RU2510247C1 - Method for prevention of infraorbital neuropathy accompanying maxillary sinusitomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgical dentistry and maxillofacial surgery. The maxillary sinusitomy is performed within a zygomaticoalveolar crest. A canine fossa is not skeletonised. A maxillary sinus cavity is inspected through a formed opening. The sinus cavity is packed with a iodoform cotton swab; an end of the cotton swab is brought out from the form opening into a nose; a wound is closed tightly with polyethyleneterephthalate from an oral cavity.

EFFECT: method enables eliminating a possibility of an infraorbital nerve injury and developing postoperative neuropathy accompanying the maxillary sinusitomy ensured by the fact that the maxillary sinusitomy is performed within the zygomaticoalveolar crest.

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Description

The invention relates to medicine, namely to surgical dentistry, and maxillofacial surgery and can be used for sinusotomy.

There is a classic way of conducting a Caldwell-Luke maxillary sinusotomy in which, after appropriate treatment of the surgical field and anesthesia, a horizontal linear incision is made of soft tissues in the region of the transition folds to the bone from the lateral incisor to the third molar. The flap along with the periosteum is separated and pulled up, exposing the area of the canine fossa.

With a chisel and a hammer or a chisel, a Voyachek creates a hole in the area of the canine fossa. Nippers or forceps bite a bone plate in the area of the front wall, after which pathologically changed tissues or the entire mucous membrane of the sinus are carefully scraped with a sharp spoon through the resulting window. After curettage of the cavity, an artificial hole is created in the direction of the nasal cavity through the lower nasal passage. The sinus is plugged, the end of the tampon is brought out into the nose, and the wound from the side of the mouth is sutured [1].

The disadvantage of this method is that conducting a maxillary sinusotomy (creating a perforation in the maxillary sinus) in the canine fossa, especially when the infraorbital foramen is located low in it, as well as creating a large perforation, there is a real possibility of damage to the infraorbital nerve as a sharp instrument, for example , when peeling the mucoperiosteal flap in the area of the canine fossa, or by the Farabef hook when stretching the edges of the wound for a better view of the irrational field. All this leads in the postoperative period to the development of persistent neuropathy by the type of loss of sensitivity in the innervation zone of the infraorbital nerve.

The objective of the proposed method: to exclude the possibility of damage to the infraorbital nerve, as well as the development of its postoperative neuropathy during sinusotomy.

The problem is solved due to the fact that a sinusotomy is performed in the area of the zygomatic alveolar ridge, after which the sinus is inspected through the formed window, the sinus is plugged with iodine-shaped turunda, the end of the turunda is pulled into the nose, and the wound from the mouth is sutured.

The method is as follows.

Under intubation anesthesia, after twice processing the surgical field, an incision of the mucous membrane is made in the region of the transitional fold of the left or right upper jaw to the bone: from the canine to the third molar. The mucoperiosteal flap is peeled and pulled up, exposing the sculoalveolar crest to the right or left, without the need to skeleton the fossa. A fissure bore in the area of the zygomatic alveolar ridge creates a perforation hole in the right or left maxillary sinus (Fig. 1). After that, through the resulting window, an audit of the maxillary sinus is performed: pathologically altered tissues or the entire mucous membrane of the sinus are carefully scraped out, foreign bodies are removed: tooth roots, filling material. Then create an artificial hole in the direction of the nasal cavity through the lower nasal passage. The sinus is abundantly washed with antiseptic solutions, tamponized with iodoform turunda, the end of the turunda is removed through an artificially created hole in the lower nasal passage, the mucoperiosteal flap is put in place, and the wound is closed tightly with lavsan from the side of the mouth.

The results of treatment of the proposed method for 10 patients with a diagnosis of chronic odontogenic sinusitis of the study group showed that in the postoperative period and in the future, all patients did not have neuropathy phenomena such as loss of sensitivity in the zone of innervation of the infraobital nerve.

All patients received positive treatment results, and the hospital stay was mainly from 8-10 days. Subsequently, the patients were discharged for outpatient aftercare at the dentist-surgeon at the place of residence.

In 12 patients of the control group with chronic odontogenic sinusitis, surgical treatment was carried out by the generally accepted method, carrying out maxillary sinusotomy in the canine fossa.

In the postoperative period, 5 patients of this group showed neuropathy as a type of loss of sensitivity in the area of innervation of the infraorbital nerve, which required additional treatment by a neurologist.

A routine examination of patients in the control group two months after surgery showed that after treatment, the neuropathologist completely restored the sensitivity in 2, partially in 1 patient. And 2 patients developed persistent neuropathy by the type of sensitivity loss in the innervation zone of the infraorbital nerve.

Clinical example 1. Patient R., 32 years old, was hospitalized in the Department of Maxillofacial Surgery 02/12/2012 year.

The patient complained of periodically occurring purulent discharge from the left half of the nose, often with a fetid odor, impaired nasal breathing on the left, unilateral headache and a feeling of heaviness in the head, paresthesia and pain in the branch area of the left maxillary nerve.

From the anamnesis it was found that these symptoms concern the patient over the past two years. I did not go to the doctor, I was treated on my own, took antibacterial and painkillers. 02/02/12, after another exacerbation, he went to the polyclinic at the place of residence to the otolaryngologist and, after X-ray control, was sent for surgical treatment to the maxillofacial surgery department.

At the external examination, there is no face configuration violation. Regional lymph nodes are not enlarged, painless on palpation. The mouth opens well, the movements of the lower jaw are not difficult. The mucous membrane of the oral cavity is pale pink, with no signs of inflammation.

