Method for surgical management of maxillary sinus diseases
SUBSTANCE: invention can be used in the surgical management of non-inflammatory maxillary sinus diseases (MSD). An endonasal opening and sanitation of the maxillary sinus are performed. A plate of a synthetic polymer, porous polytetrafluoroethylene (ePTFE) 1 mm thick and with an open porosity of 70% is used to model a transplant of an adequate shape and by 5% more than the area of a bone postoperative defect of a posterior wall of the maxillary sinus. The transplant is laid on the residual anterior bone wall of the maxillary sinus. The soft tissues are closed completely rigidly fixing the transplant to the bone.
EFFECT: method enables preventing early postoperative complications related to an in-growth of the cicatrical tissue into the sinus lumen by forming a fibrous frame of the connective tissue closing the postoperative defect.
The invention relates to the field of medicine and will find application in ENT practice in the surgical treatment of diseases of the maxillary sinus (HFI), mainly, not of an inflammatory nature.
In the late nineteenth century it was proposed surgical treatment of diseases of the HFI opening through the front wall, the so-called externally way of opening the sinuses. The front wall of the HFI covered with soft tissues of the cheeks, which are represented by the skin, subcutaneous fatty tissue and the periosteum (Corning, K. Topographic anatomy. - GMS, 1931. S. 135-136). Externally way of opening HFI involves incision of the mucous membrane and periosteum in the vestibule of the mouth on the transition to the crease, then remove part of the bone of the front wall HFI to size, allowing you to explore all of the sinus cavity, and conduct restoration activities. Complete the intervention of the restoration of the anatomical structures HFI - perform closure of bone defects.
The vast majority of relapses due to the fact that trepanation opening in the anterior bony wall of the sinus is the window for growing into its lumen scar-modified soft tissues of the cheeks, quickly leading to fibrotic degeneration of the mucous membrane (Plastic anterior bony wall of the maxillary sinus by hamartoma/ Century And. Rodin, B. N. Nechiporenko, S. M. Krut // GENRB. 1978. No. 4. - S. 95-97). The authors note that the presence of a bone defect in the anterior bony wall of the HFI leads to complications, aggravating the postoperative period, as in his cheeks are often formed infiltrates, soft tissue of the cheeks penetrate through a bony defect in the sinus cavity, they are formed granulation, in some cases, the scar tissue is fused with the walls of the sinuses, creating isolated cavity containing pus and granulation.
The number of relapses was relatively high and remained unchanged for a long time, and further, most of the proposals for the prevention of recurrence was based on this position - close trepanation opening in the anterior wall of the sinus to prevent ingrowth into its lumen scar modified soft tissues of the cheeks.
So, C. D. Malagnini ("Free transplantation of bone and cartilage tissues in otorhinolaryngology (30 years experience)" / Problems implantology in otorhinolaryngology: Sat. Tr. / IX scientific and practical use. proc. torinla. of Moscow. - M., 2000. - S. 24-26) was proposed a method of surgical treatment of diseases of the HFI, providing extranasal opening of the sinus, its restoration, filling the cavity HFI formalisation hologramm, obliterating the lumen and closing postoperative bone defect is arena sinus walls.
The disadvantage of this method is off HFI from the physiological mechanism of the nasal cavity, the interactions of the paranasal sinuses, a common mechanism of mucociliary clearance and line antibacterial defense.
Century Westemhagen (Westemhagen Century in the article "Die operative Kieferhoh-lensanierung - ein Routineemgriff?" // HN0. - 1983. - Bd.31. - H. 5. - S. 158-160) proposed a method of surgical treatment of diseases of the HFI, providing her extranasal opening, cavity sanation, and then closing the bone or freeze-dried Dura mater postoperative defect of the anterior bony wall of the HFI.
