SYSTEMATIC APPROACH TO SURGICAL CARE TO PATIENTS WITH ODONTOGENIC MAXILLARY SINUSITIS

Alekseyev S. B., Boyenko D. S., Matros-Taranets A. I., Alekseyev Y. S.

CONTENTS

Scentific article

Both medical and surgical treatment of odontogenic sinusitis has some peculiarities. Study of the effectiveness of conservative and endoscopic surgical treatment of odontogenic sinusitis relevant and useful today. Objective of the study was to develop a systematic approach to the surgical care to patients with odontogenic maxillary sinusitis. Preoperative treatment of patients started with oral cavity sanation. Simultaneously sought to achieve the restoration of the affected sinus aeration. All patients received osteoplasty of maxillary sinus in the first stage of threatment. Sinus certainly was drained and washed with an antiseptic solution. Was prescribed antibiotics and vasoconstrictor spray in the nasal cavity. Also we prescribed wetting medications and nasal showers. The second stage of the threatment was carried out under local nerve block. Operation begins with the extraction of the “cause” tooth if it was not removed earlier. Intervention technique is as follows. Trocar set above the roots of the premolars of the upper jaw and punctured the front wall of the maxillary sinus in the area of “canine fossa. ” Thereafter stylet was removed from the funnel and funnel of trocar was coupled by waveguide with the optical lighter. Thereafter the maxillary sinus was examined with emphasis on the alveolar process and the natural area of anastomosis. In the presence of polyps, cysts, foreign materials (bone fragments, teeth roots, filling materials) was performed their removal with Blakeslee forceps. At narrowing of maxillary posterior anastomosis, it was extended backwards from the sinus side. If necessary, also was performed a correction of intranasal structures. During surgery, special attention was paid to the alveolar process and the natural area of anastomosis. Operation were finishing with plasticity defect in the tooth extraction wells, using membranes of thrombocytic gel (patent for useful model number 47506 from 10. 02. 2010) In order to prevent complications in the postoperative period was used periodontal mouthpieces that was designed by our method (patent for useful model №47505 from 10. 02. 2011). Mouthpiece was produced with the help of the thermoforming machine STAR-Machine and plates Bioplast by company ScheuGmb. Under the mouthpiece to the flap area was laid the dental paste “Solkoseril”. Mouthpiece was removed after 3-4 days. As the criteria for evaluation the treatment success for patients of main and control groups was used clinical and functional parameters: the difficulty of nasal breathing, impaired sense of smell, headaches severity, sensitivity disorders of vestibular mucosa of the mouth, the relapse rate and time of hospitalization . Results of surgical treatment for all criteria were satisfactory. By the end of the first week after surgery nasal breathing difficulty, impaired sense of smell and headaches were not observed. Impaired sensation of the mucous membrane of the mouth vestibule was observed in a small number of patients. Length of stay in hospital was 5-6 days. Hole after the tooth extraction healed by primary intention without alveolar bone defect of the arc, which is especially important in further prosthetics and dental implantation process. Development of the community of otolaryngologists and maxillofacial surgeons and use of endoscopic technology opens a new stage and approach to this problem. That enables simultaneous sanation of the maxillary sinus and teeth in patients with odontogenic maxillary sinusitis, which is especially important to achieve good functional and cosmetic result in the subsequent rehabilitation, further prosthetics and dental implantation. For the first time developed the systematic way to provide surgical care for patients with odontogenic maxillary sinusitis. With the help of the system, that we propose the time of the survey and consultations of related professionals in the prehospital phase reduces. Simultaneously carried out sanation of the sinus, post-extraction holes, etc. Therefore, the time of stay in hospital and the risk of recurrence reduces, and cost-effectiveness of treatment increases.

odontogenic sinusitis, endoscopic micro-maxillary sinusotomy, cone-beam tomography

• Алексеев С. Б. Использование тромбоцитарного геля при хирургическом лечении заболеваний ЛОР-органов и че-люстно-лицевой области / С. Б. Алексеев, Д. С. Боенко, И. Н. Матрос–Таранец [и др.] // Журнал вушних, носових і горлових хвороб. – 2007. – №5. – С. 8-9.
• Алексеев С. Б. Хирургическое лечение одонтогенных гайморитов / С. Б. Алексеев, И. Х. Дуфаш, А. Г. Каминский // Матер. конф. с междунар. участием «Актуальные вопросы и перспективы развития стоматологии». – Харьков: ХГМУ.– 2011. – С. 145-146.
• Алексеев С. Б. Эндоскопическая ревизия лунок зубов после их экстракции / С. Б. Алексеев, Д. С. Боенко, Н. А. Гладко-ва [и др.] // ІІІ з’їзд української асоціації черепно-щелепно-лицевих хірургів, 17-18 травня 2013 р. – К., 2013. – С. 59-60.
• Алексеев С. Б. Система оказания хирургической помощи больным с одонтогенными гайморитами / С. Б. Алексеев, Д. С. Боенко, Н. А. Гладкова [и др.] // ІІІ з’їзд української асоціації черепно-щелепно-лицевих хірургів, 17-18 травня 2013 р. – К., 2013. – С. 71-73.
• Боенко С. К. Особенности медикаментозного и эндоскопического хирургического лечения одонтогенных гаймори-тов / С. К. Боенко, С. Б. Алексеев, Д. С. Боенко [и др.] // Журнал вушних, носових і горлових хвороб. – 2009. – №3-c. – С. 23-24.
• Боенко С. К. Диагностика и лечение одонтогенных гайморитов, вызванных попаданием пломбировочных материалов в верхнечелюстную пазуху / С. К. Боенко, И. Н. Матрос-Таранец, С. Б. Алексеев [и др.] //Матеріали XI з’їзду оторино-ларингологів України (Судак, 17-19 травня 2010 р.). – Судак, 2010. – С. 37-38.
• Боенко С. К. Эндоскопический метод лечения одонтогенных гайморитов / С. К. Боенко, И. Н. Матрос-Таранец, С. Б. Алексеев [и др.] // Матеріали республіканської наук-практ. конф. з міжнар. участю «Сучасні досягнення та пер-спективи розвитку хірургічної стоматології та щелепно-лицевої хірургії». – Харків, 2010. – С. 6-7.

«Bulletin of problems biology and medicine» Issue 2 part 1 (107), 2014 year, 051-053 pages, index UDK 616. 216. 1-002:616. 314-08-089