RU2061421C1 - Method for treating acute odontogenic maxillary sinusitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing paracentesis of maxillary sinus at the frontal wall of the sinus above the projection of the tops 65/56 teeth stepping aside form the gingival edge 20 mm upwards. Then laser radiation therapy is carried out intraparotically for the first four days with power density being equal to 50 mW/cm.sq and 180-200 mW/cv.sq for the following days. One procedure duration is 10 min. The whole treatment course consists of 7-10 procedures. EFFECT: improved functional results.

Description

 The invention relates to medicine and can be used in surgical dentistry.

There is a method of treating acute odontogenic sinusitis, in which the "causal" tooth is necessarily removed, anti-inflammatory treatment is carried out (antibiotics, sulfonamides, UHF therapy). One of the treatment conditions is the puncture of the maxillary sinus through the lower nasal passage, followed by washing it with a solution of furatsilin, rivanol or potassium permanganate. In order to improve the outflow of exudate, vasoconstrictor drops in the nose are prescribed (5% solution of ephedrine, sonarin) [1]
However, this method has a number of significant drawbacks: it provides in all cases to remove the “causal” tooth, which leads to a decrease in masticatory efficiency, the mandatory puncture of the maxillary sinus through the lower nasal passage can be accompanied by very serious complications for the patient’s health and sometimes life : nosebleeds, intracranial complication, etc. The effectiveness of physiotherapeutic treatment is insufficient due to the fact that the physiotherapeutic effect is carried out not directly on the mucous membrane of the maxillary tissue, but also on the surrounding healthy tissues. A single sinus puncture with rinsing it from a syringe is ineffective, since it does not provide the prescribed antiseptic treatment of the maxillary sinus. The use of vasoconstrictor drugs in the form of instillation into their nose due to the short duration of their exposure is also not effective enough.

A known method of treatment of odontogenic acute sinusitis, in addition to the above measures are additionally prescribed: Ray-2, fluctuating currents and the manufacture of a protective plate to close the perforation in the tooth hole to prevent reinfection [2]
However, this method of treatment attacks the same disadvantages that are characteristic of the first method. Moreover, in the presence of the maxillary sinus in the area of the hole of the extracted tooth, the dental surgeon’s task is much easier, as a rule, when perforation occurs, the inflammatory process in the maxillary sinus can be independently eliminated.

зубов с последующей катетеризацией, активной антисептической обработкой и дренированием синуса. Причем физиотерапия (лазеротерапия) производится непосредственно на слизистую оболочку синуса, с целью создания хороших условий для оттока эксудата из верхнечелюстной пазухи через естественное отверстие в среднем носовом ходе сосудосуживающие препараты вводят с помощью эндонозального электрофореза. Традиционно используют антибиотики и сульфаниамидные препараты.The aim of the invention is to increase the effectiveness of treatment of patients with acute odontogenic sinusitis, reduce complications and preserve chewing effectiveness. This goal is achieved by the fact that to eliminate acute inflammatory processes in the maxillary sinus, it is punctured in the region of the anterior sinus wall slightly above the apex

teeth followed by catheterization, active antiseptic treatment and sinus drainage. Moreover, physiotherapy (laser therapy) is carried out directly on the mucous membrane of the sinus, in order to create good conditions for the outflow of exudate from the maxillary sinus through a natural opening in the middle nasal passage, vasoconstrictor drugs are administered using endonosal electrophoresis. Traditionally, antibiotics and sulfa drugs are used.

