RU2373873C2 - Method of treating maxillary sinusitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to surgical dentistry and can be used in treatment of maxillary sinusitis. Essence of method lies in trepanation of anterior wall of maxillary sinus, sinus washing trepanation opening plasty. Maxillary sinus is washed during 3 minutes with 0.05% solution of myramistin, immobilised on "Polysorb MP", plasty of perforation opening is carried out with collagen membrane "Collost", membrane dimensions being 10 mm larger than trepanation opening. Film "Diplen-Denta" with clindamycin is put above, after that, mucous-periosteal flap, which is sewn with interrupted suture together with "Collost" membrane and "Diplen-Denta" film.

EFFECT: application of claimed invention allows to increase efficiency of maxillary sinusitis treatment, reduce number of post-operation complications and reduce terms of wound healing.

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Description

The invention relates to medicine, namely to surgical dentistry. The development of effective methods of surgical treatment of patients with chronic odontogenic maxillary sinusitis, especially caused by the removal of filling material into the sinus, is one of the urgent problems of surgical dentistry.

Known methods of treating patients with acute and chronic odontogenic maxillary sinusitis [1, 2]. The disadvantage of these methods is that the trepanation holes in the anterior wall of the maxillary sinus and the bone defect in the alveolar ridge of the upper jaw are not restored by an autograft or osteoplastic material, but are closed only by a mucoperiosteal flap, which increases the risk of sinus infection.

There is a method of treating maxillary sinusitis by conducting maxillary sinusotomy with simultaneous plastic surgery of the anastomosis of the oral cavity with maxillary sinus [3]. The disadvantage of this method is a pronounced surgical injury and a long healing period.

There is a method of surgical treatment of maxillary sinusitis (prototype), performed by opening the sinus, debridement and plastic surgery of the bone defect with a “patch” of bone matrix, moreover, a plate made of Litar hydroxyapatite-collagen material is used as a patch, and the plate is 5-8 mm larger than trepanation holes, fixation of the plate produce standard absorbable nodal threads [4].

The advantages of this method: reducing the invasiveness of the operation and the duration of the postoperative period, the insignificant complexity of the operation, the exclusion of allergic reactions, the possibility of use in children.

The disadvantages of this method are the weak osteoplastic effect of the selected preparation for bone grafting, the need for additional double perforation of the anterior maxillary sinus to fix the LITAR plate to the bone, and a high probability of wound infection.

The goal is to increase the effectiveness of treatment of patients with maxillary sinusitis using modern osteoplastic materials to close the perforation and antibacterial agents for the prevention of wound infection in the postoperative period.

This goal is achieved by washing the maxillary sinus for 3 minutes with a 0.05% solution of miramistin immobilized on Polysorb MP, closing the perforation hole in the front wall of the maxillary sinus with a membrane made of osteoplastic material based on bone collagen Collost (Biopharmholding CJSC) moreover, the dimensions of the membrane are 10 mm larger than the perforation hole, the Diplen-Dent film with clindamycin (f. Nord-Ost), the application of a mucoperiosteal flap and suturing with nodal sutures.

Polysorb-MP is an inorganic, non-selective, multifunctional enterosorbent based on highly dispersed silica with particle sizes from 5 to 20 nm [5]. Miramistin, immobilized at the Polysorb MP, in addition to pronounced antibacterial properties, has sorption, detoxification and antioxidant properties, blocks the aggressive effect of free radicals. These properties are especially important when removing filling material from the maxillary sinus, which, when stored in the sinus for a long time, has a pronounced toxic effect on its mucous membrane.

The proposed method for the treatment of maxillary sinusitis is as follows.

Under infraorbital tubal palatal and infiltration anesthesia with Ultracaini 4% solution with an adrenaline of 1: 100000 - 5 ml, a trapezoidal mucoperiosteal flap is cut out with a base facing the transitional fold. A full mucoperiosteal flap is peeled off with a raspator. In the area of the anterior wall of the maxillary sinus, the dental bursa perform trepanation of the cortical plate with a diameter of 10-15 mm. Using curettage spoons, the filling material and part of the pathologically altered sinus mucosa are removed. The sinus is washed for 3 minutes with a 0.05% solution of miramistin immobilized on Polysorb MP, the trepanation hole is closed with a Kollost collagen membrane so that the membrane overlaps the edges of the bone wound by 10 mm, a Diplen-Dent film is applied on top with clindamycin, then a mucoperiosteal flap is placed, which is sutured with interrupted sutures together with the Kollost osteoplastic membrane and the Diplen-Denta film.

The inventive method of treatment of maxillary sinusitis increases the effectiveness of treatment of maxillary sinusitis, reduces the number of postoperative complications by 35.4% and shortens wound healing time by 44.8% compared to similar treatment methods. Examples of specific performance.

Example 1. Patient S., 29 years old. Complaints of heaviness in the head on the left, nasal congestion of the left half of the nose. On the orthopantomogram - filling material in the left maxillary sinus. Diagnosis: chronic left-sided maxillary sinusitis, filling material in the left maxillary sinus.

