RU2325126C1 - Method of alveolar cleft grafting - Google Patents

Abstract

FIELD: medicine; otorhinolaryngology; maxillofacial surgery.

SUBSTANCE: essence of the invention is in formation of a mucoperiosteal flap. A vestibular flap, 2.5 x 1.5 cm large, is created which transits into mucous membrane of the cheek with a pedicle near the tooth behind the cleft. Stepping 0.5 - 1 cm back, the flap is cut crosswise to the sub mucous level and the flaps are folded to the sides by 0.3 - 0.5 cm. The flap is then pushed through the cleft into the sinus so that the epithelial flap covered the inner opening, the interim diepithelialized part filled the cleft, and the proximal epithelial flap covered the outer opening of the cleft. The flap is then fixed against the palatal side of the mucous alveolar.

EFFECT: grafting of the alveolar cleft by filling the bone defect in the alveolar; facilitation of growth of epithelial lining; prevention of recurrent cleft.

4 dwg

Description

The invention relates to medicine, namely to otorhinolaryngology, maxillofacial surgery.

Sinusitis of odontogenic etiology makes up 13.9-24% of the total number of inflammatory diseases of the maxillary sinus (V.M. Uvarov, 1962; A.G. Shargorodsky, 1985). The presence of fistulous passage from the oral cavity to the maxillary sinus, which can form after the removal of 5-8 teeth of the upper jaw, is a constant source of infection of the maxillary sinus. This dictates the need for the treatment of odontogenic sinusitis with alveolar fistula is necessary to close the fistulous passage, which is the main method of treatment of odontogenic perforated sinusitis.

To close the fistulous passage, flaps on the pedicle from the vestibular and palatine surfaces of the gums, a mucous-fatty flap from the cheek, or various allogeneic grafts are used (E.Ya. Gubaidullina, 1959; R.G. Anyutin, I.A. Romanov, 1996; V. A. Sukachev, 1978; S.S. Lavrentiev, 1995; I.V. Urazova, 1987; E.M. Osipyan, 1998; V.V. Skorobogaty, 2000, etc.). Long-term clinical observations of the results of existing methods of surgical treatment of odontogenic sinusitis with plastic surgery of the alveolar fistula of the maxillary sinus revealed a number of drawbacks, the most significant of which are partial or complete flap necrosis, transplant rejection. This leads to a relapse of the fistulous course and sinusitis, which is observed in 9-15% of cases (G.V. Starenkova, D.I. Golikov, 1976; V.A. Sukachev et al., 1996 and others). As a result, there is a need for a second operation, which is not always possible to perform due to the presence of scar tissue in the intended area of the graft and the limited area for the collection of plastic material. In addition, when using plastic flaps, only the outer part of the alveolar fistula is closed and the length of the fistula and the alveolar defect from the sinus side are not taken into account, where after the fistula is closed, a wound surface is formed, then scar tissue devoid of epithelium. Therefore, the search for new methods of surgical treatment of odontogenic sinusitis is an urgent problem.

Yu.I. Bernadsky (1984) suggests, in front of the mouth, to cut out a thick mucoperiosteal flap, to epithelialize its end, and bring it under the peeled mucous membrane at the hole on the palatine side, and then fix it with sutures to the edge of the perforation. This method is taken by the authors as a prototype.

The disadvantages of suturing perforation with vestibular flaps is:

a) Only the outer opening of the fistula is closed; changes in air pressure in the maxillary sinus, and therefore in the area of the fistula during breathing, swallowing, sneezing, leads to rejection of the flap.

b) The flap is under constant tension, which disrupts its nutrition and can cause its necrosis and relapse of the fistula.

c) Large tissue trauma due to a wide incision and separation of the periosteum during the manufacture of a trapezoidal flap.

d) The wound exudate in the postoperative period presses on the wound surface of the flap, preventing its normal growth, and the internal epithelial lining of the sinus is not formed.

e) As a result of healing in the area of the internal opening of the fistula, a scar is devoid of epithelium, and, as a result, mucociliary sinus transport is impaired.

The method of fistula repair should ensure the formation of a mobile flap that fits into the prepared bed without tension, fill in the alveolar bone defect and eliminate the oroantral communication with the formation of the epithelial lining not only from the oral cavity, but also from the sinus cavity, thereby preventing recurrence of perforation. The first and important condition for the successful plastic surgery of the alveolar fistula is the selection and development of the optimal plastic flap.

The novelty of the proposed method lies in the fact that for the plasticity of the fistulous passage, a mobile mucosal-periosteal flap is used from the vestibular surface of the gums, which will provide plasticity of the fistulous passage and epithelization of its external and internal holes. This is aimed not only at preventing relapse, but also at epithelialization of the sinus floor.

A significant difference is that they form a mucoperiosteal flap, from the vestibular surface of the gums with the transition to the mucous membrane of the cheek, measuring 2.5 × 1.5 cm, with a feeding leg in the tooth area located posterior to the fistula, 0.5 -1 cm, the flap is transversely dissected to the submucosal layer and separated in different directions by 0.3-0.5 cm, its proximal part is passed through the alveolar passage into the sinus cavity, and the distal is fixed to the palatine side of the alveolar mucosa from the side of the oral cavity. The size of the flap provides its mobility. The flap is inserted through the alveolar passageway into the sinus cavity, so that the distal epithelial area covers the internal opening of the passageway from the inside, the intermediate diepithelial part performs the passage cavity, and the proximal epithelial area covers the external opening of the alveolar passageway and is fixed with sutures to the palatine side of the alveolar mucosa.