зубов на стороне поражения пазухи. С помощью специального траокара или шаровидного бора под охлаждением его 0,05% раствором хлоргексидина биглюконата трепанируют переднюю стенку пазухи в диаметре 3-4 мм. Через трепанационное отверстие в верхнечелюстную пазуху вводят 2 полихлорвиниловых катетора. Один катетор присоединяют к системе для переливания крови, соединенной с резервуаром (стандартная емкость 250-500мл) с 0,05% раствором хлоргексидина биглюконата. Причем для подачи антисептика к системе подключен перистальтический насос. Второй катетор присоединен к слюноотсосу, катеторы фиксируют к зубам с помощью шелковой лигатуры. Перистальтический насос и слюноотсос включаются одномоментно. При этом под давлением в 1 атм. 0,05% раствор хлоргексидина биглюконата начинает поступать через катетор в верхнечелюстной синус, обильно орошая последний. Одновременно сливные воды, воспалительный эксудат, гной удаляются из пазухи через второй катетор в слюноотсос. Процедуру проводят до появления чистых промывных вод. В зависимости от состояния больного и наличия эксудита процедуру можно проводить 2-3 раза в день, учитывая, что ее проведение легко переносится больным. Активная антисептическая обработка и дренаж пазухи проводится в течение недели до стирания острых явлений воспаления в синусе. Наряду с этим в первый же день больным назначается эндонозальный электрофорез 0,1% раствора адреналина гидрохлорида N 7. Лазеротерапия назначается на 2-3 день после начала лечения и проводится внурипазушно. С этой целью через катетор в верхнечелюстную пазуху вводится стекловолоконный световод от серийно выпускаемой физиотерапевтической лазерной установки УЛОФА "Ягода", плотность мощности назначали от 50 до 200 мВт/см²2, которая обладает выраженным противовоспалительным и противоотечным действием, нормализует циркуляцию, уменьшает кровоточивость тканей и резко снижает пастогенность микрофлоры. Лазеротерапия проводится ежедневно, на курс 7-10 сеансов.The method is as follows. Under infiltration anesthesia with a 2% solution of novocaine in an amount of 2.5-3 ml, a mucous membrane is punctured with a scalpel 5-6 mm above the projection of the tips

teeth on the side of the sinus lesion. Using a special traocar or spherical boron under cooling with a 0.05% solution of chlorhexidine bigluconate, the anterior sinus wall is 3-4 mm in diameter. Through a trepanation hole, 2 polyvinyl chloride catheters are inserted into the maxillary sinus. One catheter is connected to a blood transfusion system connected to a reservoir (standard capacity 250-500 ml) with a 0.05% solution of chlorhexidine bigluconate. Moreover, to supply an antiseptic to the system, a peristaltic pump is connected. The second catheter is attached to the saliva ejector, the catheters are fixed to the teeth using silk ligature. The peristaltic pump and saliva ejector turn on simultaneously. Moreover, under a pressure of 1 atm. A 0.05% solution of chlorhexidine bigluconate begins to flow through the catheter into the maxillary sinus, abundantly irrigating the latter. At the same time, drainage water, inflammatory exudate, pus are removed from the sinus through a second catheter into the saliva ejector. The procedure is carried out until the appearance of clean wash water. Depending on the condition of the patient and the presence of exudate, the procedure can be carried out 2-3 times a day, given that it is easily tolerated by the patient. Active antiseptic treatment and sinus drainage is carried out for a week before the acute symptoms of inflammation in the sinus are erased. Along with this, on the first day, patients are prescribed endonosal electrophoresis of a 0.1% solution of adrenaline hydrochloride N 7. Laser therapy is prescribed 2-3 days after the start of treatment and is carried out intranasally. For this purpose, a fiber optic fiber from the commercially available physiotherapy laser device ULOFA “Yagoda” is inserted through a catheter into the maxillary sinus, the power density was prescribed from 50 to 200 mW / cm ² 2, which has a pronounced anti-inflammatory and decongestant effect, normalizes circulation, reduces bleeding of tissues and sharply reduces the pastogenicity of microflora. Laser therapy is carried out daily, for a course of 7-10 sessions.

 Given the effectiveness of the anti-inflammatory therapy, the question of the fate of the “causal” tooth was decided ambiguously: teeth with a cavity destroyed by a crown are removed on the first day of treatment. And the teeth, valuable in functional and cosmetic terms, were preserved. To this end, according to the indications in the very first days of treatment, the following was performed: resection of the apex of the root, amputation of the root around which the pathological process is localized, and tooth replantation.

 According to indications, the treatment was supplemented by the appointment of antibiotics, sulfa drugs, vitamins, and hypersensitizing agents.

зуба, боли в области верхней челюсти справа, гнойное отделяемое из правой половины носа. Из истории заболевания выяснено, что две недели назад резко заболел

зуб. В стоматологической поликлинике по месту жительства проведено лечение

зуба. Через 3 дня после лечения

зуба появилась отечность десны, заложенность правой половины носа. Два дня назад появилась боль в области верхней челюсти справа, боли в области

зуба.Example. Patient S. applied to the regional dental clinic of Samara on 09/15/91. complaining of severe pain in the area

tooth, pain in the upper jaw on the right, purulent discharge from the right half of the nose. From the history of the disease, it turned out that two weeks ago he fell sharply ill

tooth. In the dental clinic at the place of residence treatment

a tooth. 3 days after treatment

tooth swelling of the gums, nasal congestion of the right half of the nose. Two days ago, pain appeared in the region of the upper jaw on the right, pain in the area

a tooth.

