Method for prevention of recurrent oroantral communications

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 surgical dentistry and maxillofacial surgery, and can be used when conducting hamartoma with grafting anastomosis.

There is the classic way of surgical treatment and postoperative management of odontogenic sinusitis with a large oroantral message, in which, after appropriate processing of the surgical field and the production of anesthesia an incision of the mucosa to the bone, vykraivaya trapezoidal flap in the area of the alveolus of the tooth, which extend through the transition to fold the lateral incisors and to the third molar. The flap together with the periosteum usepreview pulled up, exposing the region of the canine fossa and the hole of the extracted tooth.

A chisel and hammer or a chisel, Vojacek in the field of canine fossa create the hole. Pliers or forceps skusyvat bone plate in the region of the front wall, then through the formed box carefully scraped with a sharp spoon diseased tissue or the whole of the mucous membrane of the sinus. Conduct an audit of the alveolus of the tooth. After curettage of the cavity creates an artificial opening in the side of the nasal cavity through the bottom of the bow. Shirt loose plugging iodoform torontoy, the end of the output pads in the nose, mucoperiosteal the flap in the area of the alveolus of the tooth mobilize, placed on the hole of the extracted tooth, and wound tightly sewn [4].

In the postoperative period turundas of the sinus is removed only for 2-3 days, and operating the stitches are removed on day 9-10.

The disadvantage of this method is that in the postoperative period, especially if there is a significant defect of the bottom of the sinus, there is always the risk of relapse oroantral messages. According to various authors, the risk ranges from 4% to 27% [1, 2, 3, 5, 6], what requires further re-admission and re-operative treatment of the patient.

The objective of the proposed method is to reduce the frequency of recurrences of oroantral messages in the postoperative period after operation of hamartoma with grafting anastomosis.

The task to solve due to the fact that the maxillary sinus plugging iodoform torontoi tightly, and the end of the pads carefully placed on the bottom of the sinus, especially in the area of the defect with subsequent removal of the pads of their maxillary sinus only 9-10 days after surgery.

The method is as follows.

Under endotracheal anesthesia after two processing operating margins spend the mucosal incision to the bone, cut out the trapezoid flap in the area of the alveolus of the tooth, which extend along the crease of the upper transition the jaw from one side to the second cutter and the other to the third molar. The flap together with the periosteum usepreview pulled up, exposing the region of the canine fossa and the hole of the extracted tooth.

A chisel and a hammer in the field of canine fossa create the hole. The pliers skusyvat bone plate in the region of the front wall, then through the formed box carefully scraped with a sharp spoon diseased tissue or the whole of the mucous membrane of the sinus. Conduct an audit of the alveolus of the tooth. After curettage of the cavity creates an artificial opening in the side of the nasal cavity through the bottom of the bow. The bosom tightly plugging iodoform torontoy, and the end of the pads carefully placed on the bottom of the sinus, especially in the area of the defect, the end of the output pads in the nose, mobilize mucoperiosteal flap in the area of the alveolus of the tooth, put it on the hole and wound tightly sewn. In the postoperative period turundas of the sinus is removed at a 9-10 day, and operating the sutures are removed at 10-11 days.

The results of the treatment offered by way of 10 patients with a diagnosis of chronic odontogenic sinusitis, sinus maxillary sinus, with a significant defect of the bottom of the sinus, showed that in the postoperative period, all patients had moderate swelling of the soft tissues of the cheek, infraorbital regions, and the pain did not differ with their intensive the awn and was easily stopped by appointment painkillers. In General the postoperative period even. Turundas from the bosom all patients were removed at 9-10 day. Operating the stitches were removed after 10-11 days after the operation.

All patients had positive results of treatment, and length of hospitalization was mainly from 11-12 days. Further patients were discharged to outpatient follow-up care by a dentist-surgeon at the place of residence.

12 patients in the control group with chronic odontogenic sinusitis, sinus maxillary sinus, with a significant defect of the bottom of the sinus, surgical treatment was performed by standard method, carrying loose tamponade sinus iodoform torontoy, then in the postoperative period turundas of the sinus was removed at 2-3 days after the operation.

All patients in this group also noted a smooth postoperative period, moderate swelling of the soft tissues of the cheek, infraorbital areas, minor pain, which was easily stopped by the appointment of painkillers.

Despite this, two patients of the control group during the time the hospital was partly divergence operating seams and the displacement of the flap with the re-formation of fistula mouth with maxillary sinus. In addition, one patient repeatedly asked to receive three weeks after you the claims, when his examination was also diagnosed with a recurrence of the fistula maxillary sinus. All this required repeated hospitalizations all three patients in the hospital and repeated surgical interventions.