RF patent №2428944 (publ. 2011, BIPM No. 26) secured Method of surgical treatment of fractures of the upper wall of the maxillary sinus," which includes the opening of the sinuses, Redressal bone fragments of the upper wall of the sinus at the seat of fracture, elimination of interposition soft tissue at the first stage of the operation, without entering into the cavity of the orbit, soft tissue of orbit and eyeball raise and set in the anatomically correct position directly from the sinuses, eliminating the interposition of soft tissues. Form the orbital fragment demineralized bone graft (VCT) in accordance with the shape and dimensions of the upper wall HFI enter and establish in his bosom, lifting him up, locking them damaged bone fragments in the right is ulozhenie. Then cut out the reference slice VCT in the form of a rigid rectangular plate, which is injected into the sinus, straight down into the strut abutting the upper part of it in the orbital fragment, and the lower in the lower portion of the lower wall of HFI. In subsequent cut a horizontal slice VCT in the form of a trapezoidal rigid plate, put it in his bosom and wide end rests in the reference slice VCT, and narrower in the lateral Bay sinus. The surgery is completed in the usual way.
The main disadvantage of the above methods is that due to the relatively late accretion of the graft with the bone edges of the wound can enter the scar-changing soft tissue into the lumen of the sinus, which, in turn, can lead to complications, aggravating the postoperative period.
The closest in technical essence of the prototype is a method of surgical treatment of diseases of the HFI described C. A. Kozlov et al. in the article "the Way of closing the anterior wall of the maxillary sinus demineralized allogenic bone graft" / Century A. Kozlov, G. B. Troshkov, C. I. Saveliev, " Vestn. surgery to them. I. I. Grekova, - 1983. - So 130. No. 3. - S. 142). The method involves extranasal opening HFI, its restoration and plastic surgical bone defect in the anterior wall of the graft. For plastics PEFC is an operational defect in the anterior wall of HFI use VCT without his special commit.
VCT after placing them in the bone wound begin to induce osteogenesis, being replaced by newly formed bone tissue. They are flexible, easy to bend, cut and modeled. However, VCT, being a wonderful material to restore the patient's own bone, quite a long time to develop reparative processes between the native bone of the patient and graft, which is confirmed by clinical (Bogatov A. R. "Plastic bone defects of the walls of the paranasal sinuses demineralized grafts (Clinical-experimental study)." - Diss. Prof. the honey. Sciences. Rostov n/a, 2011. - 317 C.) and experimental studies (Romaszewska And. And. "Osteogenesis of the frontal bone after implantation of demineralized bone graft in experimental animals" // Rossick. torinla. - №1(56). - 2012. - S. 144-148).
The disadvantages of the prototype are: long-term formation of callus and other elements of the reparative process in the hearth transplant VCT that allows ingrowth into the lumen of the HFI scar tissue during the time interval when there is a free space between the graft and the edges of the recipient's own bone, which can cause complications in the early postoperative period.
The objective of the invention is to develop a method of surgical treatment of diseases of the HFI, preventing the th development of complications in the early postoperative period, related ingrowth into the lumen of the sinus of scar tissue.
The technical result, objectively manifested in the implementation of the proposed method is to prevent ingrowth into the lumen of the HFI scar tissue in the early postoperative period, which increases the effectiveness of treatment and prevent the development of complications in the early postoperative period
The technical result is achieved by the fact that the patient perform extranasal opening HFI, its reorganization and plasticity postoperative bone defect in the anterior wall of the graft. After readjustment of HFI plate of synthetic polymer - porous polytetrafluoroethylene (ePTFE) with a thickness of 1 mm and an open porosity of 70% model transplant, adequate in form and 5% more square postoperative bone defect in the anterior wall of the HFI. Put a graft on bone remains of the front wall HFI. Soft tissue is sutured tightly, rigidly fixing the graft to the bone.
Of numerous materials, past experimental and clinical testing, the most suitable for implantation were recognized as some polymers, including synthetic polymer polytetrafluoroethylene (ePTFE), which has outstanding biological inertness, and resistance to all known pathways of biodegradation. One of the varieties of the two which is porous polytetrafluoroethylene, which happens to be 2 types of porosity: 36 and 70%, and the spatial structure provides the ingrowth of newly formed connective tissue in his column. ePTFE - synthetic polymerization product of tetrafluoroethylene, consisting of a fluorocarbon chain. Due to its unique chemical inertness, high molecular weight, absence of ester groups and carbon-it is resistant to all the most important ways of biodegradation of polymeric materials as a noncellular: nonenzymatic and enzymatic hydrolysis, oxidative degradation, catalysis metal ions. Synthetic ePTFE polymer is produced by CJSC "Scientific-production complex "Ecoflon", , Saint Petersburg (THE 9398-007-23167010-2008) in the form of a plate which is easily modeled configuration and thickness (Nikolaenko, B. N. "the Use of PTFE implants in ophthalmology": author. Diss. Kida. the honey. of Sciences, St. PETERSBURG, 2005. 23 C.).
