, 3, 5, 6], that requires further re-admission and re surgical treatment of the patient.
The objective of the proposed method is to decrease the frequency of recurrences of oroantral messages in the postoperative period after operation of hamartoma with the plastic fistula.
The posed problem is solved due to the fact that the maxillary sinus plugging iodoform turundas tightly, and the end of turunda carefully lay on the bottom of the dress, it is in the area of the defect with the subsequent removal of turunda their maxillary sinus only on 9-10 days after surgery.
The method is as follows.
Under endotracheal anesthesia after two processing operating fields carried out incision of mucosa to the bone, cut out trapezoid flap in the field of the alveolus tooth, which extend in transition the crease of the upper jaw with one hand until the second cutter, and with another - to the third molar. Flap with the periosteum usepreview pulled up, exposing the scope of the dog fossa and the hole of the extracted tooth.
With a chisel and a hammer in the field of dog dimples create a hole. SNiP skyiwwt bone plate in the area of the front wall, and then through the appeared window carefully scraped sharp spoon diseased tissue or all of sinus mucosa. - Audits the wells of the extracted tooth. After scraping cavity create an artificial hole in the side of the nasal cavity through the lower nasal passage. Shirt tightly plugging iodoform turundas, and the end of turunda carefully lay on the bottom of the dress, it is in the area of the defect, the end of turunda taken out into the nose, mobilize mucoperiosteal flap in the field of the alveolus tooth, put it in the hole, and the wound tightly sewn up. In the postoperative period turundas from sinus removed at 9-10 day, and operating the sutures are removed on 10-11 days.
The results of the treatment approach 10 patients with a diagnosis of chronic odontogenic sinusitis, sinus maxillary sinus with significant defect of the bottom of the dress, showed that in the postoperative period, all patients had moderate swelling of the soft tissues of the buccal, infraorbital areas, and pain is not distinguished by their intensity and was easily stopped by the appointment of painkillers. In General the postoperative period even. Turundas from sinus all patients were removed at 9-10 day. Operating stitches were removed 10-11 days after the operation.
All patients were positive results of treatment and the period of hospitalization was mainly from 11-12 days. In the future, patients were discharged on outpatient aftercare of the dental surgeon at the place of residence.
12 patients of the control group with chronic odontogenic sinusitis, sinus maxillary sinus with significant defect of the bottom of the sinuses, surgical treatment was performed by standard the method of exercising the loose tamponade sinus iodoform turundas, then in the postoperative period turundas from sinus deleted at 2-3 days after surgery.
All patients in this group also noted the smooth flow of the postoperative period, moderate swelling of the soft tissues of the buccal, infraorbital areas, minor pain, which was easily stopped by the appointment of painkillers.
Despite this two patients of the control group still while the hospital was partly divergence operating seams and the offset of the flap with the re-education of fistula oral cavity with maxillary sinus. In addition, one patient repeatedly appealed to receive three weeks after discharge, when his examination was also diagnosed with a relapse of sinus maxillary sinus. All this required a re-admission of all three patients in the hospital and holding of repeated interventions.
Clinical example 1. Patient Century, 39 years old, was admitted to the Department of maxillofacial surgery 12.03.2011 year.
The patient complained of purulent discharge from the left half of the nose with fetid smell, disorder of nasal breathing left, unilateral headache and a feeling of heaviness in the head, the water through the mouth to the nose.
From an anamnesis it is established, that two months ago in a polyclinic on a residence deleted 27 tooth. The removal was difficult. After removal was diagnostirovanna perforation of the bottom of the left maxillary sinus, the patient was sent to the hospital. In the hospital to appeal did not, was treated yourself: I rinsed the mouth after a meal of antiseptic solutions. A week ago appeared above symptoms, then 12.03.2011 appealed to the Department tploc and was hospitalized.
The external inspection violations configuration face. Regional lymph nodes are not enlarged, at a palpation painless. The mouth is a good movement of the lower jaw is not difficult. The mucous membrane of the oral cavity pale pink color, without signs of inflammation. Hole remote 27 tooth gaping, when the sounding is determined by a broad message of the mouth of the left maxillary sinus. When you flush the sinuses through the hole of the extracted tooth - washing water mixed with pus.