Clinical example 1. Patient C., 39 years old, was hospitalized in 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, impaired nasal breathing to the left, unilateral headache and feeling of heaviness in the head, the ingress of water through the mouth into the nose.

From the anamnesis it is established that two months ago in the clinic at the place of residence was removed 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 contact was treated independently: I rinsed my mouth after eating antiseptic solution. A week ago appeared the above symptoms, then 12.03.2011 appealed to the Department tploc and was hospitalized.

The external inspection violations of the configuration of a face. Regional lymph nodes are not enlarged, palpation painless. The mouth of the well, movement of the lower jaw is not difficult. The mucous membrane of the mouth pale pink color, with no signs of inflammation. Well udalennogo the 27 tooth gaping, when it is determined by sensing the broad message of the mouth with the left maxillary sinus. When washing the sinuses through the hole of an extracted tooth washing water mixed with pus.

On the radiograph reveals a reduction in the transparency of the left maxillary sinus.

Dental formula:

AboutAboutAboutAboutAbout
18171615141312112122232425262728
4847/td> 4645444342413132333435363738
AboutAboutAboutAboutAbout

where About is a missing tooth.

The patient was diagnosed with exacerbation of chronic odontogenic left maxillary sinus, fistula of the left maxillary sinus. After recovery of the sinus in three days surgical treatment of the patient was carried out by the proposed method: under endotracheal anesthesia, after two-time processing operating margins held incision of the mucous membrane to the bone, vykraivaya trapezoidal Los is ut in the area of the alveolus 27 tooth which was extended by the transition fold the left upper jaw 22 of the tooth to the right and up to 28 tooth to the left of the hole 27 of the tooth. The flap together with the periosteum was occupational and pulled up, exposing the region of the canine fossa and the hole 27 remote tooth.

A chisel and a hammer in the field of canine fossa has created a hole. The pliers have skuzili bone plate in the region of the front wall, then through the formed box carefully scraped with a sharp spoon diseased tissue and the entire mucosa of the left maxillary sinus. Spent curettage and revision of the alveolus 27 of the tooth. Created an artificial hole in the side of the nasal cavity through the lower left of the bow. The left maxillary sinus tightly tamponirovanie iodoform torontoy, and the end of the pads carefully laid on the bottom of the sinus, especially in the area of the defect, the end of the pads taken out through an artificial fistula in the nose. Mucoperiosteal flap in the area of the alveolus 27 tooth mobilized, put her on the hole 27 of the tooth, and the tightly wound left the house taking the Dacron.

In the postoperative period, the patient had moderate swelling of the soft tissues of the left cheek and infraorbital regions, and the pain did not differ in its intensity and was easily stopped by appointment painkillers. In General, the postoperative course was smooth. Turunc is from the sinus of the patient was removed on 10 day, while operating, the stitches were removed after 11 days after the operation.

The length of hospitalization was 11 days. In the future the patient was discharged to outpatient follow-up care by a dentist-surgeon at the place of residence.

Visual inspection of the patient within 7 days after discharge from the hospital showed that the specific complaints, the patient does not show. Locally: the wound in the mouth healed by first intention, signs of recurrence of the fistula in the left maxillary sinus no. The patient is recommended to begin the work.

Clinical example 2. Patient C., 48 years old, was hospitalized in the Department of maxillofacial surgery 15.01.2012 year. The patient complained of airflow through the nose into the mouth, the ingress of water through the mouth into the nose, moderate pain in the alveolus 16 tooth.

From the anamnesis it is established that two days ago in the clinic at the place of residence has removed 16 tooth. The removal was difficult. After removal was diagnosed with a perforated bottom right maxillary sinus, the patient was sent to the hospital. 15.01.2012 gabrielse Department tploc and was hospitalized.

The external inspection violations of the configuration of a face. Regional lymph nodes are not enlarged, palpation painless. The mouth of the well, movement of the lower jaw is not difficult. The mucous membrane of the mouth pale pink color, with no signs of inflammation. L the NCA remote 16 tooth gaping, when it is determined by sensing the broad message of the mouth with the right maxillary sinus. When washing the sinuses through the hole of an extracted tooth wash water clean.

On the radiograph reveals a reduction in the transparency of the right maxillary sinus.

Dental formula:

AboutAboutPAbout
18171615141312112122232425262728
4847 4645444342413132333435363738
ToToAbout

where About is a missing tooth, P - seal, K - root.

