RU2239470C1 - Method for treating patients for odontogenous maxillary sinusitis with oroantral fistula - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering Metrogyl-denta gel into the maxillary sinus to achieve tight contact with its walls and fistula passage obturation. Then the preparation is treated with laser radiation via hard palate mucous membrane and maxillary sinus projection through skin in the vicinity of anterior sinus wall. Infrared laser radiation of 0.85 mcm wavelength and output power of 10-12 mW is applied during 5-10 min to each field. The total treatment course is 3-7 procedures long applied every other day.

EFFECT: clearing sinus from microbial agents in accelerated mode.

Description

The invention relates to medicine, namely to surgical dentistry, maxillofacial surgery, physiotherapy, otorhinolaryngology, and can be used to treat chronic odontogenic sinusitis with oro-antral fistula.

Chronic odontogenic sinusitis most often occurs as a complication after removal of premolar and maxillary molars due to the development of periodontitis of these teeth. The most unfavorable complication is the formation of the fistulous course, the so-called oro-antral fistula, between the oral cavity and the maxillary sinus after tooth extraction. In this case, a situation arises in which the natural difference in pressure in the affected sinus, nasal cavity and mouth is disturbed during conversation, breathing, etc. There is also a violation of blood circulation, inhibition of the function of the ciliated epithelium and constant boiling of the fistulous passage with air flow and separated in the form of serous or purulent exudate with a pressure difference between the oral cavity and nasal cavity (during inhalation and exhalation, eating, etc.), which prevents its closure and supports the inflammatory process in the sinus.

A known method of preoperative preparation of the maxillary sinus for osteoblenoplasty with perforated odontogenic sinusitis, including the introduction of the sorbent SUMS-1 into the maxillary cavity by means of a microirrigator (RF Patent No. 2110963, publ. 1998).

The disadvantage of this method is that the sorbent SUMS-1 is not an antibacterial drug and does not affect the microflora that caused sinusitis, but only adsorbs the contents of the sinus. Therefore, during this method, the inflammatory reaction decreases, and after its termination a relapse of the disease is possible, in addition, this technique does not allow the fistulous passage to close on its own.

The closest is a method for treating diseases of the frontal and maxillary sinuses, including catheterization of the frontal and maxillary sinuses, washing the sinuses with an antiseptic solution and introducing 0.9% saline into the sinus cavity with isothiorbamine dissolved in it, exposure to a helium-neon laser through a catheter (RF Patent No. 2148424, publ. 2000).

The disadvantage of this method is the introduction of a liquid pharmaceutical product in the sinus, which is not adsorbed on the mucous membrane of the sinus and does not provide a prolonged effect due to its flow in the presence of fistulous passage and natural fistula with the middle nasal passage. The drug cannot provide obstruction of the fistulous course, and conducting laser radiation through a catheter requires specially trained personnel.

The task posed by the authors is to eliminate these shortcomings by affecting the altered sinus mucosa, restoring the motor function of the ciliated epithelium, as a result - accelerating debridement, cleansing and restoration of the maxillary sinus mucosa, as well as the possibility of dense obstruction of the oro-antral anastomosis, the possibility of closing it without surgical treatment, reducing the likelihood of complications, reducing the duration of rehabilitation.

To this end, in a method for the treatment of chronic odontogenic sinusitis with oro-antral anastomosis, including the introduction of a drug into the sinus cavity with subsequent exposure to laser radiation, it is proposed to introduce a gel into the maxillary sinus of metrogil-dent before tight contact with its walls and obstruction of the fistulous course and affect the drug through the mucosa of the hard palate and the projection of the maxillary sinus through the skin in the region of the anterior sinus wall by laser radiation in the infrared wavelength range of 0.85 μm at the output power 10-12 mW for 5-10 min per field, for a course of 3-7 procedures every other day.

The gel base contributes to a more complete conduct of laser radiation to all the walls of the maxillary sinus. In addition, a gel introduced into the sinus during interaction with laser radiation in the infrared wavelength range of 0.85 μm restores and enhances the motor function of the preserved cells of the ciliated epithelium, which contributes to the quick cleansing of the sinus from microbial agents and is an artificial obturator of sinus fundus perforations, which contributes to spontaneous closure of the fistulas of the maxillary sinus bottom, and with persistent fistulas, it allows only plastic fistula passage without radical maxillary sinusitis, since this technique Allows not only to clean the sinus from microbial agents and their metabolic products, but also to restore the polyposely changed sinus mucosa.

