The way preoperative preparation of the maxillary sinus to osteoplastic in perforating odontogenic maxillary sinusitis

 

(57) Abstract:

Usage: for preoperative preparation of the maxillary sinus to osteoplastic in perforating odontogenic maxillary sinusitis. The inventive gaymorovu cavity injected sorbent SUMS-1 through microirrigation. Introduction through the perforation hole or fistula in the projection of the alveolus of the tooth. The sorbent is in the form of mist (5,0-15.5 g of sorbent in a hypertonic solution of sodium chloride). Daily for 4-5 Nam they control the detoxification of the mucosa. Osteoblastic perform at a positive control. Control lead with paramarine test. 1 C.p. f-crystals.

The invention relates to medicine, namely to oral surgery, and can be used to eliminate inflammation in the mucosa of the maxillary sinus with odontogenic perforating Amorite before osteoplastic.

Frequency inflammation of the maxillary sinus odontogenic origin is quite high and is 30 - 40% of the total number of inflammatory diseases of the paranasal sinuses [1].

Among odontogenic sinusitis perforating range from 41.2 per cent to 91,7% [2].

In these cases, the doctor's tactics is to eliminate inflammation in the maxillary sinus and the elimination of fistula between the mouth and sinus.

For the preparation of the maxillary sinus to a plastic closure of the perforation hole or fistula use anti-inflammatory drug therapy in combination with fiziolechenie [3, 5], and lavage of the maxillary sinus with antiseptic solutions (furacin), dioxidine, chlorhexidine and other ), antibacterial agents (bacteriophage, antibiotics) or their combination [1 - 3, 5].

There is a method of preparation of the maxillary sinus to a plastic closure of the defect, including washing her dissolve wish 5 - 8 times every 2 to 3 days [1, 3].

However, if this is not achieved sufficient detoxification of the maxillary sinus and plastic closing of the defect is performed on unprepared tissues, which leads to slow recovery and the occurrence of relapses.

In addition, the sensitivity of microorganisms to most antibiotics recently reduced, which is caused not only extend the duration of treatment, but more severe course of the disease with various complications [6]. Many patients suffer from allergic intolerance to medications.

The use of new antibiotics, the dose of the well-known drugs, the use of different drug combinations do not allow to reduce the frequency of relapses and chronicity of the process [1 - 3].

So it is known that antibiotics are immunosuppressants and slow regeneration.

The known method of preparation for surgery for odontogenic perforating the sinus infection by antibiotic and anti-inflammatory treatment, sinus rinse solution furacin 1 : 5000, introduction to the bosom of 50,000 units monomitsina for 8 to 9 days with subsequent tamponade perforation aunia sine chlorhexidine digluconate to 0.05%, exposure to low-frequency ultrasound and cover the walls of the sinus by a thin layer of oxydex [3].

The use of ultrasound is not possible to widely use this method as ultrasound and other methods of physiotherapy is contraindicated in a number of concomitant diseases. In addition, these methods as the previous is not achieved detoxification sinus.

Now go an extensive search of the optimal preoperative preparation of the maxillary sinus (rehabilitation) to a plastic closure of the defect.

As the prototype is taken treatment of inflammatory diseases of the maxillary (maxillary) sinuses on author.St. N 1783981 [7]. The way the prototype performed as follows. In the projection of the maxillary cavity from the vestibule of the mouth at the level of 2 - 5 teeth usepreview the periosteum and expose the area of the canine fossa. At the bottom it is produced trepanation hole through it from the maxillary sinus, remove the purulent content, granulation tissue, polyps, impose fistula with the lower nasal passage through the fistula into the bosom injected Teflon drain tube. The sinus is filled with sorbent "Eleven", which was previously in the amount of 1.0 g diluted in 0.9% solution of chlorine is up. In the nasal cavity impose gauze swab, which will be removed after 24 hours Rinse sinus carried out after 48 - 72 h, then remove the drain. Sorbent "Eleven" absorbs microbial body absorbs wound, which reduces post-operative swelling of the tissues and provides a more rapid epithelialization of the mucous membrane of the maxillary sinus.

The method has significant drawbacks. Online access via canine fossa traumatic sorbent "Eleven" has no trapnest to the absorption of poisons from the mucous membrane of the maxillary sinus, and a single change of Elevina" after 48 - 72 h not attained the reorganization of the sine and the health of the mucous membrane in such a way that she was prepared for surgery.

