RU2790935C1 - Surgical method for treatment of odontogenic cysts of the upper jaw - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to surgical dentistry and maxillofacial surgery, and is intended for use in the treatment of odontogenic cysts of the upper jaw of any size that are not directly related to the maxillary sinus. The operation is performed under infiltration anesthesia, an incision is made along the alveolar ridge of the upper jaw, a trapezoidal muco-periosteal flap is cut out and peeled off. After exposing the bone wall above the cyst, a trepanation hole is created smaller than the anterior wall of the cyst, the cyst is removed, one of the walls of which is the mucous membrane of the inferior nasal meatus. The entire mobile mucous membrane adjacent to the cystic cavity is removed. Next, a non-woven bandage soaked in a solution of povidone-iodine is placed in the bone cavity. After that, in order to distinguish the oral cavity from the cavity of the defect, soft tissues are sutured in the area of the vestibule of the oral cavity. For the first two days, the bandage is tightened by 10 cm. On the 3^rd day after the operation, the bandage is removed completely through the inferior nasal meatus, preventing the bandage from engaging with the bone protrusions and edges of the bone wound. The sutures are removed on the 10^th day after the operation.

EFFECT: method, due to the use of non-woven material that prevents the edges from shedding and the leaving of cotton fibers and woven fragments in the cyst cavity, and the use of povidone-iodine as a drug that reduces the sliming of the bandage and the leaving of iodoform crystals in the bone cavity, reduces the rehabilitation period of the patient, prevents a number of complications associated with inflammatory phenomena in the postoperative period.

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Description

The invention relates to medicine, in particular to surgical dentistry and maxillofacial surgery, and is intended for the treatment of odontogenic cysts of the upper jaw of any size, not directly related to the maxillary sinus.

Jaw cysts occupy the 1st place in frequency among other odontogenic neoplasms. They occur in people of different ages and are formed on the upper jaw 3 times more often than on the lower one. [Ed. A.Yu. Drobysheva, O.O. Yanushevich "Maxillofacial Surgery". - M.: "GEOTAR-Media", 2018, p. 636-644, 880)].

Nunez-Urrutia S. et al. (2010) in the course of their research found that the size of odontogenic cysts ranged from 2.0 to 60.0 mm, with an average value of 18.4 mm. The share of radicular cysts of small and medium sizes from (7 to 13 mm) accounts for 73.49±2.24%. [Bayramukov, Kh.Kh. Treatment of periradicular cysts of the human jaws: abstract of the thesis. dis.cand.med. Sciences: 14.00.21 / Bayramukov Hasan Hamidovich. - Voronezh, 2002 - 19 s] A radicular cyst of considerable size can be the cause of a pathological fracture not only of the lower, but also of the upper jaw [Ivashchenko, N.I. Cyst as a cause of fracture of the upper jaw / N.I. Ivashchenko, A.N. Ivashchenko // Dentistry. - 2008. - T. 87, No. 4. - S. 46-47].

Surgical method of treatment (cystectomy) is a radical operation. From the vestibular surface of the alveolar process of the jaw, a mucoperiosteal flap is cut out and exfoliated, with resection and/or retrograde filling of the tips of the roots protruding into the cyst cavity, complete removal of the cyst membrane with wound closure. In the future, the bone is restored by organizing a blood clot, similar to how it happens after a tooth extraction operation [Ed. A.Yu. Drobysheva, O.O. Yanushevich "Maxillofacial Surgery". - M: "GEOTAR-Media", 2018, p. 644-648, 880)].

The disadvantages of the above surgical method (cystectomy) are: incomplete removal of the cyst membrane, which leads to a recurrence of the disease, a large amount of damage, leading to bleeding, trauma to the maxillary neurovascular bundle, infection of the osteoplastic material used to fill the bone defect, development of odontogenic maxillary sinusitis, long restoration of bone tissue from 6 months to 1 year.