The patient was diagnosed odontogenic right maxillary sinusitis, perforation of the bottom of the right maxillary sinus through the hole remote 16 tooth.

Surgical treatment of this patient was carried out by the proposed method: under endotracheal anesthesia, after two-time processing operating margins held incision of the mucous membrane to the bone, vykraivaya trapezoidal flap in the area of wells remotely what about the 16 tooth which was extended on an interim crease of the right upper jaw 12 of the tooth to the left and up to 18 tooth to the right of the hole 16 of the tooth. The flap together with the periosteum was occupational and pulled up, exposing the region of the canine fossa and the hole remote 16 tooth.

A chisel and a hammer in the field of canine fossa has created a hole. The pliers have skuzili bone plate in the region of the front wall, then through the formed box carefully scraped with a sharp spoon diseased tissue and the entire mucosa of the right maxillary sinus. Spent curettage and revision of the alveolus 16 tooth. Created an artificial hole in the side of the nasal cavity through the lower right of the bow. Right maxillary sinus tightly tamponirovanie iodoform torontoy, and the end of the pads carefully laid on the bottom of the sinus, especially in the area of the defect, the end of the pads taken out through an artificial fistula in the nose. Mucoperiosteal flap in the area of the alveolus 16 tooth mobilized, put her on the hole 16 of the tooth, and the tightly wound left the house taking the Dacron.

In the postoperative period, the patient had moderate edema of the soft tissues of the right cheek and infraorbital areas and moderate pain, which was easily stopped by appointment painkillers. In General, the postoperative course was smooth. Turundas of the sinuses in the Aulnay deleted 10 day, while operating, the stitches were removed after 11 days after the operation.

Time of hospitalization was 12 days. In the future the patient was discharged to outpatient follow-up care by a dentist-surgeon at the place of residence.

Visual inspection of the patient within 14 days after discharge from the hospital showed that the specific complaints, the patient does not show. Locally: the wound in the mouth healed by first intention, signs of recurrence of the fistula of the right maxillary sinus is not present.

The advantages of the proposed method lies in the fact that, as the bosom was swabbed torontoi tightly and turunda is 9-10 days, reduces not only the risk of divergence operating seams as due to release of specimens from the sinuses through the seams at random sneezing patient and the risk associated with Smoking patient and meal. Simultaneously, within 10 days is favorable healing, engraftment and epitelizatia mucosa, as well as flap - antiseptic and regenerating effect of iodoform on the maxillary sinus.

Literature

1. Esikuva T.S. Modern methods of diagnosis and treatment of odontogenic oroantral messages and maxillary perforating sinusitis. / Tselikov // Abstract. dis. CMN - 1996. - 23 S.

2. Lavrent'ev S. Application in complex treatment of odontogenic perforating sinusitis OST is autoplastic fistula bottom of the maxillary sinus. / Set // Abstract. dis. CMN - 1996. - 24 S.

3. Mukhametzyanov T.S. Comprehensive treatment of odontogenic perforating sinusitis. / Tashmuhamedova // Abstract. dis. CMN - 1990. - 23 S.

4. Robustula YEAR "dental Surgery". M. 2003. - 504 S.

5. Shulman FI Foreign body in the maxillary sinus. Doctor's tactics./ V.A. Kozlov, Fieselman. // 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. / Fieselman // Mater. VII international conference of oral and maxillofacial surgeons and dentists, 28-30 may 2002, St. Petersburg. - 2002. - S-171.

The method of relapse prevention oroantral messages, including incision of the mucous membrane to the bone with the cutting trapezoidal flap in the area of the alveolus of the tooth, the extension of the section on transition the crease of the upper jaw to the second cutter on one side and to the third molar on the other, the exposed area of the canine fossa and the alveolus of the tooth, holding hamartoma in the field of canine fossa, scraping pathologically changed tissues or the whole of the mucous membrane of the maxillary sinus, the revision of the alveolus of the tooth, creating an artificial hole in the side is from the nasal cavity through the bottom of the bow, conducting tamponade of the maxillary sinus iodoform torontoi with the removal end of the nose pads, the mobilization of mucoperiosteal flap in the area of the alveolus of the tooth and its placement on the hole, the stitches tightly, characterized in that the maxillary sinus plugging iodoform torontoi tightly, and the end of the pads carefully placed on the bottom of the sinus, especially in the area of the defect with subsequent removal of the pads from the maxillary sinus only 9-10 days after surgery.



 

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