Method of treating odontogenic maxillar sinusitis with oroantral fistula

FIELD: medicine.

SUBSTANCE: postoperative period involves tamponage with Coletex-AGGDM wet tissue within middle nasal passages. The tamponage area is exposed to laser light in the infrared band at a wave length 0.95 mcm at the output power of 2-3 mWt for 4-5 min. After the exposure, the tissue is left for one day. The following procedures are performed with the tissues placed in the middle nasal passage within a natural fistula and on a mucous membrane of a hard palate in a projection of a maxillary sinus bottom. The tamponage area and skin in the projection of the maxillary sinus within an anterior sinus wall are exposed. 2-3 procedures are performed at the output power of 5-7 mWt for 7-10 min for one field. 4-6 procedures are performed at the power of 15-20 mWt for 3-10 min for each field. After the exposure is terminated after each procedure, the endonasal tissue is left for 6-8 hours.

EFFECT: method enables providing higher clinical effectiveness by antibacterial, antiseptic, anti-oedematous effects, recovering the ciliary transport function without injuring the ciliated epithelium; eliminating the postoperative complications, such as sinus bleeding and cicatrical deformity of the mucous membrane.

2 ex

 

The invention relates to medicine, namely to oral surgery, maxillofacial surgery, otolaryngology, and can be used for rehabilitation of patients with inflammatory diseases of the maxillary sinus.

Often after surgery, sinusotomy complications associated with dysfunction of ciliary transport, scar formation in the cavity of the maxillary sinus, requiring additional surgical procedures or long-term postoperative treatment (treatment of sinus antiseptic solution). These complications usually occur when swelling in the area of natural fistula maxillary sinus, when the surgeon during the operation does not produce a natural extension of fistula in his unit.

Rapid restoration of the integrity and function of the ciliated epithelium of the maxillary sinus and the nasal cavity is the main task of the surgeon after the surgery, sinusotomy and is directly dependent on the state of natural anastomoses of the middle nasal passage.

There is a method of photodynamic treatment of acute purulent sinusitis (RF Patent No. 2228775, IPC A61N 5/067, publ. 2004), which are as follows: Maxillary sinus through the puncture needle Kulikovskii through the bottom of the bow is released from the hold, give it (through puncture needle) photosensitizer (PS), namely the porphyrin chlorin number, carry out irradiation of the walls of the sinus laser radiation with a wavelength matching the wavelength of peak absorption used FS. Irradiation is carried out 2 hours after the introduction of the FS. The set dose is conducted in stages with an interval of 20-30 s, during which the sinus blow (through puncture needle is drawn through the lower nasal passage)without accumulation of mucus.

When using this method of manipulation in the cavity of the maxillary sinus, is not considered a natural state of fistula, when the block which restore the integrity of the ciliated epithelium does not occur and increases the probability of relapse of maxillary sinusitis. All manipulations are performed by puncture of the maxillary sinus through the lower nasal passage, which is not physiological, because no epithelium and, as a consequence, the natural cleansing of the cavity of the sinus with the help of ciliary transport.

The closest is a method of treatment of chronic odontogenic sinusitis with Oro-antral sostem (RF Patent No. 2285524, IPC A61N 5/067, publ. 2004), including the introduction of a medicinal product by laserform through the mucosa of the hard palate and the projection of the maxillary sinus through the skin in the area of the anterior wall of the sinus laser radiation in the infrared range of wavelength of 0.85 μm.

The disadvantage of this method is that the gel is injected directly into the cavity of the maxillary sinus and, in fact being the obturator Oro-antral fistula, impedes the function of the ciliated epithelium of the maxillary sinus and promotes long-term maintenance effects of the maxillary sinus, which subsequently requires the use of more conservative methods of recovery of the mucosa of the maxillary sinus.

The problem posed by the authors, is to eliminate the mentioned disadvantages, to improve the effectiveness of treatment, to develop a set of measures that will simultaneously affect the swelling of the mucous membrane of the maxillary sinus, and the elimination of abnormal bacterial flora, and to restore the function of the ciliary transport without trauma ciliated epithelium and save or prompt restoration of its functions by restoring the patency of the fistula natural.