A similar surgical method is (cystotomy) - a method in which a mucoperiosteal flap is cut out and exfoliated from the vestibular surface of the alveolar process of the upper jaw, a part of the cyst wall is excised and a long-term persistent communication with the oral cavity is created, in view of which the main mechanism of cyst growth is eliminated - increase in hydrostatic pressure. The period of restoration of bone tissue takes 1.5-2 years [Ed. A.Yu. Drobysheva, O.O. Yanushevich "Maxillofacial Surgery". - M.: "GEOTAR-Media", 2018, p. 648-650, 880)].

The disadvantage of this surgical method is the long-term preservation of the postoperative defect, which requires medical supervision for at least 1 year. During this period of time, the patient regularly visits the doctor 2 times a week. Also, during the reception, food remains and oral fluid enter the cavity of the defect and lead to irritation of the mucous membrane, leading to patient discomfort.

In the journal: Clinical practice 2019, volume 10, No. 3, pp. 83-90, a team of authors: Maksimova N.V., Dulov F.V., Tkachuk M.F., describes a clinical case of treating a follicular cyst of size by communicating the latter with nasal cavity and tamponade of the bone cavity with iodoform turunda, which is excreted through the lower nasal passage and removed on the 4th day.

The disadvantage of the above method of treatment is the use of iodoform in large cavities that do not have mucocillary transport and the impossibility of mechanically treating the bone cavity after removal of the turunda, iodoform residues remain there for a very long time, since iodoform is extremely poorly soluble in water. And also the introduction of the drug on the gauze turunda is not rational, since when the gauze turundas are removed, they, in turn, crumble and leave cotton fibers and tissue fragments in the bone cavity, which is a nutrient medium for many microorganisms.

The objective of this invention is to reduce the time of postoperative rehabilitation of the patient and eliminate the need for regular, long-term medical monitoring of the patient.

The proposed technique is to eliminate intracystic hydrostatic pressure by connecting the cyst cavity with the lower nasal passage into a single cavity, without involving the maxillary sinus.

The method is carried out as follows:

The operation is carried out under infiltration anesthesia, an incision is made along the alveolar ridge of the upper jaw, a trapezoidal muco-periosteal flap is cut out and peeled off. After the bone wall is exposed above the cyst, a burr hole is created with a size smaller than the front wall of the cyst, the cyst is removed, one of the walls of which is the muco-periosteal complex of the lower nasal passage. The entire mobile mucous membrane of the nasal cavity adjacent to the cystic cavity is removed in order to obtain a wide stable communication of the nasal cavity with the cystic cavity. Next, a non-woven bandage impregnated with a solution of povidone-iodine is placed in the bone cavity. Then the soft tissues are sutured in the area of the vestibule of the oral cavity to delimit the oral cavity from the defect cavity. The bandage is tightened by 10 cm. The first two days and completely removed on the 3rd day after the operation. The sutures are removed on the 10th day after the operation.

Thus, the proposed modification of cystotomy of the maxillary cyst allows to reduce the period of rehabilitation of the patient, due to the fact that the environment of the nasal cavity is less aggressive than the oral cavity, and the use of non-woven material prevents the edges from shedding and leaving cotton fibers and tissue fragments in the cyst cavity, which prevents a number of complications associated with inflammation in the postoperative period. The use of povidone-iodine as a drug reduces the glazing of the bandage and the leaving of iodoform crystals in the bone cavity. It also reduces the frequency of visits for examinations to the doctor.

Clinical example No. 1.

Patient D., born in 1986 applied to the Department of Oral and Maxillofacial Surgery of the Clinical Hospital in Ryazan with complaints about the curvature of the dentition in the frontal section of the upper jaw on the left, nasal voice, nasal congestion on the left. On a cone-beam computed tomogram, a rounded focus of bone tissue destruction with a clear limited contours is determined. The supernumerary tooth is located in the cavity of the maxillary destruction focus, partially pushing back the anteroinferior wall of the left maxillary sinus and the inferior turbinate by 12 mm relative to the inferior turbinate on the opposite side. Surgery was performed as described above. The postoperative period was uneventful. 3 months after surgical treatment: the face is symmetrical; the mouth opens in full by 5 cm; nasal breathing is free. With anterior rhinoscopy, the nasal septum is in the midline. In the anterior section of the left nasal passage, a formed wide communication with the defect cavity is determined. The mucous membrane of the nose is not edematous, moist; the nasal passages are free, the shells are not enlarged, in the nasal passages there is scant mucous discharge. Regional lymph nodes are within the physiological norm. According to cone-beam computed tomography: as a result of the operation, a slightly more expanded left nasal passage was formed due to the transfer of the cyst cavity into the cavity of the left nasal passage. Thus, the cystic cavity is a bony niche lined with the mucous membrane of the nasal passage. There is a significant decrease in the size of the bone niche.