In addition, in the maxillary cavity in addition to the discharge of the mucous membrane there is always a gas, not drained this cavity can not be. The prototype cavity is filled with gel, i.e., non-porous tube with full closure and operative access and holes in the nasal cavity, which makes it impossible for her gas exchange.

To increase the effectiveness of treatment of odontogenic perforating sinusitis by detoxification preparation of the maxillary sinus to the plate is eccii of the alveolus of the tooth impose a suspension of sorbent SUMS-1 on hypertonic solution of sodium chloride in the amount of 5 - 15 g daily for 4 - 5 days. They control the degree of detoxification mucosa using paramarine test, and if positive carry plastic defect.

The inventive method is as follows.

Patient dialysis sinus through the perforation hole or fistula in the mouth by chlorhexidine digluconate 0,02%, wash the pus and mucus to clean wash water. If necessary (the presence of thick pus, necrotic masses) perform lysis of proteolytic enzymes - trypsin, Hampson and others After lavage of the maxillary sinus are applique sorbent SUMS-1. Pre-cooked coarse sorbent suspension in 10% sodium chloride solution from the calculation of 5.0 - 15.5 g of sorbent in to 20.0 ml. Suspension is thoroughly shaken, then injected through the perforation hole or fistula in the area of the extracted tooth with a syringe and a thin catheter (microirrigation). After this message close iodoform torontoy and protective plate. The next day, the sorbent wash out the sinuses with an antiseptic solution and again introduce a freshly prepared suspension. The procedure is repeated daily for 3 - 5 days before removal of the two is considered as the " daily of the first portion of the wash liquid. Then spend aminoplastics operation.

The globules of sorbent size 0.1 - 0.2 mm allow you to enter them via syringe and the catheter. It is this dispersion provides deposition in the maxillary sinus of the sorbent, her whole filling and application contact of the sorbent with the mucous membrane of the maxillary sinus.

Flow, saturation, and exposure to a hypertonic solution of sodium chloride creates liquorrhea in the cavity (the lymphatic drainage of the mucous membrane). After the introduction, flush and full tamponade sorbent sinus is active inoome between excreta and mucous absorption of a toxin adsorbent on the exposure time to 1 day. It is known that the capacity of the maxillary sinus is 10 to 12 cm, which allows you to enter a 5.0 - 15.5 g of sorbent. This number creates conditions sorption of toxins from the mucosa.

Used carbonaceous mineral sorbent-based alumina relates to the field of materials with a wide range of applications in medicine, veterinary medicine, food industry wastewater and gas emissions in the chemical, biotechnological industry [8 - 10].

Sorbent SUMS-1 the social matrix, covered with chemically pure carbon. Standardization of grain size 0.1 - 0.2 mm, their deliquescence when microirrigation flow through the catheter into the cavity to avoid access through the dog hole with trauma to the wall of the maxillary sinus.

It sorbent SMS-1 has a high sorption capacity due to the "wholenote carbon radicals directly contact pin (application) with the mucous membrane of the maxillary sinus.

SMS-1 has alternating hydrophobic and hydrophilic centers that provides natural movement and movement of granules in the nasal cavity, and this is in contrast to the intestine and other active peristaltically or shrinking bodies is particularly important.

This sorbent has a physico-chemical structure in the form of rings in the center, which already allows you to capture the microbial cell and hold the plasma area of the division (reproduction). Subsequently, the washing cavity from the sorbent removed and actively fixed in the rings of microbial cells.

As shown by laboratory and clinical studies, the sorbent SUMS-1 absorbs the medium - and high-molecular compounds, which include mucus and liquid excreta with whom the project is ensured by physical contact, it is established that he is indifferent as a foreign body and no leukocyte and BloodRayne secretion of the reaction. At the same time, a secreted toxin immediately fixed sorbent and does not cause sustain inflammation in the cavity.

In contrast to the "Glavina" sorbent SUMS-1 absorbs the gas itself improves gas exchange. This is proved when it is used in enterosorption (see technical conditions TU 64-6-401-87 and the conclusion of the public health Ministry to eliminate flatulence).

The proposed method is used in 26 patients with perforative odontogenic maxillary sinusitis: 9 patients were treated in outpatient conditions and made it possible to avoid surgical treatment of these patients was carried out covering the area of the defect with fibrin glue; 17 patients treated in the hospital, where after preoperative detoxification they performed the operation hamartoma with grafting anastomosis.

The immediate and remote results of observations carried out in 1 - 2 - 4 months indicate the absence of inflammation in the sinus and recurrence of fistula.

