A method for the treatment of chronic odontogenic sinusitis with oroantral message

 

(57) Abstract:

The invention relates to medicine, namely to dental surgery. The method is further carried out nutritiously electrophoresis with 1-3% solution of dimethyl sulfoxide through oroantral hole with a gradual increase in exposure from 15 to 25 min, amperage 1-3 µa; 5-7 sessions. The method improves the efficiency of the treatment.

The invention relates to medicine, namely to oral surgery, and can be used for the treatment of chronic odontogenic sinusitis with oroantral message.

Known for gentle treatment of odontogenic sinusitis, which is the conservative treatment of the mucous membrane by washing the cavity with antiseptic solutions with the subsequent closure of the fistula using local fabrics, plastics, without conducting radical hamartoma /Melnikov, A. C. "Features gentle methods of treatment of sinusitis associated with pathology of the oral cavity"., the journal "Bulletin of otorhinolaryngology", 1984, No. 3, S. 30/.

Cons: superficial and short-term effects of medicinal substances leads to a low efficiency of treatment and recurrence of disease is of sidebow disease.

This task is achieved by the readjustment of the sinus in the preoperative period in the form of fractional dialysis. The new way is to conduct vnutricerepnogo electrophoresis with 1-3% solution Dimexidum /dimethyl sulfoxide/ in combination with other drugs /enzymes, antibiotics, non-steroidal anti-inflammatory drugs/ via oroantral message with an exposure of 15 to 25 min, amperage 1-3 MCA, 5-7 sessions using carbon electrodes, such as carbon filament Chis-5000.

The method is as follows.

In the preferred period and as an independent method of intensive conservative treatment of odontogenic sinusitis oroantral message hold fractional dialysis of the maxillary sinus through the available oroantral message antiseptic solution, enzymes, 10% Dimexidum in the volume of 150-200 ml, T - 37, daily rate 7-14 procedures. Duration of dialysis 1-1,5 hours For this patient give a horizontal position, in fistulous course enter the subclavian catheter d - 0.6-1.5 mm thick, attach system for transfusion of blood, filled with an antiseptic solution, set the arrival rate of restores and is collected in a tray.

Then spend electrophoresis, which is performed with the help of a special device consisting of a system of transfusion krovezamenitelej, subclavian catheter, tee, electrode. In oroantral message enter the subclavian catheter d - 1,4-2,0 mm, attached to him tee, one of the two remaining outputs of the tee is connected to the system for transfusion of blood, filled with 50 ml of electrolyte, to another, an elastic tube with a clip from a similar system with a length of 30-50 cm /depending on the distance between the patient and the apparatus for electrophoresis/.

The active electrode is conducted through the said tube and subclavian catheter so that it protrudes into the cavity of the sinus 1 see as the active electrode is used, for example, carbon fiber Chis-5000, with a diameter of 1 mm Passive electrode is fixed on the skin of the submandibular region. The sinus is filled with electrolyte, consisting of 1-3% solution Dimexidum in combination with an antibiotic when purulent form of the disease, with acetylsalicylic acid or with a solution of KI in hyperplastic form of sinusitis, then regulate the flow of solution 10-20 drops per minute, including apparatus set amperage 1-3 µa. The power is spotila procedures, with a gradual increase from 15 to 25 minutes Exposure time of 15 min does not provide a sufficient effect, and more than 25 min tiring for the patient. Electrophoresis is carried out daily or every other day. The number of sessions 5-7. /Number of sessions is less than 5 a short-term effect, and more than 7 increases the duration of treatment/.

In the absence of complaints, production of clean wash water, limited modification of the mucosa are close operation oroantral messages through local fabrics, plastics. For this purpose under provodnikovym anesthesia freshen the edges of the fistula by two converging incisions that continue to transition the crease with the formation of Muco-netcasting trapezoidal flap, fabric usepreview, exposing the alveolar bone with a bone defect in the area of the extracted tooth. Spend curettage of the wells and, if possible, the size of the bone defect, remove through him the pathological sinus mucosa, adjacent to suishu. Shirt is washed with antiseptic solution, then aspiritual the contents of the suction apparatus. The flap is mobilized by dissection of the periosteum at its base, devitalizirovannah edge injected under the periosteum of the alveolar ridge with the palatal side, the top flap tx2">

Example 1.