сохранена, на жевательной поверхности имеется пластмассовая пломба, перкуссия зуба несколько болезненна. Пальпация задне-латеральной стенки верхне-челюстного синуса болезнена.Objective: Face symmetrical, crown

saved, on the chewing surface there is a plastic filling, percussion of the tooth is somewhat painful. Palpation of the posterior lateral wall of the maxillary sinus is painful.

зуба с распространением его в область бифуркации. При передней риноскопии отмечается гнойное отделяемое из естественного отверстия в правой половине носа. t 38,5^oС. Электродонтометрия:

60 мкА,

65 мкА,

-70 мкА. Диагноз: Острый одонтогенный гайморит справа, кистогранулема в области

.On the panoramic x-ray of the upper jaw, a pronounced darkening of the maxillary sinus on the right is noted on the right. On the intraoral radiograph of the alveolar process of the upper jaw, a defect in its bone tissue in the region of the apex of the medial buccal root is noted on the right

tooth with its spread in the area of bifurcation. With anterior rhinoscopy, purulent discharge from a natural hole in the right half of the nose is noted. t 38.5 ^o C. Electrodontometry:

60 μA

65 μA

-70 μA. Diagnosis: Acute odontogenic sinusitis on the right, cystogranuloma in the area

.

зуба. Шаровидным бором под охлаждением 0,05% раствором хлоргексидина биглюконата в диаметре 3-4 мм. Через трепонационное отверстие в верхнечелюстную пазуху введены два полихлорвиниловых катетора, один из которых соединен с емостью с 0,05% раствором хлоргексидина бигклюконата, а второй с слюноотсосом. По вышеописанной методике произведена антисептическая обработка пазухи. На 2-й день начата внутрипазушно лазеротерапия, плотность мощности 100 мВТ/см²2. После нормализации температуры тела произведена операция ампутация медиальношечного корня

с пластикой дефекта кости верхней челюсти деминерализованным аллотрансплантатом. С первого дня лечения эндонозальный электрофорез с 0,1% раствором адреналина гидрохлорида. Лечение с самого начала дополнено назначением антибиотиков, сульфаниламидных препаратов, витаминов, гипосенсибилизирующие препараты.Treatment: under infiltration anesthesia with 2% novocaine solution in an amount of 3 ml, a mucous membrane was punctured with a scalpel 4-5 mm above the root projection

a tooth. Spherical boron under cooling with a 0.05% solution of chlorhexidine bigluconate in a diameter of 3-4 mm. Two polyvinyl chloride catheters were inserted into the maxillary sinus through a treponation hole, one of which is connected to a capacity with a 0.05% solution of chlorhexidine biggluconate, and the second to a saliva ejector. According to the above method, antiseptic sinus treatment was performed. On the 2nd day, intra-axillary laser therapy was started, power density 100 mW / cm ² 2. After normalization of body temperature, the operation was performed amputation of the medial-neck root

with plastic bone defect of the upper jaw demineralized allograft. From the first day of treatment, endonosal electrophoresis with 0.1% solution of adrenaline hydrochloride. Treatment from the very beginning is supplemented by the appointment of antibiotics, sulfa drugs, vitamins, hypersensitizing drugs.

 7 days after the operation, the sutures were removed, the wound healed by first intention, the phenomena of inflammation in the sinus were completely eliminated. A follow-up examination after three months is healthy.

 Thus, the proposed method for the treatment of acute odontogenic sinusitis can significantly increase the effectiveness of treatment, significantly reduce the number of complications, in most cases, to maintain chewing function. Clinical findings support these findings.

Claims (1)

A method of treating acute odontogenic sinusitis by puncture of the maxillary sinus, antiseptic treatment, physiotherapy and anti-inflammatory treatment, characterized in that, in order to reduce complications, the puncture of the maxillary sinus is performed in the anterior sinus wall over the projection of the tips of the 65/56 teeth, stepping up from the gingival margin upwards 20 mm, then after antiseptic treatment, laser therapy is carried out intra-tracheously in the first four days at a power density of 50 mW / cm ² , and on subsequent days at a density of 180-200 mW / cm ² procedures 10 min, treatment 7-10 procedures.