RU2131751C1 - Method of treatment of chronic odontogenic maxillary sinusites with oroantral communication - Google Patents

Abstract

FIELD: medicine, in particular, operative dentistry. SUBSTANCE: intrasinusal electrophoresis with 1-3-% solution of dimethylsulfoxide is performed additionally through oroantral hole with gradual increase in exposition from 15 to 25 min, at current strength of 1-3 mcA within 5-7 seances. EFFECT: enhanced efficiency of treatment. 2 cl, 3 ex

Description

 The invention relates to medicine, namely to surgical dentistry, and can be used to treat chronic odontogenic sinusitis with oroantral communication.

 Known gentle method for the treatment of odontogenic sinusitis, which consists in the conservative treatment of the mucous membrane by washing the cavity with antiseptic solutions, followed by closure of the fistula using plastic with local tissues without radical sinusotomy / Melnikov A.V. "The possibilities of gentle methods of treatment of sinusitis associated with pathology of the oral cavity.", Journal "Bulletin of Otorhinolaryngology", 1984, N 3, p. thirty/.

 Disadvantages: superficial and short-term exposure to a drug substance leads to low treatment efficacy and relapse of the disease.

 The invention is aimed at solving the problem: improving the effectiveness of treatment and prevention of relapse of the disease.

 The specified task is achieved due to the rehabilitation of the sinus in the preoperative period in the form of fractional dialysis. New in the method is to conduct intra-sinus electrophoresis with a 1-3% solution of dimexide / dimethyl sulfoxide / in combination with other drugs / enzymes, antibiotics, non-steroidal anti-inflammatory drugs / through an oroantral message with an exposure of 15 to 25 minutes, current 1-3 μA, 5-7 sessions using a carbon electrode, such as a carbon thread UKN-5000.

 The method is as follows.

 In the preferred period and as an independent method of intensive conservative treatment of odontogenic sinusitis with oroantral communication, fractional dialysis of the maxillary sinus is carried out through the existing oroantral communication with solutions of antiseptics, enzymes, 10% dimexide in a volume of 150-200 ml, T - 37, daily, course 7- 14 treatments. The duration of the dialysis is 1-1.5 hours. For this, the patient is given a horizontal position, a subclavian catheter d of 0.6-1.5 mm is inserted into the fistulous course, a blood substitute transfusion system filled with an antiseptic solution is connected, and the rate of solution delivery is set to 60 drops in a minute. Excess fluid flows independently through the sinus opening into the nasal cavity and collects in the tray.

 Then electrophoresis is carried out, which is carried out using a special device consisting of a blood transfusion transfusion system, subclavian catheter, tee, and electrode. A subclavian catheter d - 1.4-2.0 mm is inserted into the oroantral communication, a tee is attached to it, a blood transfusion system filled with 50 ml of electrolyte is connected to one of the two remaining exits of the tee, and an elastic tube with a clip from a similar system is connected to the other 30-50 cm long / depending on the distance between the patient and the electrophoresis apparatus /.

 The active electrode is passed through the specified tube and subclavian catheter so that it protrudes into the sinus cavity by 1 cm. As an active electrode, for example, a carbon thread UKN-5000 with a diameter of 1 mm is used. A passive electrode is attached to the skin of the submandibular region. The sinus is filled with an electrolyte consisting of a 1-3% solution of dimexide in combination with an antibiotic in the purulent form of the disease, with acetylsalicylic acid or KI solution in the hyperplastic form of sinusitis, then the flow of the solution is 10-20 drops per minute, the device is turned on, the strength is established current 1-3 μA. A current of less than 1 μA gives a lesser phoretic effect, more than 3 μA - can cause irritation of the sinus mucosa. Exposure procedure with a gradual increase from 15 to 25 minutes. Exposure of less than 15 minutes does not provide a sufficient effect, and more than 25 minutes is tiring for the patient. Electrophoresis is performed daily or every other day. The number of sessions is 5-7. / The number of sessions less than 5 gives a short-term effect, and over 7 increases the duration of treatment /.