According to our observations made in the clinic of otorhinolaryngology state budgetary educational institution of higher professional education "Rostov state medical University" of Ministry of health of Russia (Growth (MCM) was found in 3 patients operated previously, according to the present method, with a second opening through HFI 12, 13, and 18 days after the first intervention, under the grafts made of ePTFE, established on the area after operation the th bone defect in the anterior wall of HFI, formed fibrous skeleton of coarse-fibered connective tissue that covers the postoperative bone defect in the anterior wall of the HFI, insulating bosom against the ingress of scar tissue cheeks.
The proposed method is as follows.
In a patient with the disease HFI non-inflammatory type, such as a cyst, perform extranasal the opening of the sinuses. HFI sanitize and remove the cyst. Then from the plate of ePTFE with a thickness of 1 mm and an open porosity of 70% model transplant, adequate in form and 5% more square postoperative bone defect in the anterior wall of the HFI. Put a graft on bone remains of the front wall HFI, the soft tissue is sutured tightly, rigidly fixing the graft to the bone.
In the postoperative period antibacterial drugs the patient is not appointed, the sutures will dissolve on their own within 5-6 days after surgery. Patient discharged within 1-2 days after surgery to outpatient care physician at the place of residence.
Practical feasibility of the proposed method is illustrated by an example from clinical practice.
Example: the patient M, 38 years old, medical history, No. 297/792, was treated at the ENT clinic of the Rostov state medical University, diagnosed with retention cyst of the right HFI - education by size 12×22 mm, filled with a homogeneous liquid content, the outcome is the future of alveolar Bay, it was clearly foreseeable at HFI on computerized tomography of the paranasal sinuses. The next day after hospitalization was carried out surgical treatment according to the claimed method.
It was made extranasal opening right HFI and subsequent sanitation - removing retention cysts of the alveolar Bay sinus. Then from the plate of synthetic polymer - porous polytetrafluoroethylene (ePTFE) with a thickness of 1 mm and an open porosity of 70% of the simulated graft in the form of bone postoperative bone defect in the anterior wall of the HFI and 5% more of its area. The remnants of the anterior bony wall of the HFI laid the prepared graft of a porous tetrafluoroethylene (ePTFE). Then the graft is laid in the soft tissue of the cheeks, which are rigidly fixed it, after which the soft tissue is sutured with catgut tightly. Through the day the patient is examined: the seams are good, the clearance between them is detachable from the wound no.
In the postoperative period antibacterial drugs the patient was not prescribed. Strands of catgut resolved independently. After 1 day after surgery the patient M in a satisfactory condition and was discharged for outpatient care physician at the place of residence. The time of stay of the patient M patient was 3.4 bed-day.
Control examination of a patient in 1.5 months. not found the OS is ogneni in the early postoperative period, related ingrowth into the lumen of the HFI scar tissue.
The proposed method was tested in the ENT clinic of Rostov state medical University in 15 patients and showed positive results. Recurrence of disease or development processes in HFI associated with ingrowth into the lumen of the sinus of scar tissue, in the near and long-term postoperative periods a single patient were noted. The average time of hospital stay was 3.6 bed-days. The postoperative period in all patients was uneventful, cosmetic defects of the face was not.
The average time of hospital stay of 15 patients with diseases of the HFI-cysts HFI operated according to the prototype, was 6, 12 bed-days, which is 1.7 times more than the average time of hospitalization of patients operated using the proposed method.
Thus, compared with the prototype of the proposed method has the following advantages: prevents the development of complications in the early postoperative period associated with ingrowth into the lumen of the sinus of scar tissue, and almost 1.7 times reduces the treatment time.
The method of surgical treatment of diseases of the maxillary sinus (HFI), including extranasal opening HFI, its reorganization and plasticity postoperative bone defect its anterior wall of the graft, characterized in that after Sana the AI HFI of the plates of synthetic polymer porous polytetrafluoroethylene (ePTFE) with a thickness of 1 mm and an open porosity of 70% model transplant, adequate in form and 5% more square postoperative bone defect in the anterior wall of HFI, put a graft on the remnants of the anterior bony wall of the HFI, the soft tissue is sutured tightly, rigidly fixing the graft to the bone.