Clinical example No. 2.

Patient K., born in 1970 applied to the Department of Maxillofacial Surgery of the Clinical Hospital in Ryazan with complaints of swelling in the region of the anterior teeth of the upper jaw. On a cone-beam computed tomogram, a rounded focus of bone tissue destruction with a clear limited contours is determined. The roots of the teeth 1.2, 1.1, 2.1, 2.2, the top of the root 2.1 is sealed, penetrates into the cavity of the cyst. The focus of destruction partially pushes back the anteroinferior wall of the left nasal passage. Surgery was performed as described above. The postoperative period was uneventful. 3 months after surgical treatment: the face is symmetrical; the mouth opens in full by 5 cm; nasal breathing is free. With anterior rhinoscopy, the nasal septum is in the midline. In the anterior section of the left nasal passage, a formed wide communication with the defect cavity is determined. The mucous membrane of the nose is not edematous, moist; the nasal passages are free, the shells are not enlarged, in the nasal passages there is scant mucous discharge. Regional lymph nodes are within the physiological norm. According to cone beam computed tomography. According to cone-beam computed tomography: as a result of the operation, the bone cavity was merged with the left nasal passage. There is a significant decrease in the size of the bone cavity.

Clinical case #3

Patient S., born in 1974 applied to the Department of Maxillofacial Surgery of the Clinical Hospital in Ryazan with complaints of some discomfort in the upper jaw, an accidental finding on a cone-beam computed tomogram. On CBCT, a focus of destruction of the bone tissue is rounded with a clear limited contour, tooth 1.1 is destroyed, the root of the tooth communicates with the cyst cavity. The cavity of the cyst does not push back the lower nasal passage, but is directly adjacent to the lower right nasal passage. Surgery was performed according to the above method (Fig.: 1; 2; 3; 4). The postoperative period was uneventful. 4 months after surgical treatment: the face is symmetrical; the mouth opens in full by 5 cm; nasal breathing is free. With anterior rhinoscopy, the nasal septum is in the midline. In the anterior section of the left nasal passage, a formed wide communication with the defect cavity is determined. The mucous membrane of the nose is not edematous, moist; the nasal passages are free, the shells are not enlarged, in the nasal passages there is scant mucous discharge. Regional lymph nodes are within the physiological norm. According to cone-beam computed tomography: as a result of the operation, a slightly more expanded right nasal passage was formed due to the transfer of the cyst cavity into the cavity of the right nasal passage. There is a significant decrease in the size of the bone niche.

Claims (1)

A surgical method for the treatment of odontogenic cysts of the upper jaw, including removal of the cyst, followed by plasty of the mucoperiosteal flap and suturing of soft tissues in the vestibule of the mouth, characterized in that the movable mucous membrane of the nasal cavity adjacent to the cyst cavity is removed and a communication between the nasal cavity and the cavity is created cysts, then a bandage is placed in the bone cavity, impregnated with a solution of povidone-iodine, which prevents mucus and leaving iodoform crystals in the bone cavity, and made of non-woven material, which prevents the edges from shedding, leaving cotton fibers and tissue fragments, then soft tissues are sutured in the vestibule area of the oral cavity, delimiting the oral cavity from the cavity of the defect, the first two days the bandage is tightened by 10 cm, and on the 3rd day after the operation the bandage is removed completely through the lower nasal passage, preventing the bandage from catching on the bone protrusions and the edges of the bone wound, while the sutures are removed on the 10th day after the opera tions.

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