Малоінвазивний хірургічний метод лікування перфоративного гаймориту

Abstract

Серед поширених патологій верхньощелепної пазухи – одонтогенний гайморит, перфорація й нориці дна гайморової пазухи. У роботі запропоновано малоінвазивні хірургічні методи лікування цих патологій і модифікацію різних видів оперативного втручання з найменшою травматизацією і тривалістю операції. Описано кілька модифікованих методів закриття ороназального сполучення й вилучення сторонніх тіл: 1. Закриття перфорованого отвору, утвореного в процесі операції видалення, із закриттям його «Біоміном». 2. Розкриття гайморової пазухи в ділянці її передньої стінки й видалення стороннього тіла без вишкрібання патологічної слизової оболонки гайморової пазухи й без утворення сполучення з нижнім носовим ходом. 3. Одночасне розкриття гайморової пазухи з операцією видалення причинного зуба при хронічному одонтогенному гаймориті й за наявності стороннього тіла в її порожнині без вишкрібання й без створення сполучення з нижнім носовим ходом. Післяопераційну рану опромінювали гелій-неоновим лазером, що забезпечує лагідніший перебіг загоєння рани після оперативного втручання.

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 perforated sinusitis, there is a need to develop new non-invasive methods of prevention 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 antrostomy, 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), GAP “Biomin”. 1. 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. 2. 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 (with Kergap), GAP Biomin. After that, cover the maim with the cut bone flap and suture with the “Vikril 3.0” material. 3. 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 sinusotomy using the Caldwall-Luc method, which became the goal of our research. Description of surgical interference: under local anesthesia, we simultaneously carry out an operation for removing the causative tooth and make a trapezoidal incision in the area of the maxillary sinus transitional wall. After that, we make a bone hole on the anterior wall of the maxillary sinus, do not sculpt the pathologically altered mucus, remove the foreign body through the bone hole. Antiseptic treatment is carried out during surgical interference. If there is a route between the maxillary sinus and the lower nasal passage, we do not form another one. After applying antiseptic, we put the bone flap onto the place and fixed with non-absorbing sutures, sew the removed tooth well with a pre-closed perforation aperture using osteoplastic material (Kergap), GAP Biomin. After that, we irradiate the surgical wound with a helium-neon laser, which provides a gentler healing period of the wound after surgery. Seams are removed on the 8th-12th day after surgery. The patients were examined both in the short term and in the long-term, after a year or more. No relapses of the oronasal route were found, bone wound healed in the period of 6-8 months, and contrast Rg-scans showed no regression of polyposis and granulation dilatations. In our opinion, this is the result of etiopathological treatment aimed at eliminating the cause. Thus, according to our research treatment and prevention of perforated sinusitis requires etiopathological treatment. The formation of an oronasal route during the causative tooth removal of odontogenic sinusitis requires the closure of this route with osteoplastic material (Kergap), GAP Biomin, 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. Eliminating the inflammation cause of the maxillary sinus in combination with the osteoplastic closure of the oronasal route with tight suturing is a thorough treatment compared to the traditional technique. The regularities discovered as a result of clinical and X-ray quality assessment of non-invasive surgical methods for the treatment of chronic perforated sinusitis require further long-term studies and evaluation of other factors that influence the success of chronic perforated sinusitis treatment.