The reduction of inflammatory changes in the sinus was controlled using sinusoscopy through the lower nasal passage or the oro-antral fistula. Treatment ends after the closure of the anastomosis during exposure to the sinus and restoration of its mucous membrane.

The use of photophoresis of metrogil-dent gel makes it possible to clear the sinus of the bacterial flora that causes odontogenic sinusitis (Porphyromonas gingivalis, Prewotella intermedia, P. denticola, Fusobacterium fusiformis, Wolintlla recta, Treponema sp., Eikenella corodens, Borrelus victorini melidis). , quickly restore the function and structure of the ciliated epithelium, which helps to cleanse the sinus of microbial agents and their metabolic products. Metrogil-denta gel is a mechanical obturator of the perforation or fistulous passage, after which spontaneous closure of the anastomosis is possible, which makes it possible to conservatively treat odontogenic sinusitis with oro-antral fistula on an outpatient basis, without resorting to radical maxillary surgery with plastic fistula.

The use of this method of treatment for irreversible changes in the sinus epithelium in the postoperative period allows you to duplicate the closure of the perforation not only with a mucous flap, but also with a metrogil-gel, and its photophoresis helps to reduce the inflammatory reaction and, as a result, exudation, which, in turn, can negatively affect the closure of the fistulous course.

Example 1

Patient N., born in 1961, No. 8578, was admitted to the clinic of maxillofacial surgery for anastomosis of the maxillary sinus with oral cavity with serous-purulent discharge from the fistulous passage on the left. On days 1, 3, 5, 7, the gel was introduced through the fistulous course of the metrogil dent before close contact with the sinus walls and obstruction of the fistulous course. The number of injections of the drug was determined in accordance with the size of the fistulous course and sinus volume. From the first injection of the drug, photophoresis was performed daily by laser radiation in the infrared wavelength range of 0.85 μm with an output power of 10 mW for 5 min per field (total time 10 min).

From the beginning of treatment, a sharp increase in the volume of exudation was noted. The patient noted a decrease in the feeling of heaviness in the infraorbital region on the left and an improvement in nasal breathing. On the 4th day of treatment, the amount of exudate was reduced, on the 5th day during sinusoscopy, residual sinus edema was noted in the area of the fistulous passage. On the 7th day the patient was discharged home in satisfactory condition. During the follow-up examination on the 10th day, sinusitis was not detected, the fistulous course is closed. When monitoring after 3 months, the disease recurrence was not detected.

Example 2

Patient B., born in 1975 (No. IB 8537), was admitted with a diagnosis of chronic odontogenic sinusitis with a fistula on the left. Objectively, at the time of admission, the fistulous passage is 4-5 mm in size, purulent discharge from the fistulous passage. On the roentgenogram of the paranasal sinuses, a complete “darkening” of the sinus. From the moment of arrival on the 1st, 3rd, 5th, 7th, 9th day, photophoresis of the gel metrogilant was performed by laser radiation in the infrared wavelength range of 0.85 μm with an output power of 12 mW for 5 min per field (total time 10 min).

During photophoresis, the patient noted a significant increase in the volume of exudation from the fistulous passage and from the left nasal passage. Subjectively noted a significant improvement in nasal breathing. On the 9th day, sinusoscopy was performed, there are no pathological changes in the sinus. In connection with the large size of the fistulous passage, its plastic was performed by local tissues, without radical maxillary sinusotomy. After 3 months of recurrence of sinusitis and fistulous course no.

Thus, the application of the proposed method can significantly increase the effectiveness of treatment of odontogenic sinusitis with oro-antral fistula, reduce the number of surgical interventions, reduce the risk of complications, shorten the treatment and rehabilitation of patients with this pathology.

This method can be recommended for use in maxillofacial surgery, physiotherapy, surgical dentistry, otorhinolaryngology.

Claims (1)

A method for the treatment of chronic odontogenic sinusitis with oro-antral anastomosis, including the introduction of a drug into the sinus cavity with subsequent exposure to laser radiation, characterized in that a metrogil-dent gel is introduced into the maxillary sinus until it comes into contact with the sinus walls and obstruction of the fistulous passage, followed by laser irradiation in the infrared wavelength range of 0.85 microns with an output power of 10-12 mW for 5-10 minutes per projection of the maxillary sinus through the skin and from the side of the sky for a course of 3-7 procedures every other day.