An X-ray revealed a decrease in the transparency of the left maxillary sinus, the presence of a foreign body (retained 28 teeth) in the left maxillary sinus (Fig. 2).

Dental formula

ABOUT ABOUT ABOUT eighteen 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 ABOUT ABOUT ABOUT

where O is a missing tooth.

The patient was diagnosed with chronic odontogenic left-sided maxillary sinusitis, a foreign body (retained 28 tooth) of the left maxillary sinus. Surgical treatment of this patient was carried out by the proposed method.

After intubation anesthesia, after a double treatment of the surgical field, a mucosal incision was made in the region of the transitional fold of the left upper jaw to the bone: from the canine to the third molar. The mucosal-periosteal flap was exfoliated and pulled up, exposing the left zygomatic alveolar ridge. A fissure bore in the area of the left sculoalveolar ridge created a perforation hole in the left maxillary sinus (Fig. 3). After that, a retarded 28 tooth was removed through the resulting window (Fig. 4) and the left maxillary sinus was revised: the pathologically changed sinus mucosa was carefully scraped out. Then created an artificial hole in the direction of the nasal cavity through the left lower nasal passage. The sinus was abundantly washed with antiseptic solutions, tamponized with iodoform turunda, the end of the turunda was brought out through an artificially created hole in the nose, the mucoperiosteal flap was put in place, and the wound was closed tightly with lavsan (Fig. 5) from the mouth.

In the postoperative period, the patient did not exhibit neuropathy (as loss of sensitivity) in the innervation zone of the left infraobital nerve. Wound healing - without features.

The hospitalization period was 9 days, the patient was discharged for outpatient follow-up care at the dentist-surgeon at the place of residence.

A follow-up examination of the patient 6 days after discharge from the hospital showed that the patient does not complain. Locally: the wound in the oral cavity healed by primary intention, there are no signs of neuropathy in the innervation zone of the left infraobital nerve. The patient was removed surgical sutures, it is recommended to proceed to work.

Clinical example 2. Patient B., 48 years old, was hospitalized in the Department of Maxillofacial Surgery 04/16/2012. The patient complained of pain in the right half of the face, slight congestion of the right half of the nose, swelling of the cheeks that appeared about a week ago.

From the anamnesis: is being treated by a dentist three months ago. He notes that during the treatment of 15 teeth after passage of the root canals when washing with an antiseptic, he felt the appearance of fluid in the nose, after which the tooth was filled. A week ago, the above complaints appeared. He again applied to the dental clinic, where filling material was found in the maxillary sinus on the dental image, and was sent to the hospital for treatment.

During an external examination, a moderate violation of the face configuration was determined due to the smoothness of the right nasolabial fold, its palpation is painless. The mouth opens well, the movements of the lower jaw are not difficult, in full. In the oral cavity, moderate pain is determined by the transitional fold of the right upper jaw in the projection of 14.15.16 teeth. Percussion of the 15 tooth is painless. On a direct x-ray of the sinuses, there is a decrease in pneumatization of the right maxillary sinus, the presence of a foreign body (filling material) in the right maxillary sinus.

Dental formula

ABOUT P P P P ABOUT ABOUT eighteen 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 ABOUT P P P ABOUT ABOUT ABOUT

where O - missing tooth, P-seal.

The patient was diagnosed with chronic odontogenic right-sided maxillary sinusitis, a foreign body (filling material) of the right maxillary sinus. After anti-inflammatory therapy, surgical treatment of this patient was carried out by the proposed method.

After intubation anesthesia, after a double treatment of the surgical field, a mucosal incision was made in the region of the transitional fold of the right upper jaw to the bone: from the canine to the third molar. The mucoperiosteal flap was exfoliated and pulled up, revealing the right zygomatic alveolar ridge. A fissure bur in the region of the right sculoalveolar ridge created a perforation hole in the right maxillary sinus. After that, through the resulting window, we conducted an audit of the right maxillary sinus: carefully scrubbed the pathologically changed sinus mucosa and removed the foreign body - filling material. Then created an artificial hole in the direction of the nasal cavity through the right lower nasal passage. The sinus was abundantly washed with antiseptic solutions, tamponized with iodoform turunda, the end of the turunda was brought out through an artificially created hole in the nose, the mucosal-periosteal flap was put in place, and the wound was tightly closed with lavsan from the side of the mouth.

In the postoperative period, the patient did not have neuropathy phenomena (such as loss of sensitivity) in the innervation zone of the right infraobital nerve. Wound healing took place without features.

The hospitalization period was 10 days, the patient was discharged for outpatient follow-up at the dentist-surgeon at the place of residence.

Control examination of the patient 10 days after discharge from the hospital showed that the patient does not complain. There are no signs of neuropathy in the innervation zone of the right infrabital nerve. Locally: the wound healed by first intention, surgical sutures were removed in the clinic. The patient began to work.

The proposed method eliminates the possibility of damage to the infraorbital nerve, since a maxillary sinusotomy is performed in the area of the alveolar ridge and there is no need to exfoliate tissue and skeleton the fossa. Due to this, patients in the postoperative period do not have neuropathy phenomena such as loss of sensitivity in the area of innervation of the infraobital nerve.

Literature

1. Robustova T.G. Surgical Dentistry. - M., 2003. -504 p.

Claims (1)

A method for the prevention of neuropathy of the infraorbital nerve, including sinusotomy, characterized in that the sinusotomy is performed in the area of the sculoalveolar ridge, after which the sinus is inspected through the window, the iodoform turunda is tamped, the end of the turunda is pulled into the nose, and the wound is removed from the side.

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