RU2159586C1 - Method for making plastic repair of the anterior wall of the maxillary sinus - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves placing implant produced from polyester-fluorolon threads onto the periosteum. Maxillary sinus is preliminarily treated using ultrasonic cavitation with 0.5% aqueous chlorhexidine solution during 120 s and lincomycin during 60 s. Sutures are layer-by-layer treated with low frequency ultrasonic radiation during 30 s. EFFECT: prevented complications.

Description

 The invention relates to medicine, namely to ENT surgery, and can be used for surgical interventions in the maxillary sinus for various diseases, including tumors.

 Currently, inflammatory diseases of the paranasal sinuses occupy a leading place in ENT pathology and account for 36% of all patients in ENT hospitals. The percentage of odontogenic sinusitis ranges from 2 to 50 of the total number of patients with pathology of the maxillary sinuses.

 A known method of plastics defect of the anterior bone wall by using a plate, which, instead of biting and breaking, is cut whole. However, the disadvantage of this method is that the plate turned out to be smaller than the hole that arose and after replantation could fall into the sinus cavity (Pantyukhin V.P. New modification of radical surgery on the maxillary sinus // Some questions of surgery and traumatology: Sat. Tr. - Novosibirsk, 1963 , pp. 329-331 .: Yashan I.A., Masik A.F. Osteoplastic surgery in case of sinusotomy // Actual problems of otorhinolaryngology. - K .: Zdorovya, 1967, p. 146-147; Sanderson B. Physiologie maxllary antrostomy - update // Laringoscope. - 1983. - Vo.93, N 2; 15.).

 The closest to the achieved positive result is the method of plastic surgery of the defect of the anterior wall of the maxillary sinus by replacing the implant with porous titanium nickelide, adopted as a prototype (Izvin A.I. Surgical rehabilitation of patients with cysts and cyst-like formations of the maxillary sinuses // News of Otorhinolaryngology and Logopathology. - St. Petersburg, 1988; 3: 71-72). After performing extranasal surgical sanitation of the maxillary sinus, the sterilized titanium nickelide plate was modeled according to the shape of the bone defect in the sinus anterior wall, saturated with antibiotics, and placed on this bone defect before suturing. The plate was covered with previously peeled soft tissues, which were sutured from catgut. The known method has good cosmetic and functional effects, eliminates the retraction of soft tissues into the trepan cavity and preserves the anatomical relief of the sinus and its pneumatization.

 However, due to the absence of the mucous membrane from the sinus side and the placement of the implant directly on the bare bone, there is a great risk of infection of the graft and surrounding tissues, the possibility of prolapse of the plate in the sinus.

 A positive result of the claimed invention is the reduction of complications after sinusotomy.

 A positive result is achieved by using a fragment of an alloplastic material made of polyester-fluorone filaments, laying it on the periosteum with preliminary sanitation of the maxillary sinus using ultrasound cavitation with a 0.5% aqueous solution of chlorhexidine for 120 seconds and lincomycin for 60 seconds, and layer-by-layer processing of joints is carried out by low-frequency ultrasound for 30 seconds. The method is as follows.

