RU2289335C1 - Method of reconstructing bone walls of maxillary sinus - Google Patents

Abstract

FIELD: maxillofacial surgery.

SUBSTANCE: after opening of sinus, damaged bone tissue and pathologic contents are removed, endonasal canal for postoperative drainage is formed, and bone defect is replaced by titanium nickelide tissue made from thread having diameter 50-60 μm and mesh size 10 to 1000 μm. Titanium nickelide tissue is attached to soft tissues by means of interrupted sutures in the region of anterior, superior, and posterior borders. Inferior border is placed either under periosteum of the alveolar outgrowth above gingival border by 1-2 mm or, when teeth are missing, under periosteum of the bone portion of hard palate.

EFFECT: reduced risk of detachment of sutures and prevented destructive changes of bone walls of sinus.

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Description

The invention relates to medicine, namely to surgical dentistry and maxillofacial surgery, and is intended for the treatment of patients with diseases accompanied by destructive changes in the bone walls of the maxillary sinus.

The closest technical solution is a method for reconstructing the bony walls of the maxillary sinus with destructive sinusitis, including subperiosteal exfoliation of soft tissues, opening the sinus with removal of the affected bone tissue and pathological contents, forming an endonasal canal of postoperative drainage, modeling a plate implant made of porous titanium nickelide corresponding to the shape of a titanium nickelide corresponding to the shape of titanium nickelide and saturating it with antibiotics, replacing a bone defect, coating the implant with soft t canals and wound closure [New technologies in maxillofacial surgery based on superelastic materials and shape memory implants / P.G.Sysolyatin, V.E. Gunter, S.P.Sysolyatin and others - Tomsk: STT, 2001. - P.139].

The disadvantages of this method are the possibility of the formation of a postoperative defect due to the divergence of soft tissue sutures with subsequent exposure to the implant material of the oral contents, time and labor costs for the individual manufacture of the implant, the possibility of developing allergic complications due to the use of the antibiotic.

The objective of the invention is to increase the efficiency of surgical treatment of patients with diseases accompanied by destructive changes in the bone walls of the maxillary sinus.

The problem is achieved in that in a method for reconstructing the bone walls of the maxillary sinus, including subperiosteal exfoliation of soft tissues, opening the sinus with removal of the affected bone tissue and pathological contents, forming the endonasal canal of postoperative drainage, replacing the bone defect with a nickel-titanium implant, covering it with soft tissues and suturing the wound, new is that the bone defect is replaced with a tissue of titanium nickelide made from a thread with a diameter of 50-60 microns with a size rum cells of 10-1000 μm, which is installed taking into account its overlap by 3-5 mm around the perimeter and fixed to soft tissues with interrupted sutures in the region of the anterior, upper and posterior edges, and the lower edge is placed under the periosteum of the alveolar process 1- above the gingival margin 2 mm. In cases of missing teeth on the upper jaw, the lower edge of the implant is placed under the periosteum of the bony part of the hard palate.

Due to its superelasticity and biocompatibility with body tissues, titanium nickelide tissue, after being placed under the mucoperiosteal flaps in the projection of the defect, creates an additional framework in the area of the defect in the walls of the maxillary sinus, due to the fine mesh structure it prevents penetration of the contents of the oral cavity into the maxillary sinus through it cases of discrepancies in soft tissue seams.

The method is as follows. Soft tissues are dissected and subperiosteal below the transitional fold in the projection of the anterior external wall of the maxillary sinus with excision of the fistulous passage in cases of its presence, it is opened or accessed in the sinus, the affected bone tissue and pathological contents of the sinus are removed, the endonasal canal of the drainage drainage is formed, the bone defect is replaced from titanium nickelide made of a thread with a diameter of 50-60 microns with a mesh size of 10-1000 microns, which is set taking into account its overlap by 3-5 mm across imetru and fixed to the soft tissues interrupted sutures in the front, upper and rear edges, the bottom edge is placed under the periosteum of the alveolar bone above the gingival margin of 1-2 mm. In cases of missing teeth on the upper jaw, the lower edge of the implant is placed under the periosteum of the bony part of the hard palate, soft tissues are laid in place, and the wound is sutured tightly.