SUBSTANCE: bioactive porous 3D-matrix for tissue engineering involves a resorbed partially crystalline polymer having a porosity of 60-80% and a pore size of 2 to 100 mcm. A biopolymer gel having a particle size of 30-100 mcm is incorporated into a portion of the pores. A polymer/gel ratio makes 99:1 to 50:50 wt %. The matrix is prepared by grinding a mixture of gel and polymer powder having an average particle size of 100 mcm, and the prepared mixture fills prepared moulds to be placed in a high-pressure chamber wherein the temperature is increased to 25-40°C first, and then the CO2 pressure is increased to 4.0-25.0 MPa. The system is kept in the above environment for 1 hour, and then the chamber pressure is discharged to an atmospheric one for 30-120 minutes; thereafter the temperature is decreased to a room value, and the patterns are removed.
EFFECT: ensuring flexibility of using the matrix in various organs and systems, no toxicity, higher ability to tissue regeneration stimulation, prolonged effect of biostimulation.
6 cl, 5 ex, 1 tbl, 4 dwg
SUBSTANCE: tissue regeneration or healing is stimulated when using a structure comprising a multilayer plate of a collagen membrane material, which contains a lamellated barrier material of pure collagen prepared of a natural collagen tissue; the lamellated barrier material containing a barrier layer with an outer smooth barrier surface and a fibre surface, which is opposite the outer smooth barrier surface. The structure additionally contains a matrix layer of a collagen sponge material adjoining the fibre surface.
EFFECT: matrix layer of the collagen sponge material is absorbed by an individual's body at a higher rate, than the lamellated barrier material.
20 cl, 3 dwg, 5 ex
SUBSTANCE: invention refers to medicine. There are described methods for making implantable medical devices, preferentially of PEEK, having antimicrobial properties. The antimicrobial action is ensured by implantation of ceramic particles containing antimicrobial metal cations into the molten PEEK resin to be cooled and finally shaped by injection moulding, cutting and mechanical treatment or by other processing methods.
EFFECT: implants possess effective antimicrobial action for reducing a bacterial growth and a risk of infection.
12 cl, 1 dwg, 3 tbl
SUBSTANCE: invention refers to medicine. What is described is a method for preparing a cell-free organic tissue of a human or animal origin for the vitality recovery, particularly for introducing living cells, involving a stage of making a number of holes (4; 14) in the cell-free organic tissue (2; 12) through its surface (8; 18) and setting in the tissue (2; 12); wherein the said number of holes (4; 14) is formed using a needle or a kit of needles. The holes (4; 14) are partially intersected thereby forming partially connected holes (4; 14).
EFFECT: invention also refers to a respective cell-free organic tissue (2; 12) of the human or animal origin.
17 cl, 3 dwg
FIELD: process engineering.
SUBSTANCE: invention relates to medicine. Proposed method can be used in stomatology and orthopedics for production of medical materials stimulating recovery of bone tissue defects, for making dental stopping and dental pastes. It comprises preparation of mix containing compounds of calcium, phosphorus, silicon and sodium, impregnation of bioinertial incombustible porous matrix with made mix, matrix is composed of ceramics from aluminium or zirconium oxides followed by calcination. Note here that silicon compound represents tetraethoxysilane. Note also that phosphoric acid ether is used as phosphorus compound. Calcium and sodium compounds are represented by their carboxylates in polar organic solvent. This method includes making the thin layers on more strong bioinertial porous ceramics. Note also that said process involves no special complicated equipment and expensive reagents.
EFFECT: production of glass ceramics directly from solution omitting sol preparation stage, simplified and accelerated process.
7 cl, 5 ex
SUBSTANCE: invention refers to porous microsphere granules with the adjusted particle size for bone tissue regeneration. The above microspheres have a size within the range of 1-1000 mcm, have through pores of the size of 1-100 mcm and total porosity 40-75%. The declared microsphere granules are prepared by granulation by electrospinning, and heat-treated. A mixture used to form the granules by electrospinning contains a mixture of magnesium orthophosphate and biological hydroxyapatite of bovine demineralised bones in ratio 0.5:1.0, as well as 1-3% sodium alginate in distilled water and a hardener representing saturated calcium chloride.