To assess the effectiveness of the proposed method the analysis of the incidence of maxillary sinusitis of odontogenic perforative on mater what RIT. All patients underwent traditional preoperative preparation and a plastic closure of the defect bottom of the maxillary sinus. In 8% of cases after surgery, there was a relapse (fistula) that, in our opinion, was due to insufficient sanitization of the sinus before surgery. All patients were treated with fixed, pre-operative preparation takes from 7 to 14 days.

The study of indicators of contamination point of the mucous membrane in the area of anastomosis in the bottom wall of the maxillary sinus and pus from the past showed that the pus before treatment she was (2 - 4) 107CFU/ml, whereas in punctate these patients (1 - 2) 106CFU/g of tissue. And on the 3rd day detoxification sinus sorbent SUMS-1 the number of microbes in 1 g of tissue was 102SOME, and 4 - day 5 - 101SOME. While the traditional application of the antiseptic treatment of sinus number of microorganisms on the 6th day of treatment was 105SOMETHING that was not possible to carry out surgical treatment.

To determine the extent of detoxification patients were identified leukocyte index of intoxication (LII) [11], normal LEAH equal to 1.0 to 1.5. In most patients with ruptured odontogenic maxillary sinusitis pop the treatment of decline was slower. On the 14th day from the beginning of the treatment - 1.58, while processing a sinus sorbent SUMS-1 LII on the 3rd day after treatment sinus sorbent was 1,32 and normalized already on the 4 - 5th day.

In addition, to determine the degree of intoxication in the bosom determined the time of death of the Paramecium in the first portion of wash water (FR) [12] . Patients with traditional processing method of the maxillary FRI normalized by 9 - 18th day after the start of treatment, whereas patients who were biodetoxification of the maxillary sinus, normalization metric FRI after 4 - 6 days.

At endoscopy sinus after reorganization sorbent SMS-1 was noted slight infiltration of the mucosa and the absence of swelling.

Along with the above methods, we carried out histological examination of the mucosa of the maxillary sinus, in which after detoxification sorbent SMS-1 was detected pattern of chronic inflammation without the expressed leukocyte infiltration.

A thorough revision of the maxillary sinus during surgery has allowed to draw a conclusion about the complete washout of the sorbent particles were not detected during visual osmitrol clinic CGMA with complaints of headache, General malaise, fever up to 38oC, stuffy nose left, bad breath, presence of purulent discharge from the alveolus 7. Two months ago, after removal of 7 patient began to feel the passage of air through the hole remote 7, ingress of liquid food in the nose. Appeared purulent discharge from the hole. A week ago after hypothermia appeared pain in the upper jaw on the left side, worse when bending my head, deteriorated General condition, fever, purulent discharge became abundant with an unpleasant odor.

The local survey was determined by swelling of the soft tissues in the region of the upper jaw to the left, here pain to palpation. Breathing through the left nostril is difficult, when the front rinoskopii visible "purulent track" in the lower nose go left. In the oral cavity in the area of the missing 7 fistula, which abundantly separated pus with a foul-smelling odor. On the x-ray paranasal sinuses was observed homogeneous darkening of the maxillary sinus to the left, on the radiograph of the upper jaw in Yusupov shadow tooth density, shaped like a tooth root.

Diagnosis: exacerbation of chronic odontogenic perforate the R blades.

On the day of receipt sinus washed through a fistula in the area of the hole 7 isotonic solution of sodium chloride, in the first portion of the wash water to determine the date of death of the Paramecium. FRI amounted to 0.4. Continue rinsing the sinus chlorhexidine 0,02% transparent to the wash water.

Cooked coarse suspension of sorbent SUMS-1, for this purpose, 10 mg of sorbent mixed with 20,0 ml of hypertonic (10%) solution of sodium chloride. Suspension dialed in the syringe, through the fistula by means of microirrigation introduced in gaymorovu shirt. The mouth of the fistula closed iodoform torontoy and a protective plastic plate prepared in advance.

The next day were removed skid plate, and iodoform turunda, repeated primarily test. Sinus washed up transparent wash water and re-filled with a sorbent.

Already on the 3rd day of using local sorption disappeared fetid smell, decreased amount of purulent discharge, stopped the pain in the upper jaw on the left side, improved overall health. On the 5th day of application of the sorbent disappeared stuffy nose.

In parallel with the local impact was conducted traditional anti-inflammatory treatment.

what lacocque. On the 5th day of application of the sorbent identified a single colony epidermal Staphylococcus.

LEAH on the day of receipt amounted to 2.5, and after detoxification on the 5th day was equal to 1, which is the norm.