 After sedation, local infiltration and conduction anesthesia, a U-shaped incision is made of the mucous membrane of the vestibule of the oral cavity to the periosteum at the level of the first premolar of the upper jaw. In this case, the medially located vertical section is at the canine level, and the second vertical section is 1 cm outward. Both incisions are connected by semi-oval dissection of soft tissues at the level of the transitional fold. The cut mucous membrane with the underlying soft tissues is mobilized and pushed up, the anterior sinus wall in the area of the dog's bag is covered with the periosteum. A U-shaped incision is made, the periosteum (base directed towards the orbit) is exfoliated with a raspator and its displacement up. With a sharpened bit, trepanation of the front wall of the maxillary sinus is performed in the form of a “window” (its diameter depends on the volume of surgical intervention). The attitude to the mucous membrane should be gentle, therefore only pathological contents are removed (cyst walls, polyps, areas of polypositely modified, hyperplasticized mucous membrane, mucopurulent exudate). Then, the maxillary sinus is sanitized using ultrasound (ultrasound) cavitation using the LORA-DON ultrasound apparatus. The walls of the maxillary sinus are treated with a voiced antiseptic solution of a 0.5% aqueous solution of chlorhexidine, which was supplied by continuous irrigation of the sinus under the working surface of the waveguide using a disposable 10.0 syringe for 120 seconds. The layer of voiced solution between the bone wall of the sinus and the waveguide should be at least 1 mm. The optimal parameters for sounding maxillary sinuses in cavitation mode are: frequency 26.5 kHz; the oscillation amplitude of the radiating waveguide of the nozzle-raspator is 30 μm and the exposure is 120 seconds. Using the same technique, ultrasound cavitation of the sinuses is carried out with a solution of antibiotic lincomycin (5-8 ml), which disinfected aerobic and anaerobic microflora for 60 seconds. The voiced fluid has a pronounced cleansing, as it removes necrotic tissue sites, and an antimicrobial effect. At the final stage (after applying the anastomosis with the nasal cavity and plugging the latter), the periosteal flap is placed in place and fixed on three sides with fluoroest. After the periosteum was fixed, the entire surface is treated with a 0.5% aqueous solution of chlorhexidine and low-frequency ultrasound (exposure time - 30 sec). Then a fragment of the graft is cut out, which is pre-sterilized using the steam method at a steam pressure of 110 kPa. The implantable fragment of polyester-fluoron filaments modeled by the size of the area and the shape of the bone defect was saturated with antibiotic (lincomycin) by soaking. The fragment is laid and fixed with the underlying periosteal flap on four sides with the same thread from fluoroest. The implant surface is also treated with an antiseptic and a low-frequency ultrasound for 30 seconds. Next, the implant is covered with a previously exfoliated muscular-mucous flap, on which nodal catgut sutures are applied. Seams are treated with ethyl alcohol.

 Clinical example: Patient U. 16 years old; I.B. N 1515 was admitted to the clinic of ENT diseases on 03.22.99 with a diagnosis of left-sided cystic sinusitis for surgical treatment. 03/26/99 - left-sided sinusotomy with removal of the cyst walls, followed by ultrasound cavitation in a medium of 0.5% aqueous solution of chlorhexidine and lincomycin (180 sec); plastic closure of the defect of the anterior wall with a fragment of polyester-fluoron filaments impregnated with a solution of lincomycin; layer-by-layer treatment of sutures with an antiseptic and low-frequency ultrasound. The postoperative period without complications: tissue reaction to the implant was not observed, pathological discharge from the nose was not, wound healing by primary intention. On the 4th day after the operation, the maxillary sinus was rinsed through the imposed anastomosis with a solution of furatsilina - the wash liquid is clean. In the postoperative period, computed tomography of the operated sinus was performed - the graft is not displaced, there is no retraction of soft tissue into the sinus. The patient was discharged 10 days after surgery.

 Thus, the application of the proposed method contributes to the preservation of the skeleton of the sinus, its function and thereby reduces the number of postoperative complications and relapses of the disease.

 Due to the placement of alloplastic material (a fragment of an artificial vascular prosthesis) on the periosteal flap, which can be cut out of any size, this technique allows you to protect the transplant from direct contact with the mucous membrane of the maxillary sinus.

 When fixing this material, not only to the periosteum, but also to the overlying muscular-mucous flap, creates a good framework and prevents the prolapse of soft tissues in the sinus.

 Preliminary sanitation of the maxillary sinus by ultrasound cavitation in an antiseptic medium - 0.5% aqueous solution of chlorhexidine (exposure 120 sec) and antibiotic solution - lincomycin (exposure 60 sec), as well as layer-by-layer treatment of joints with low-frequency ultrasound (exposure 30 sec) eliminates the possibility infection of the graft and surrounding soft tissues.

 The inventive method for plastic closure of a defect in the anterior wall of the maxillary sinus can also be used for repeated (reoperations) in the sinus, tumor processes, in which extended radical surgery on the maxillary sinus is usually used.

Claims (1)

 A method for plasticizing a defect in the anterior wall of the maxillary sinus by using a graft of alloplastic material, characterized in that the graft consists of polyester-fluorone filaments, it is placed on the periosteum with preliminary sanitation of the maxillary sinus using ultrasonic cavitation with a 0.5% aqueous solution of chlorhexidine during 120 s and lincomycin for 60 s, and layer-by-layer treatment of the sutures is carried out by low-frequency ultrasound for 30 s.