EFFECT: invention provides preparing the microsphere granules possessing biocompatibility, biodegradation, osteoinduction and osteoconduction properties and able to be substituted by the bone tissue.
SUBSTANCE: invention relates to medicine, namely to ophthalmosurgery, and in particular to scleroplasty. Transplant for scleroplasty has polymeric base, covered with porous layer of the same polymer. As polymer base, transplant includes layer, made from porous stretched polytetrafluoroethylene, which has nodular-fibrillar structure. As porous layer, it includes layer of porous polytetrafluoroethylene, which has volume fraction of void space 15-40%, specific surface of void space 0.25-0.55 mcm2/mcm3, average distance between voids in volume 25-30 mcm and average chord volume 8-25 mcm, with the total width of transplant constituting 0.15-0.35 mm (first version). Transplant for scleroplasty can also include porous layer of polymer, whose surface is processed to add compatibility with sclera tissue. Transplant surface is processed by application of allogenic dermal fibroblasts of 3-5 passages of culturing, with the total width of transplant being 0.15-0.35 mm (second version).
EFFECT: chemically and biologically inert transplant, which ensures effect of invasion of sclera tissues, is obtained.
SUBSTANCE: invention relates to chemical-pharmaceutical industry and represents artificial dura mater, produced from electrospinning layers by technology of electorspinning, with electrospinning layer, consisting of, at least, hydrophobic electrospining layer, which is produced from one or several hydrophobic polymers, selected from polylatic acid and polycaprolactone.
EFFECT: invention ensures creation of artificial dura mater, which has good tissue compatibility, anti-adhesiveness and possibility of introducing medications, preventing cerebrospinal fluid outflow during regeneration of person's own dura mater.
30 cl, 7 ex, 11 dwg
SUBSTANCE: invention refers to medicine, particularly to ophthalmic and maxillofacial surgery, and aims at repairing post-traumatic defects and deformations of the eye-pit bottom and walls. What is described is an implant in the form of a solid perforated plate which is formed by photocuring of a light curing composition; when heated the implant (a cure temperature 70-90°C) keeps the shape after self-cooling that provides high strength and biocompatible properties of the material. The cure temperature of the material is much higher than a temperature of a human body that ensures maintaining the physical and mechanical properties of the implant inserted in the human body, namely the material remains strong, when fixed it shows no cutting and breaking. Before the implantation, the plate is heated to the required temperature and bent so that it is congruently repeats the eye-pit shape in a place of the defect, overlaps the defect and supports the eye in the right anatomical position.
EFFECT: reducing the likelihood of graft rejection and reducing a quantity of various complications by improving the biocompatible properties of the material.
1 tbl, 5 ex
SUBSTANCE: group of inventions refers to medicine. In a method for making an antimicrobial silver-containing endoprosthesis according to the 1 version, a mesh material is made of synthetic polymer fibres with a silver-containing composition in a solution, dried; the endoprosthesis made of polyvinylidene fluoride monofilaments of the diameter of 0.09-0.15 mm in the form of a form-stable combined weaved knitted cloth at surface density of the endoprosthesis 80-200 g/m2, processed for 2-4 hours in 3-15% silver nitrate solution in dimethylsulphoxide, dried in air for 17-20 hours, processed again, dried, additionally processed in the composition consisting of 4-8 wt % of aqueous sodium hydroxide, 6-10 wt % of aqueous ammonium and 0.3-0.7 wt % of aqueous glucose in proportions 100:4:4, at temperature 20-25°C, and then washed in water, and dried. According to the 2 version, the endoprosthesis made of polypropylene monofilaments of the diameter of 0.07-0.15 mm, at surface density 20-120 g/m2, processed in 5-15% silver nitrate solution in dimethylsulphoxide, dried for 5-8 hours, processed again, dried, processed in the composition (as provided by the first version) in proportions 100:7:9 at temperature 20-25°C, and then washed in water, and dried.
EFFECT: group of inventions provides prolonged antimicrobial action of the endoprosthesis.
2 cl, 2 tbl, 3 dwg
SUBSTANCE: invention refers to medicine, namely to oncology and can be used in treating central obstructing tracheal and bronchial tumours. A bare metal-frame endoprosthesis is implanted into the place of the obstructing tracheal and bronchial tumour to recanalise a tracheal or bronchial lumen. Observing a tumour tissue prolapse through an endoprosthesis wall requires performing an argon plasma coagulation procedure at power 35-45 Wt.
