RU2225176C1 - Method for maxillary sinusotomy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: the present innovation deals with treating patients with chronic sinusitis maxillaris. One should cut and exfoliate mucosoperiosteal fragment, develop osseous fenestra, remove foreign bodies and pathologically altered sinus mucosa. Moreover, developing of osseous fenestra should be carried out by keeping mucosa together with periosteum so, that at lancing the sinus the diameter of osseous plate should be higher against fenestra developed. After removing foreign bodies and pathologically altered sinus mucosa the developed osseous-mucosoperiosteal fragment should be returned to its previous place and fixed with sutures. The method enables to decrease the number of complications due to keeping osseous anterior wall of sinus and accelerate the healing. EFFECT: higher efficiency of operation conducted. 1 dwg, 1 ex

Description

 This invention relates to medicine, namely to surgical dentistry, and can be used in the treatment of patients with chronic sinusitis.

 In the process of endodontic treatment, the filling material is often removed beyond the apex of the tooth root into the maxillary sinus. In addition, during the removal of molars of the upper teeth, it is possible to push the roots into the sinus. At the same time, pathological changes occur in the sinus, the correction of which is possible only when the foreign body is removed from the sinus.

 A known method of maxillary sinusotomy, which consists in the fact that after cutting and exfoliation of the mucoperiosteal flap along the anterior wall of the maxillary sinus, a bone window is formed through which the removal of foreign bodies and pathologically altered mucosa from the sinus [Bezrukov V.M., Robustova T.G. . Guidelines for surgical dentistry and maxillofacial surgery, p.320-321].

 The disadvantages of this method is a large bone defect formed in the anterior wall of the maxillary sinus, numbness in the premolar region.

 The aim of this invention is to reduce the number of complications due to the preservation of the bony anterior sinus wall and accelerate healing.

 This goal is achieved in that in the method of maxillary sinusotomy by cutting and exfoliating a mucoperiosteal flap, forming a bone window, removing foreign bodies and pathologically altered sinus mucosa, a distinctive feature is that the bone window is formed while preserving the mucous membrane with the periosteum, so that when opening the sinus, the diameter of the bone plate is larger than the formed window, the bone-mucosal-periosteal flap formed after removal of foreign bodies and ologicheski modified sinus mucosa is recycled to place and fix sutures.

 The essence of the method is as follows.

 Perform appropriate conduction or infiltration anesthesia. Next, an incision is made along the transitional fold from 2 to 7 teeth. The mucosal-periosteal flap is exfoliated, but retained on the site of the proposed bone window. A bone window is formed (Fig. 1) with a small fissure bore, so that when opening the sinus, the diameter of the bone plate is larger than the formed window. An osteotomized bone plate with a mucoperiosteal flap fixed to it is pulled up. Foreign bodies (roots, filling material, pins), polyposis of the mucosa are removed from the sinus. If necessary, an anastomosis is formed with the lower nasal passage and the sinus is plugged with iodoform turunda. The bone-periosteal soft tissue flap is returned to its place and fixed with vicryl sutures. The mucoperiosteal flap is returned to its place and fixed with sutures.

Example. Patient K. complained of periodically recurring severe headaches, as well as suppuration from the left half of the nose, which appeared 2 months after filling 26 teeth. In the x-ray, the root canals 26 are sealed to the apex; a large amount of foreign material is noted in the maxillary sinus. The tooth is covered with a ceramic-metal crown. When percussion is painless. The patient is offered surgical treatment. An arcuate incision from 2 to 7 teeth was performed under conduction anesthesia. Then, using a raspator, a mucosal-periosteal flap was detached, preserving it in the area of the proposed bone window. The external cortical plate is trepanated according to the projection of the anterior wall of the maxillary sinus, using a small fissure bur, at an angle of 45 ^o .

 The bone window is stored on the periosteal soft tissue leg. The removal of excess foreign body (filling material), the removal of polyps. X-ray control was carried out. The bone window is returned to its place and is fixed with sutures. The operation is completed by suturing the wounds of the mucosa and periosteum.

 3 months after surgical treatment, there are no complaints from the patient. On an x-ray, pathological changes in the sinus are not detected.

 The advantages of this method include the fact that the method is applicable for the treatment of all types of sinusitis, regardless of its causes. The method allows to reduce the invasiveness of the intervention due to the sparing attitude to bone structures. This method allows you to save the anatomical integrity of the outer wall of the maxillary sinus due to an improved technique of surgical intervention and to avoid a large number of complications.

Claims (1)

Method of sinusotomy by cutting and exfoliating a mucoperiosteal flap, forming a bone window, removing foreign bodies and pathologically altered sinus mucosa, characterized in that the formation of a bone window is carried out while maintaining the mucous membrane with the periosteum so that when opening the sinus the diameter of the bone plate is larger formed window, the resulting bone-mucosal-periosteal flap after removal of foreign bodies and pathologically altered sinus mucosa is returned to esto, and fixed joints.