Example. Patient M., 56 years old, was admitted to the hospital with a diagnosis of Right-sided chronic maxillary sinusitis, oroantral fistula, condition after cystectomy of the upper jaw. Three months ago, he was operated on for a radicular cyst of the right upper jaw, after which an oroantral message was noted. Objectively: From the vestibular side of the alveolar process of the right upper jaw, an oroantral fistula was determined, the dental formula was 11, 21, 23, 24, 33, 32, 32, 41, 42, 44. Surgery was performed with reconstruction of a defect in titanium nickelide tissue. Under general anesthesia, the mucous membrane and periosteum are cut below the transitional fold by 5 mm with excision of the fistulous course, from 11 teeth to the projection of the cheek-alveolar ridge. Soft tissues are mobilized upward, the absence of the alveolar process, the anterior external wall of the maxillary sinus to the infraorbital foramen from the 11th tooth to the zygomatic alveolar ridge, the bony structures of the anterior and middle sections of the sinus internal wall in the projection of the lower and middle nasal passage, 4.0 × 5 in size, was revealed. 5 cm. The affected areas of bone tissue and pathological contents of the maxillary sinus were removed, soft tissues were excised in the projection of the defective internal wall of the sinus, the defect of the anterior external sinus wall was replaced by an elastic with a titanium nickelide fabric made of a thread with a diameter of 50 μm with a mesh size of 500 μm, installed with a defect overlap of 5 mm along the front, upper and rear edges, which were fixed to the soft tissues with internal interrupted sutures, the lower edge of the implant was placed under the periosteum of the bone part hard palate, soft tissue laid in place, the wound is sutured tightly. Postoperative course without complications, sutures were removed after 10 days. Wound healing is primary. When viewed after 1.5 years from the intervention, a relapse of the disease was not noted.

In Fig.1, patient M. before surgical treatment.

In Fig.2, a tissue made of titanium nickelide is installed in the region of the defect of the alveolar process, anterior outer wall of the upper jaw and under the periosteum of the bone part of the hard palate of patient M.

In Fig.3, patient M. 1.5 years after surgical treatment

The advantages of the proposed method are that as a result of using the maxillary sinus of the implant material in the form of titanium nickelide tissue as a bone wall replacement defect, postoperative defects, superelasticity and tissue retention of liquids do not reliably isolate the oral cavity from the maxillary sinus, which eliminates the effects of the contents of the oral cavity cavities in cases of discrepancy of external sutures or necrosis of a part of the mucosal-periosteal flaps. In these situations, the wounds heal by secondary intention along the implant material. Due to the biochemical and biomechanical compatibility of titanium nickelide with body tissues, the connective and bone tissue from the recipient areas grows through the implant structure with the formation of a tissue regenerate in the area of the former flaw.

Clinical trials of the proposed method were carried out on 20 patients who underwent reconstruction of defects of the anterior and lower walls of the maxillary sinus that arose as a result of unsuccessfully performed sinusotomies, destructive processes of inflammatory genesis or exposure to tumor and tumor-like states of the upper jaw, using titanium nickelide tissue. In 17 cases, primary wound healing was determined, in 3 patients - partial divergence of sutures and secondary wound healing. In the process of monitoring patients for 1.5-2 years, no anatomical and functional disorders associated with the operations were detected.

Claims (1)

The method of reconstruction of the bone walls of the maxillary sinus, including subperiosteal exfoliation of soft tissues, opening the sinus with removal of the affected bone tissue and pathological contents, forming the endonasal canal of postoperative drainage, replacing the bone defect with a nickel-titanium implant, covering it with soft tissues and suturing the wound, characterized in that the bone defect is replaced with a titanium nickelide fabric made from a thread with a diameter of 50-60 μm with a mesh size of 10-1000 μm, which is installed with the overlap of the defect by 3-5 mm around the perimeter and is fixed to the soft tissues with interrupted sutures in the area of the front, upper and rear edges, and the lower edge is placed either under the periosteum of the alveolar process above the gingival margin by 1-2 mm, or, in the absence of teeth under the periosteum of the bony part of the hard palate.

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