On the radiograph reveals the lack of transparency of the left maxillary sinus.
The dental formula:
About About About About About 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 About About About About Aboutwhere is the missing tooth.
The patient was diagnosed aggravation of chronic odontogenic left maxillary sinusitis, sinus left maxillary sinus. After rehabilitation sinus within three days surgical treatment of the patient implementing proposed by the way: under endotracheal anesthesia, after two processing operating fields spent incision of mucosa to the bone, vykraivaya trapezoid flap in the field of the alveolus 27 of the tooth, which was extended at transition fold the left upper jaw to 22 of the tooth on the right, and up to 28 tooth left of wells 27 of the tooth. Flap with the periosteum was osepaishvili and pulled up, exposing the region dog-pits, and pit remote 27 of the tooth.
With a chisel and a hammer in the field of dog holes created a hole. The cutter has skusil bone plate in the area of the front wall, and then through the appeared window carefully scooped out a sharp spoon pathologically changed tissues and all of the mucous membrane of the left maxillary sinus. Held curettage and revision of the alveolus 27 of the tooth. Created an artificial opening in the side of the nasal cavity through the lower nasal passage. The left maxillary sinus tightly tamponiruut iodoform turundas, and the end of turunda carefully laid on the bottom of the dress, it is in the area of the defect, the end of turunda brought out through the artificial fistula in the nose. Mucoperiosteal flap in the field of the alveolus 27 tooth mobilized, put him on the 27 hole tooth, and wound tightly left the house taking lavsan.
In the postoperative period, the patient had moderate swelling of the soft tissues of the left cheek and infraorbital areas, and pain is not distinguished by their intensity and was easily stopped by the appointment of painkillers. In General the postoperative period was smooth. Turundas from the bosom of the patient has removed 10 days, and operating the stitches were removed after 11 days after the operation.
The terms of hospitalization was 11 days. Later the patient was discharged on outpatient aftercare of the dental surgeon at the place of residence.
Control examination of the patient in 7 days after discharge from hospital has shown that specific complaints of the patient does not show. Locally: the wound in the mouth healed by first intention, signs of relapse of the fistula left maxillary sinus not. The patient is recommended to begin the work.
Clinical example 2. Patient Century, 48 years old, was admitted to the Department of maxillofacial surgery 15.01.2012 year. The patient complained of airflow through the nose to the mouth, the water through the mouth, nose, mild pain in the alveolus 16 of the tooth.
From an anamnesis it is established, that two days ago in a polyclinic on a residence removed 16 tooth. The removal was difficult. After removal was diagnosed with perforated bottom right of the maxillary sinus, the patient was sent to the hospital. 15.01.2012 gabrielse to the Department tploc and was hospitalized.
The external inspection violations configuration face. Regional lymph nodes are not enlarged, at a palpation painless. The mouth is a good movement of the lower jaw is not difficult. The mucous membrane of the oral cavity pale pink color, without signs of inflammation. Hole remote 16 tooth gaping, when the sounding is determined by a broad message of the oral cavity with the right maxillary sinus. When you flush the sinuses through the hole of the extracted tooth - rinse waters clean.
On the radiograph reveals the lack of transparency of the right maxillary sinus.
Tooth formula:
About About P About 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 To To Aboutwhere is the missing tooth, t - seal, K - root.
The patient was diagnosed with odontogenic right maxillary sinusitis, perforation of the bottom right maxillary sinus through the hole remote 16 of the tooth.
Surgical treatment of the patient implementing proposed method: under endotracheal anesthesia, after two processing operating fields spent incision of mucosa to the bone, vykraivaya trapezoid flap in the field of the alveolus 16 of the tooth, which was extended at transition fold right upper jaw to 12 of the tooth on the left and up to 18 tooth right of wells 16 of the tooth. Flap with the periosteum was osepaishvili and pulled up, exposing the region dog-pits, and pit remote 16 of the tooth.