EFFECT: method enables reducing the number of complications and providing the fast and complete recovery of the external respiratory function, and relieving intoxication by an ability of the bare metal frame endoprosthesis to dilate the tumour tissue to a scheduled size and an ability to perform the argon plasma coagulation through its wall that makes it possible to use a low-activity delivery of argon.
2 cl, 3 ex
SUBSTANCE: endonasal separation of soft tissues of the nasal dorsum is performed. Cartilaginous and bone portions of the nasal hump are transected with the hump left attached on a distal soft-tissue cartilaginous pedicle within an internal valve of the nose. The hump is brought out from the wound bending on the preserved pedicle backwards. That is followed by an external surgical modelling of the brought-out hump, the hump reattachment and fixation with percutaneous sutures. A cephalic portion of the hump is transfixed with an absorbable suture, and an end knot is tied up. The hump is bent to the previous position with tracing the free suture end under soft tissues of the hump. The suture is brought out through a nasal point percutaneously into the glabella centre and fixed to the skin. The reattached hump is additionally fixed with two side percutaneous sutures arranged from both sides of the nose at the level of the middle of a triangular cartilage.
EFFECT: more effective surgical operation, namely the safety of the natural contours of osteocartilaginous structures of the nasal dorsum and structures of the internal valve of the nose, the absence of undesired secondary changes accompanying the reattachment of the hump by preserving the residual blood supply through the distal pedicle, the absence of the postoperative displacement of a structure of the nasal dorsum by preserving the initial fixation of a tissue flap in the distal portion and the additional suture percutaneous fixation in three points.
1 ex, 7 dwg
SUBSTANCE: two parallel incisions of the mucous membrane and the periosteum are performed. The first incision is performed at 1-1.5 cm from an attachment line of an anterior end of the inferior nasal concha to the nasal septum and extends to the nasal septum within its lower one-third. The second incision is performed at a level of the posterior end of the inferior nasal concha. Both incisions extend onto the nasal septum and are connected on the nasal septum in the U-way in parallel to the attachment line of the inferior nasal concha. The created flap is separated from the bone base of the nasal bottom and from the base of the nasal septum within its lower one-third. The created flap is used to form a fold by turning it inside; the fold simulates the inferior nasal concha and forms the inferior nasal meatus and the common nasal passage within the lower one-third of the nasal cavity.
EFFECT: method enables normalising the nasal respiration by repairing the nasal structures and increasing the tissue volume with the use of the non-rejected, non-lysed patient's material preserving the volume for a long period of time, causing the minimum risk of a secondary infection and possessing good permeability for blood vessels.
SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can be used in endoscopy. An intralaryngeal infusion device comprises a syringe with a luer adapter and a hollow curved tube 230 mm long. A working end of the tube from its outer side is threaded, which is provided to screw a stop nut and a pivot tip in the form of a base-closed hollow cylinder on. A tubular leg threaded on an inner surface extends from a side surface. A perforated segment having 5-7 holes of the diameter of 0.1-0.2 mm is provided on the side surface of the cylinder above the tubular leg.
EFFECT: device enables applying a drug preparation, or a dye in small doses, directly on the involved region of the larynx by spraying it uniformly through the small holes.
2 cl, 1 dwg
SUBSTANCE: invention refers to medicine, namely to ophthalmology and otorhinolaryngology, and aims at surgical management of chronic dacryocystitis. An endoscopic examination covers the inferior concha, and a nasal canal is inspected from a transmaxillary approach to determine an involvement level: at the level of a distal portion and a valve of Hasner, at the level of a middle one-third of the nasal canal, and at the level of a proximal portion and a bed of the lachrymal sac. The involved levels are decompressed by a resection of narrowed or injured tissues and/or bone walls. The surgical effectiveness is endoscopically controlled with an intra-operative irrigation of the lachrymal passages from the maxillary sinus and under the inferior concha.
EFFECT: method provides the minimally invasive manipulations with reducing a recurrence rate of dacryocystitis and its postoperative complications, ensuring higher therapeutic effectiveness by using a differentiated approach to choosing a surgical technique depending on a causation of the disease and the height of the lachrymal passages obstruction.