Treatment. A gentle sinusotomy without creating an anastomosis with the nasal cavity was performed. The filling material is removed completely. The maxillary sinus is washed for 3 minutes with a 0.05% solution of miramistin immobilized according to Polysorb MP. Plastic surgery of the anterior wall of the Kollost collagen biomembrane 10 mm larger than the trepanation hole was performed using a Diplen-Dent film with clindamycin, which, together with the mucoperiosteal flap, are fixed with interrupted sutures. The postoperative period was uneventful. On the 3rd day, edema was less than 1/4 of the value of intraoperative edema. On the 6th day, edema in the area of the soft tissues of the cheek was not determined. Palpation of the anterior wall of the maxillary sinus is slightly painful, there is no nasal congestion, no purulent-serous discharge. Nasal breathing is good. The patient was discharged on the 7th day. On examination, 45 days after surgery, the trepanation hole is not determined radiologically and according to ultrasound echoostometry. During the follow-up examination after 2, 3, and 6 months, according to the survey X-ray, the bone density in the area of surgical intervention was 430, 560, and 890 units, respectively, according to the Hounsfield scale.

Example 2. Patient O., 19 years old. Complaints of heaviness in the head when bending, purulent discharge and nasal congestion in both halves of the nose. On the survey roentgenogram of the sinuses - a decrease in pneumatization of both maxillary sinuses, filling material in the right sinus. Diagnosis: bilateral chronic maxillary sinusitis, filling material in the right sinus.

Treatment. Performed simultaneous bilateral sparing sinusotomy without creating anastomosis with the nasal cavity. Filling material removed. The maxillary sinus is washed for 3 minutes with a 0.05% solution of miramistin immobilized according to Polysorb MP. The front wall of the maxillary sinus was plasticized on the right and left by the Kollost collagen biomembrane 10 mm larger than the trepanation hole, the membrane was covered on top with a Diplen-Dent film with clindamycin and, together with the mucosal-periosteal flap, the membrane and film were fixed with nodular sutures. The postoperative period was uneventful. On the 5th day, edema in the area of the soft tissues of the cheek was not determined. Palpation of the anterior wall of the maxillary sinus is painless, there is no nasal congestion. Nasal breathing is good. The patient was discharged on the 6th day. On examination 2 months after the operation, the trepanation hole is not determined radiologically and according to ultrasound echoostometry. During the follow-up examination after 2, 3, and 6 months, according to the survey X-ray, the bone density in the area of surgical intervention was 430, 560, and 890 units, respectively, according to the Hounsfield scale.

Example 3 (prototype). Patient S., amb. card number 20917. Complaints upon receipt of moderate pain in the upper jaw on the right, serous discharge from the right half of the nose. On the orthopantomogram - filling material displayed in the right maxillary sinus. Diagnosis: chronic right-sided maxillary sinusitis, filling material in the right maxillary sinus.

The patient was treated with maxillary sinusitis according to the method of the prototype.

After surgery, the patient notes moderate pain in the area of intervention. A day later, puffiness appeared in the incision area and the temperature was up to 38.8 ° C, the patient was prescribed antibacterial and desensitizing therapy. After 6 days, the general condition improved slightly, 9 days after the operation, edema in the intervention area is preserved. The patient was discharged on the 14th day. On examination 2 and 4 months after surgery, according to the data of ultrasonic echoosteometry, a trepanation hole is still determined. During the follow-up examination after 6 and 12 months according to the survey X-ray, the bone density in the area of surgical intervention was 460 and 630 units, respectively, according to the Hounsfield scale.

In total, according to the above method, 49 people aged 17 to 55 years were operated on, including 29 women and 20 men. The number of postoperative complications in the form of edema and inflammation was 19.8% during interventions according to the method of the prototype and 11.2% according to the claimed method. Long-term results of the implementation of the proposed method for the treatment of chronic maxillary sinusitis showed its high efficiency and the absence of relapse of the disease in all operated patients.

Information sources

1. RF patent No. 2035894 dated 05/27/1995.

2. RF patent No. 2061421 from 06/10/1996.

3. USSR Author's Certificate No. 1560124, A61B 17/00, 1990.

4. RF patent No. 2269945, A61B 17/00, A61B 27/24.

5. Polysorb. Vidal Handbook 2007, p. 891. Register of Medicinal Products of Russia (RLS) 2007, p. 710., Www.polisorb.ru.

Claims (1)

A method of treating maxillary sinusitis by trepanation of the anterior wall of the maxillary sinus, washing the sinus and the plastic of the trepanation hole, characterized in that the maxillary sinus is washed for 3 minutes with a 0.05% solution of miramistin immobilized on Polysorb MP, plasticizing the collagen perforation hole with the Kollost membrane, and the membrane is 10 mm larger than the trepanation hole, a Diplen-Dent film with clindamycin is placed on top, then a mucoperiosteal flap, which The second one is flashed with interrupted sutures together with the Kollost membrane and Diplen-Denta film.