MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS
About the author:
Shvets A. I., Gorbachenko O. B., Dubrovina E. V., Koptev M. M., Bilych A. M.
METHODS AND METHODOLOGIES
Type of article:
The main factors of the odontogenic maxillary sinuses inflammation are perforation of the maxillary sinus bottom during teeth removal, anatomical and physiological features of the maxillary sinus structure when the root or roots are located in the cavity of the maxillary sinus, which is independent of the dental surgeon in any case, a perforation of the maxillary sinus bottom during teeth removal, as well as more complex chronic processes in periodontium, which form resorption of bone tissue within the bottom of the maxillary cavity, and clinical cases with the root penetrating the cavity of the maxillary sinus or the foreign body penetrating the genyantrum. Difficulties appear in the operation of removing the upper jaw teeth, which are located near the bottom of the maxillary cavity or in the genyantrum cavity, and in the presence of inflammation, accompanied by bone resorption. Therefore, in order to prevent complications of perforative sinusitis, there is a need to develop new non-invasive methods of prophylactic and treatment of perforation of the bottom of the maxillary cavity. One can state with certainty that traditional traumatic surgical interference, such as Caldwell-Luc radical antrotomy, is less frequently used in clinical practice. Nowadays many authors offer less traumatic methods for treating perforations and maxillary sinus fistula. We also offer our options of surgical interference using the domestic bone and plastic material kergap. In the case of the foreign body penetrating the maxillary sinus cavity, under the conduction anesthesia, a mucosal flap from the vestibular side is formed, and, if necessary, another one may be formed from the palatine side. We extend the bone hole to the necessary size so that it is possible to get the foreign body out through it, use a curettage spoon to remove the pathologically altered mucous membrane of the maxillary cavity till a healthy bone, then cover the bone hole with the osteoplastic material and cover it with the mucous flap, fix it and suture with the vikril (3,0) material. In case of maxillary cavity perforation during teeth removal operation, which roots break through the bottom of the maxillary sinus, which does not depend on the experience and qualifications of the dental surgeon, the edges of the perforated hole are smoothed with a cutter or bone forceps in such a way that there are no sharp perforation eminences. Be sure to wash the sinus with a warm solution of antiseptic. We cover the bone joint between the maxillary and the oral cavity kergap. After that, cover the maim with the cut bone flap and suture with the vikril (3,0) material. In more complex clinical cases, such as chronic long-term inflammatory processes without exacerbation of pathological processes in the genyantrum sinus of odontogenic origin, when a foreign body penetrates the maxillary cavity, we decided to modify extreme maxillary sinusotomyusing the Caldwall-Luc method, which became the goal of our research. Thus, according to our research treatment and prevention of perforated sinusitis requires etiopathological treatment. The formation of an oronasalroute during the causative tooth removal of odontogenic sinusitis requires the closure of this route with osteoplastic material kergap, while suturing the tooth. In the case of a foreign body entering the maxillary cavity, the traditional method opens the maxillary cavity in order to remove the foreign body through the anterior wall of the maxillary sinus and treats it with the solution of antiseptics without making a route with the lower nasal passage. It can be combined with the causative tooth removal and the tight suturing of the mucous flaps, which is less a traumatic surgical interference than the extreme Caldwall-Luc method of sinusotomy.
perforated sinusitis, minimal invasive surgical methods for treatment, kergap
- Dovbnya YuM, Pronina OM. Morfometrychna kharakterystyka seroznykh zaloz slyzovoyi obolonky lobovoyi pazukhy lyudyny. Aktualʹni problemy suchasnoyi medytsyny: Visnyk Ukrayinsʹkoyi medychnoyi stomatolohichnoyi akademiyi. 2015;15(4):227-9. [in Ukrainian].
- Pronina Ye, Dovbnya Yu, Yeroshenko G. Morfological and functional features of human frontal sinus anterior wall glands. Cambridge Journal of Education and Science. 2016;15(1):89-92.
- Malanchuk VO. Khirurhichna stomatolohiya ta shchelepno-lytseva khirurhiya. K: Lohos; 2011. 634 s. [in Ukrainian].
- Timofeyev AA. Rukovodstvo po chelyustno-litsevoy khirurgii i khirurgicheskoy stomatologiі. K.: Meditsinskaya líteratura; 2002. 1022 s. [in Russiаn].
- Potapchuk AM, Melʹnychuk DV. Khronichni odontohenni haymoryty. Naukovyy visnyk Uzhhorodsʹkoho universytetu. Seriya «Medytsyna». 2012;(1):194-200. [in Ukrainian].
- Hotʹ IM, Sorokivsʹkyy IS. Usunennya pislyaekstraktsiynykh oroantralʹnykh spoluchenʹ. Visnyk problem biolohiyi i medytsyny. 2013;2(4):11-3. [in Ukrainian].
- Visscher SH, van Roon MR, Sluiter WJ, van Minnen B, Bos RR. Retrospective study on the treatment outcome of surgical closure of oroantral communications. J Oral Maxillofac Surg. 2011 Dec;69(12):2956-61.
- Bilash SM, Pronina OM, Koptev MM, Pyroh-Zakaznykova AV. Klinichna anatomiya ta operatyvna khirurhiya dilyanok i orhaniv holovy, shyyi, hrudey ta zhyvota. Poltava: Kopir servis; 2017. 170 s. [in Ukrainian].
Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 (144), 2018 year, 282-285 pages, index UDK 616.216.1-002+616.314)-089