The method is developed on corpses.

An example of the method is presented in the diagrams.

The method is carried out in the following way. After opening the affected maxillary sinus and removing the inflamed mucosa in the area of the alveolar bays and the bottom of the maxillary sinus, in the area of the internal opening of the fistula with a bone spoon, the alveolar passage is freed from granulation and epithelium. From the vestibular surface, from the transitional fold, with the transition to the inner surface of the cheek, a 2.5 × 1.5 cm mucoperiosteal flap with a feeding leg near the base posterior to the fistula of a lying tooth is cut out (Figure 1). Retreating from the edge of 1 cm, the flap is transversely incised to the submucosa. The edges of the incision are divorced and separated by 5 mm in different directions (Figure 2). Thus, two epithelial sites are formed on the flap - distal (Figure 2, a) and proximal (Figure 2, b) and diepithelial area (Figure 2, c). Using a button probe, the flap is inserted into the fistulous opening (Figure 3). The distal site using endoscopic forceps under the control of the endoscope is straightened at the bottom of the maxillary sinus so that it covers the inner opening of the alveolar passage (Figure 3, a). The proximal site is placed on the external opening of the alveolar passage and is sutured with atraumatic material with separate interrupted sutures to the mucous membrane along its circumference (Figure 3, b). A wound defect on the inner surface of the cheek is sutured with separate interrupted sutures, a wound of the mucous membrane in the region of the anterior maxillary sinus is also sutured (Figure 4).

Thus, fistula plastic surgery is performed from the side of the oral cavity (proximal site (Figure 3, b)), the alveolar bone defect is eliminated with a soft-tissue epithelial area (Figure 3, c), and the defect of the maxillary sinus is filled with the help of the distal epithelial site (Figure 3 , a) and the internal opening of the fistula is closed.

The proposed method for plasty of the alveolar fistula allows you to quite effectively close the fistulous opening, to provide epithelization of the sinus floor. This method can be recommended in clinical practice for the surgical treatment of odontogenic perforated sinusitis.

Literature

1. Anyutin R.G., Romanov I.A. Sparing maxillary sinusitis in patients with perforated odontogenic sinusitis. // Ross. rhinol. - 1998. - No. 2. - S. 34.

2. Bernadsky Yu.I. Fundamentals of surgical dentistry. Kiev, "Vishka school"; 1984. - S.165.

3. Bogatov A.I., Zakharova I.A., Malakhova M.A. Odontogenic perforated sinusitis. Monograph. M., 2003.

4. Lavrentiev S.S. Application in the complex treatment of odontogenic perforated sinusitis of osteoplasty of fistulas for the maxillary sinus: Abstract. dis. ... cand. honey. sciences. / S.S. Lavrentiev. - M., 1995 .-- P.16.

5. Osipyan E.M. Comparative evaluation of various methods of treatment of patients with odontogenic perforated sinusitis. / E.M. Osipyan, A.A. Nazarova, I.V. Popenko // Materials of the anniversary conference, dedicated. 90th birthday of prof. M.S. Makarova. - Stavropol, 1998 .-- S.341-343.

6. Starenkov G.V., Golikov D.I. Damage to the maxillary sinus during tooth extraction. // Materials of the VI scientific-practical conference of dentists of the Kalinin region. - Kalinin, 1976 .-- S.93-98.

7. Sukachev V.A. A new technique for eliminating the post-extraction message of the maxillary sinus with the oral cavity. / V.A. Sukachev, A.A. Kulakov, N.P. Gritsay // Health of Tajikistan. - 1978. - No. 1. - S. 38.

8. Sukachev V.A., Kozlov Yu.I., Kulakov A.A. Treatment of perforations and fistulas of the maxillary sinus. Method. Recommendations - 1996.

9. Uvarov V.M. Odontogenic sinusitis. L., 1962.

10. Urazova. I.V .. Embryoplasty of postoperative tissue defects during surgical interventions in the maxillofacial region: Abstract. dis. ... cand. honey. sciences. / I.V.Urazova. - Perm, 1987 .-- 15 p.

11. Shargorodsky A.G. Inflammatory diseases of the maxillofacial region and neck. M .: Medicine, 1985.

Claims (1)

The method of plasty of the alveolar fistula, including the formation of a mucosal-periosteal flap, characterized in that a vestibular flap is formed with a transition to the mucous membrane of the cheek, measuring 2.5 × 1.5 cm with a feeding leg in the area of the tooth located posterior to the fistula, departing 0. 5-1 cm, the flap is transversely dissected to the submucosal layer and separated in different directions by 0.3-0.5 cm, the flap is passed through the alveolar passage into the sinus cavity so that the distal epithelial site covers the internal opening of the passage from the inside, the daily diepithelized part performed the passage cavity, and the proximal epithelial site covered the outer opening of the alveolar passage, while it was fixed to the palatine side of the alveolar mucosa.

Images