On the 6th day PT was 25.1 and on the same day patient surgery hamartoma, during which removed polypous mucosa and tooth root. Held plastic buccal fistula-deshevym flap. Sutures were removed on the 8th day after surgery, the wound healed by first intention. Control examination after a month, and then after 2 months revealed no recurrence of the disease.

Example 2. Patient C. , 37 years old, came in out-patient Department dental clinic CGMA complaints against ingress of liquid food in the nose and purulent discharge from wells previously deleted 6. The tooth was removed about three months ago, after removal appeared airflow through the hole and when you call the next day closure of the hole, this manipulation is performed repeatedly in a week. After treatment has been formed fistula and the patient is directed stomatologica.

Local examination revealed nasal breathing through the right nostril, swelling of the mucous membrane nobama sinuses visible darkening of the maxillary sinus on the right.

Diagnosed with chronic sinusitis of odontogenic perforative right. Treatment on an outpatient basis. Preparation of the maxillary sinus to the closure of fistula and determining its detoxification was carried out analogously to example 1.

Detoxification of the maxillary sinus took 5 days, then completely stopped discharge from the fistula, nasal breathing is restored. On the control radiographs showed pneumatization maxillary sinus.

LEAH before detoxification sinus was 1.75, 4 days was equal to 1.0, which is the norm.

PT on the first day corresponded to 1.1, on the 5th day - 25,6 that is the norm.

Conducted biodetoxification maxillary sinus sorbent SUMS-1 allowed after 5 days of training to produce the sealing fibrin fistula glue by well-known methods. Follow-up after 1 and 3 months revealed no recurrence of the disease. Thus, in this case it was possible to avoid surgical intervention.

Sources of information

1. The Bernadsky Y. I., Zaslavsky N. And., The bernadska gg Purulent oral and maxillofacial surgery. - Kiev, 1983, S. 89 - 90; 184 - 197.

2. Lavrent'ev, S. C. Application in the complex treatment of, the. 6 - 8.

3. Bogatov, A. I. New methods of diagnostics, treatment and rehabilitation of patients with perforations and foreign bodies of the maxillary sinuses.// Abstract. Diss. Kida. the honey. Sciences., Samara, 1991, S. 4 - 11.

4. Levenets A. K. complications of the maxillary sinus during surgery tooth extraction, methods of treatment and prevention.// Abstract. dis. Kida. the honey. Sciences, M, 1965, S. 8.

5. Deryabin E. I. , Agapov C. S. Surgical treatment of chronic odontogenic sinusitis with the use of carbon dioxide (CO2) laser.// Prevention and treatment of dental diseases., Izhevsk, including 1, 1995, S. 91 - 92.

6. Leontiev I.e. Berillo E. A., Permitin L. D. the question of the microflora in chronic polypous sinuitis. - Journal of USN., nose. and throat diseases, 1983, No. 6, S. 31 - 35.

7. Auth. St. N. 1783981. A method of treating inflammatory diseases of the maxillary sinus.

8. Reva L. I. prospects of application of sorbent SUMS-1 in clinical practice. // Proceedings of scientific-practical conference on March 31, 1994., Novosibirsk, 1995. - S. 29 - 30.

9. Borodin, Y. I., lubarsky M. S. and other Sorption-application and lymphotropic methods in treatment of burns.// Reports of the scientific-practical conference on March 31, 1994., Novosi The I. I. Frolov, etc.

11. Flight B. A., Chernyshev, A. K., Nikonov B. M. and other Comparative characterization method for assessing the toxicity of the blood plasma and the severity of intoxication in acute diffuse peritonitis. Journal of surgery, 1983, No. 6, S. 53 - 55.

12. Krachunov E. C., A. Ostrovsky,, Luzina E. C., Methods for the determination of the degree of intoxication. - Medical care, 1988, No. 7, S. 47 - 49.

1. The way preoperative preparation of the maxillary sinus to osteoplastic in perforating odontogenic maxillary sinusitis, including the production of access gaymorovu cavity, draining and filling her with a sorbent solution of sodium chloride, the exposure of the sorbent and its subsequent leaching, characterized in that the sorbent is used SMS-1, which is injected in gaymorovu cavity through microirrigation through the perforation hole or fistula in the projection of the alveolus of the tooth in the form of a suspension of 5.0 - 15.5 g of sorbent in a hypertonic solution of sodium chloride daily for 4 to 5 days they control the degree of detoxification of the mucosa and, if so, perform osteoplastic.

2. The method according to p. 1, characterized in that the control of the degree of detoxification of the mucous membrane of the maxillary groove

 

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