For this purpose in the treatment of odontogenic maxillary sinusitis with Oro-antral sostem, including the introduction of a medicinal product, the impact on the drug through the mucosa of the hard palate and the projection of the maxillary sinus through the skin in the anterior wall of the sinus laser radiation in the infrared range of wavelength of 0.85 μm, proposed quality is TBE drug use moistened towel "Collex-AGDM". In doing so, a tamponade of a damp cloth in the middle nasal passage immediately after the operation, carry out impact on the region tamponade laser radiation in the infrared range with output power of 2-3 mW for 4-5 minutes After irradiation, the cloth leave for days. Subsequent procedures are conducted by placing napkins on average, the forward progress in the field of natural fistula and on the mucous membrane of the hard palate in the projection of the bottom of the maxillary sinus. Irradiated region tamponade and the skin projection of the maxillary sinus anterior wall of the sinus, and 2-3 of the procedures performed with an output of 5-7 mW for 7-10 minutes on the field and 4-6 treatments are carried out with a capacity of 15-20 mW 3-5 min on each field, while at the end of radiation after each procedure endonasal napkin leave for 6-8 hours.

The proposed method of treatment allows not only to achieve the introduction of drugs more physiological way immediately after surgery, but also to eliminate the phenomenon of post-operative complications such as bleeding and inflammation in the sinus, not acting aggressively on the mucous membrane of the sinus and causing her cicatricial deformity. During the method occurs antibacterial antiseptic anti-edema effect that will quickly restore the function of the ciliary transport of the mucous membrane of the maxillary sinus, when there is a natural readjustment of the sinus. When applying this method, the rehabilitation of patients with maxillary sinusitis is reduced by 3-4 days of disability.

The implementation of the method is demonstrated on specific clinical examples.

Example 1

Patient M born in 1965 he enrolled in the Department of maxillofacial surgery with complaints of difficulty in nasal breathing right, discharge from the nose with an unpleasant odor, water from the oral cavity into the nasal cavity.

From the anamnesis: in the 3 months prior to admission in the dental clinic at the place of residence has been removed, the tooth is 1.7, then the patient began to notice the water from the oral cavity into the nasal cavity. After 1 month there was a feeling of heaviness in the right infraorbital region for specialized medical help, the patient is not treated. 2 months after the onset of severe pain in the right infraorbital region was hospitalized in the Department of maxillofacial surgery with a diagnosis of chronic odontogenic maxillary sinusitis on the right, Oro-antral fistula in the area of the tooth 1.7.

During the preoperative examination revealed a total darkening of the cavity of the maxillary sinus, block natural anastomoses of the middle nasal passage. The Department conducted operation sinusotomy right with the plastic Oro-antral fistula and expanded the e natural anastomoses of the middle nasal passage. After the operation, the average of the bow was swabbed with a napkin "Collex-AGDM" and posted to the region tamponade (endonasal) laser radiation in the infrared range output power of 3 mW 5 min, the tissue was left in the middle nasal passage in 1 day. We did not report bleeding in the postoperative period of the middle nasal passage. On the 2nd day after endoskopicheskoi rehabilitation of the nasal cavity were replaced napkins in the middle nasal passage, placing napkins on the mucous membrane of the hard palate in the projection of the bottom of the maxillary sinus and the 2nd and the 3rd day was affected by laser irradiation output power of 6 mW for 8 minutes on each field and region natural fistula and the projection of the maxillary sinus from the hard palate and the front wall. The cloth was left under the middle nasal sink 6 hours after the procedure. Then from 4 to 6 days worked 20 mW for 3 minutes on each field.

At 1 day after the procedure, the patient noted a significant reduction in the feeling of heaviness in the recovery area, phenomena bleeding from the recovery area, we did not observe. When rinoskopii we noted a significant reduction in edema in the field of natural fistula daily. The patient was discharged on day 7. Postoperative recurrence was not bluedale.