With a chisel and a hammer in the field of dog holes created a hole. The cutter has skusil bone plate in the area of the front wall, and then through the appeared window carefully scooped out a sharp spoon pathologically changed tissues and all of the mucous membrane of the right maxillary sinus. Held curettage and revision of the alveolus 16 of the tooth. Created an artificial opening in the side of the nasal cavity through the lower right of the bow. Right maxillary sinus tightly tamponiruut iodoform turundas, and the end of turunda carefully laid on the bottom of the dress, it is in the area of the defect, the end of turunda brought out through the artificial fistula in the nose. Mucoperiosteal flap in the field of the alveolus 16 tooth mobilized, put him on the hole 16 teeth, and wound tightly left the house taking lavsan.
In the postoperative period, the patient had moderate swelling of the soft tissues of the right cheek and infraorbital areas and moderate pain, which was easily stopped by the appointment of painkillers. In General the postoperative period was smooth. Turundas from the bosom of the patient has removed 10 days, and operating the stitches were removed after 11 days after the operation.
The terms of hospitalization was 12 days. Later the patient was discharged on outpatient aftercare of the dental surgeon at the place of residence.
Control examination of the patient 14 days after discharge from hospital has shown that specific complaints of the patient does not show. Locally: the wound in the mouth healed by first intention, signs of relapse of the fistula right maxillary sinus not.
Advantages of the proposed method are that, so as sinus Packed by turundas tightly and turunda is it 9-10 days, reduces not only the risk of divergence operating joints as a result of the release of the specimens out of the bosom through seams accidental sneezing patient and the risk associated with Smoking sick and meals. Simultaneously, within 10 days is favorable healing, engraftment and epitelizatia mucous membranes, and flap - antiseptic and regenerative effect of iodoform on the maxillary sinus.
Literature
1. Esikova T.S. Modern methods of diagnostics and treatment of odontogenic oroantral messages and maxillary perforating sinusitis. / Tselikova // Avtoref. dis. CMN - 1996. - 23 C.
2. Lavrent'ev S. Application in complex treatment of odontogenic perforating of sinusitis osteoarthropathy fistula bottom of the maxillary sinus. / Sat // Avtoref. dis. CMN - 1996. - 24 C.
3. Mukhametzyanova T.S. Complex treatment of odontogenic perforating sinusitis. / Tashmuhammedova // Avtoref. dis. CMN - 1990. - 23 C.
4. Robustova YEAR "Surgical dentistry". M. 2003. - 504 S.
5. Shulman FI Foreign body maxillary sinuses. The tactics of the doctor./ V.A. Kozlov, Peasholme. // Proceedings of the VII all-Russian Congress of dentists, 10-13 September 2001 - Moscow. - 2001. - P.98-100.
6. Shulman FI Clinical features of chronic maxillary sinusitis, evolved as a result of penetration into the bosom of the filling material. / Peasholme // Mater. VII international conference of maxillofacial surgeons and stomatologists, 28-30 may 2002, St. Petersburg. - 2002. - S-171.
The way relapse prevention oroantral messages, including incision of mucosa to the bone with cutting out trapezoidal flap in the field of the alveolus tooth, the renewal of the section on transition crease of the upper jaw to the second cutter on the one hand and to third molar on the other, the exposed area of the dog holes and wells remote tooth, holding hamartoma in the field of dog fossa, scraping pathologically changed tissues or all of the mucous membrane of the maxillary sinus, the revision of the alveolus tooth, artificial holes towards the nasal cavity through the lower nasal passage, conducting tamponade of the maxillary sinus iodoform turundas with the removal end of turunda in the nose, the mobilization of the mucoperiosteal flap in the field of the alveolus tooth and its placement on the hole stitching of the wound tightly, wherein maxillary sinus plugging iodoform turundas tightly, and the end of turunda carefully lay on the bottom of the dress, it is in the area of the defect with the subsequent removal of turunda from the maxillary sinus only on 9-10 days after surgery.