Patient R., 59 years old, was admitted to the hospital with a diagnosis of chronic odontogenic sinusitis oroantral message in wells

Within 4 years disturb periodically discharge from the left half of the nose, slight pain in the projection of the left maxillary sinus. Exacerbation of sinusitis is connected with disease of the teeth, the latter arose after removal from the education oroantral messages. Conducted comprehensive anti-inflammatory treatment, antibacterial and physiotherapy, rehabilitation sinus. The result was quiet the inflammation, but oroantral message is preserved.

On the day of receipt of the complaint, typical of sinusitis, were absent when the survey found oroantral message in hole size 0.5 cm in diameter, from which stood a purulent exudate. In the preoperative period, the course vnutricerepnogo electrophoresis and fractional dialysis, for this purpose, taking into account Pogramme used ampicillin. The introduction of the electrode and the solution was carried out through oroantral message in wells , with rated current of 2.0 mA, duration from 15 to 25 minutes course of 6 treatments, every other day. Total antibacterial laces hole of the extracted tooth.

Surgical treatment carried out in the form of closure of the fistula with local tissues with partial destruction of the mucous membrane of the sinuses adjacent to suishu. Postoperative period was unremarkable. The wound healed by first intention.

Long-term outcomes tracked through 9 months of recurrence of sinusitis was not.

Example 2.

Patient H., 35 years old, was admitted to the hospital with a diagnosis of chronic odontogenic sinusitis, fistula in wells

Patient 3 months ago have removed a tooth, then 2 days later appeared pain in the upper jaw, increased T body. ENT specialist conducted an anti-inflammatory treatment for acute sinusitis, sinus puncture obtained pus, which received the pus, which is removed by washing the sinuses. The treatment was not completed. Before admission to the clinic the patient is not treated.

On the day of receipt of the complaint, typical of sinusitis, was absent. During the examination on the alveolar ridge in the area discovered oroantral message size 1 x 0.8 cm, filled with thickened, hypermonogenic mucous membrane of the sinus. The first days of the washing water contained mucopurulent clots. During endoscopic examination of the m period, the course of fractional dialysis and vnutricerepnogo electrophoresis in 10 days with 2.5% KI solution in 3% solution of DMSO /DMSO/, lasting from 15 to 25 min, rated current of 1.5 μa, daily, 7 sessions.

After a course of conservative treatment of the washing water became clean, endoscopically the increase in volume of the sinus due to reduce swelling of the mucous membrane.

Transaction closure of the fistula using local fabrics, plastics, removing the diseased mucous membrane of the sinuses adjacent to suishu. Postoperative period was unremarkable. Healing smooth, the primary tension. Next the results are good.

Example 2.

Patient, 35 years, was admitted to the hospital with a diagnosis of chronic tangency sinusitis, the sinus in the field

3.6 month ago removed a tooth, perforation of the sinus was not recognized. One month after acute respiratory illness appeared purulent discharge from the left half of the nose. Was held twice the rate of conventional anti-inflammatory treatment with the reorganization of the sinus. Found fistula in the area of patient referred for surgical treatment to the dentist. Upon receipt of a complaint, typical of sinusitis, were absent on the alveolar ridge in the area discovered a thin fistulous passage in his bosom, the washing water is clean. The x-ray is EN course vnutricerepnogo electrophoresis with 5% solution of aspirin in 3% solution of dimethyl sulfoxide, current strength of 2.0 μa, with a duration of 15-20 min, the number of procedures 5 daily. Surgery closure of the fistula with local tissues with the removal of the diseased mucous membrane of the sinuses adjacent to suishu. Healing smooth, by first intention.

Next the results are good.

Using the proposed method of treatment improves the efficiency of treatment of patients with chronic odontogenic maxillary sinusitis, reduce the number of relapses. The effects of medicinal substances by electrophoresis provides deeper penetration of the mucous membrane, which in chronic sinusitis more often thickened, giperplazirovanne, helps reverse the development of pathological changes in the mucous membrane that helps to prevent recurrence of the disease. The technique vnutricerepnogo electrophoresis noninvasive, relatively simple, since it does not require a sinus puncture for injection electrode, which eliminates the need to attract daily for conducting electrophoresis of the doctor, and the availability of special tools. Nutritiously electrophoresis may be called by the nurse in dental clinic.

 

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FIELD: medicine, phthisiology.

SUBSTANCE: one should create pulmonary atelectasis from inside due to applying bronchial valve in tuberculosis-affected lung in case of bronchoscopy depending upon localization of tubercular process. The method enables to avoid course anatomical alterations and functional disorders, avoid the development of reactive exudative pleuritis and rigid pneumothorax.

EFFECT: higher efficiency of therapy.

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