Example 2

Patient P. born in 1978 was admitted to the Department of oral and maxillofacial surgery with a diagnosis of chronic odontogenic fungal maxillary sinusitis, foreign body left maxillary sinus.

Complaints at the time of admission: pain in the left infraorbital area, discharge from the left nasal passage.

From history: 10 years ago during the endodontic treatment of the tooth 2.6 in the cavity of the left maxillary sinus was injected filling material, after 7 years, the patient began to complain of periodic obstruction of nasal breathing on the left easily fixed by the use of vasoconstrictor drugs.

In the preoperative period computed tomography detected a foreign body in the region of the floor of the maxillary sinus hypertensives density, uneven thickening of the mucous membrane in the region of the floor of the maxillary sinus, closing the lumen to the level of the middle nasal passage.

Patients received endoscopic surgery, during which the cavity of the maxillary sinus deleted: foreign body (filling material) and the surrounding mycelium of the fungus (confirmed histologically), marked polypous changes of the mucosa in the area of the walls of the maxillary sinus, extend a natural anastomosis with the middle nasal passage.

On Windows the years of operation the area of the middle nasal passage was swabbed with a napkin "Collex-AGDM" and held laser radiation in the infrared range to the area tamponade (endonasal) output power of 3 mW, 5 min, napkin left in the middle nasal passage in 1 day. We did not report bleeding in the postoperative period of the middle nasal passage. On the 2nd day after endoscopic rehabilitation of the nasal cavity were replaced napkins and overlay napkins on the mucous membrane of the hard palate in the projection of the bottom of the maxillary sinus and the 2nd and the 3rd day was affected by laser irradiation on the area's natural fistula, and the projection of the maxillary sinus from the hard palate and the anterior wall of the output power of 7 mW for 10 min on each field. The cloth was left under the middle nasal sink for 8 hours after the procedure. Next 4 to 6 days affected every field of 15 mW for 5 minutes

Daily conducted endoscopic monitoring the status of the mucous membrane of the maxillary sinus through enhanced natural fistula. On the 3rd day noted a significant reduction in swelling of the mucous membrane of the maxillary sinus and decrease the size of polypous growths, the absence of complaints from the patient. The patient was discharged on the 6th day. In the remote period after 6 months of recurrent sinusitis no, nasal breathing is not impaired.

In this way the treatment in 114 patients, this group was compared with the control, where they spent only endoscopic reorganization of the nasal cavity in posleoperatsionnom period and said, in the group treated by the proposed method, noted the lack of complaints in patients already on the 2nd day after the operation, on the 3rd day already 97 patients considered normal nasal breathing, these data confirmed objective method spirometry.

The method reduces the time of rehabilitation in the postoperative period to reduce the likelihood of bleeding in the postoperative period and other complications, reduce hospital stay.

Treatment of odontogenic maxillary sinusitis with Oro-antral sostem in the postoperative period, including the introduction of a medicinal product, the impact on the drug through the mucosa of the hard palate and the projection of the maxillary sinus through the skin in the anterior wall of the sinus laser radiation in the infrared range of wavelength of 0.85 μm, characterized in that the quality of drug use moistened towel "Collex-AGDM, perform tamponade damp cloth in the middle nasal passage immediately after the operation, carry out impact on the region tamponade laser radiation in the infrared range with output power of 2-3 mW for 4-5 min after irradiation cloth, leave for a day, the following procedures are conducted by placing napkins on average, the forward progress in the field of natural the military fistula and on the mucous membrane of the hard palate in the projection of the bottom of the maxillary sinus, irradiated region tamponade and the skin projection of the maxillary sinus anterior wall of the sinus, and 2-3 of the procedures performed with an output of 5-7 mW for 7-10 minutes on the field and 4-6 of the procedures performed with a capacity of 15-20 mW 3-5 min on each field, while at the end of radiation after each procedure endonasal napkin leave for 6-8 hours.



 

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