6 cl, 8 dwg
SUBSTANCE: anaesthetising is followed by sectioning at 6 mm from a gingival margin in parallel to the jaw curvature with leaving the periosteum intact. A mucous flap is mobilised from the jaw with minimally injuring a region of the gingival papillas. After the exposed root surfaces are prepared, the flap is displaced to a dentin-enamel border overlapping the existing recessions and going beyond by 1-2 mm. A small redundancy of soft tissue is created within the roots of teeth, thereby forming a soft-tissue fold. The flap is fixed at a number of places with interrupted sutures delivered through interdental spaces on the lingual or palatal sides. A tensionless flap side facing the created vestibule depth is fixed with 3-4 sutures to the peritoneum.
EFFECT: by correcting the small oral vestibule and eliminating or relieving the dental recession, the technique enables correcting the oral soft tissue pathology more effectively.
3 dwg, 2 ex
SUBSTANCE: endonasal approach is formed to create a window until the periorbit protrudes into the nasal cavity in the form of a dome. A surface of the domed periorbital protrusion is linearly dissected at a depth of 2-3 mm in an oval path along the protrusion border from a point of one pole to the opposite pole. That is followed by exposure to an alternating RF current of power 10-150 Wt and intermittency 10-50%. Fatty tissue is formed through the created window.
EFFECT: higher clinical effectiveness, reduced number of injuries, no aesthetic changes ensured by managing the penetration of a cutting instrument, eliminating the involvement of oculomotor muscles, providing reliable haemostasis, reducing a reactive response and an inflammatory reaction of the tissues surrounding the incisional wound.
2 dwg, 2 ex
SUBSTANCE: surgical field for graft sampling is prepared. An opening having a diameter equal to that of a dental implant to be implanted is formed in a donor area. A trephine is used for graft sampling so that to centre the formed opening. A created bone disk is removed from the donor area, and several bone rings of the thickness of no more than 3 mm are formed with using dental forceps. The formed rings are placed on the implant successively, i.e. the first ring is placed, then the second one so that to provide a gap to be filled with bone chips between the rings. The bone graft is placed into the prepared source bed and fixed with the implant. Gaps between the bone graft and source bed are filled with the bone chips. The wound is sutured unstrained.
EFFECT: by using the modelled transplant, the method enables replacing the bone volume in a combination with placing the dental implant.
SUBSTANCE: invention refers to medicine, namely to dentistry, and aims at the prevention of the perforated maxillary sinus mucosa in the sinus lifting surgery. An incision is performed under local anaesthesia along the maxillary ridge bone. A mucoperiosteal graft is separated, and an anterolateral wall of the maxillary sinus is skeletonised. An autogenous bone is sampled from the zygomaticoalveolar ridge and an anteriolateral wall of the sinus. A flexible endotracheal tube with an inflated cuff is inserted into the middle nasal passage, wherein air in injected to provide obturation of an opening between the nasal cavity and the sinus. The bone fragment is gently displaced upwards together with the maxillary sinus, and an autoplasma membrane is fixed thereto. After the osteoplastic material and implants are inserted, the defect area of the anterolateral wall of the maxillary sinus is covered with the platelet-rich autoplasma membrane. The mucoperiosteal graft is placed back, and the wound is closed. The stitches are taken out on the 7-8th day.
EFFECT: by obturation the opening between the nasal cavity and the sinus, the method provides preventing the perforated maxillary sinus mucosa in the sinus lifting surgery.
2 cl, 5 dwg
SUBSTANCE: local anaesthesia is applied. A mucoperiosteal flap is formed by two horizontal incisions at a base of the gingival interdental papillas from the vestibular and oral side and by two vertical incisions from the periphery of the gum to a transitory fold. Partial gingivectomy is performed. Dental deposits, granulations and epithelial strands grown into an internal surface of the flap are removed. The periphery of the alveolar process is treated. An osteoplastic material is applied. The cardioplant xenopericardial plate is applied as a barrier between the flap and the treated surface of the dental root. The smoother superficial layer is turned to face the epithelium, while the rough inner layer is turned to face the bone. The flap is sutured in each interdental space and within the vertical incisions.
EFFECT: higher clinical effectiveness in periodontal diseases and optimising the bone tissue regeneration.
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.
3 dwg, 1 ex