In the absence of complaints, obtaining clean wash water, a limited change in the mucous membrane, an operation is performed to close the oroantral communication by plastic surgery with local tissues. To do this, under the conduction anesthesia, the edges of the fistula are refreshed with two converging incisions, which continue to the transitional fold with the formation of a mucosal-supra-trapezoidal flap, the tissues are separated, exposing the alveolar process with a bone defect in the area of the extracted tooth. The curettage of the hole is performed and, if the size of the bone defect allows, a pathologically changed sinus mucosa adjacent to the fistula is removed through it. The sinus is washed with antiseptic solutions, then the contents of the electric suction are aspirated. The flap is mobilized by dissecting the periosteum at its base, the de-epithelialized edge is inserted under the periosteum of the alveolar process from the palatine side, the top of the flap is sutured with a U-shaped nylon seam, the wound is sutured with suture material
Examples of specific performance.

 Example 1

В течение 4 лет беспокоят периодически выделения из левой половины носа, незначительные боли в проекции левой верхнечелюстной пазухи. Обострение гайморита связывает с заболеванием зубов, последнее возникло после удаления

с образованием ороантрального сообщения. Проведено комплексное противовоспалительное лечение, антибактериальное и физиотерапевтическое лечение, санация пазухи. В результате стихли явления воспаления, но ороантральное сообщение сохранилось.Patient R., 59 years old, was admitted to the hospital with a diagnosis of chronic odontogenic sinusitis with oroantral communication in the dimples

For 4 years, periodically, discharge from the left half of the nose, minor pains in the projection of the left maxillary sinus are disturbing. An exacerbation of sinusitis is associated with dental disease, the latter occurred after removal

with the formation of the oroantral communication. Conducted a comprehensive anti-inflammatory treatment, antibacterial and physiotherapeutic treatment, rehabilitation of the sinus. As a result, the phenomena of inflammation subsided, but the oroantral communication remained.

размером 0,5 см в диаметре, из которого выделялся гнойный экссудат. В предоперационном периоде проведен курс внутрисинусного электрофореза и фракционного диализа, для этого с учетом пиограммы использован ампициллин. Введение электрода и раствора осуществлялось через ороантральное сообщение в области лунки

, с силой тока 2,0 мкА, продолжительность от 15 до 25 мин курсом 6 процедур, через день. Общее антибактериальное лечение не проводилось. Для контроля эффективности лечения использована эндоскопия верхнечелюстной пазухи через лунку удаленного зуба.On the day of receipt of the complaint, specific for sinusitis, were absent, during the examination, an oroantral message was found in the area of the socket

0.5 cm in diameter, from which purulent exudate stood out. In the preoperative period, a course of intra-sinus electrophoresis and fractional dialysis was carried out, for this, ampicillin was used taking into account the pyogram. The introduction of the electrode and the solution was carried out through oroantral communication in the area of the hole

, with a current strength of 2.0 μA, a duration of 15 to 25 minutes in a course of 6 procedures, every other day. General antibacterial treatment was not carried out. To monitor the effectiveness of treatment, endoscopy of the maxillary sinus through the hole of the extracted tooth was used.

 Surgical treatment was performed in the form of closure of the fistula with local tissues with partial removal of the sinus mucosa adjacent to the fistula. The postoperative period was uneventful. The wound healed by primary intention.

 Long-term results were traced after 9 months - there was no relapse of sinusitis.

 Example 2

Больному 3 месяца назад удалили

зуб, после чего через 2 дня появились боли в области верхней челюсти, повысилась T тела. Лор-врачом проведено противовоспалительное лечение по поводу острого гайморита, при пункции пазухи получен гной, который получен гной, который удален путем промывания пазухи. Лечение не было завершено. До поступления в клинику больной за помощью не обращался.Patient H., 35 years old, was admitted to the hospital with a diagnosis of chronic odontogenic sinusitis, fistula in the region of the socket

The patient was removed 3 months ago

tooth, after which after 2 days there were pains in the upper jaw, increased T of the body. An ENT doctor carried out anti-inflammatory treatment for acute sinusitis, with a sinus puncture, pus was obtained, which was obtained by pus, which was removed by washing the sinus. The treatment was not completed. Before admission to the clinic, the patient did not seek help.

обнаружено ороантральное сообщение размером 1 x 0,8 см, заполненное утолщенной, гипермированной слизистой оболочкой пазухи. Первые дни промывные воды содержали слизисто-гнойные сгустки. При эндоскопическом исследовании обнаружено, что слизистая оболочка альвеолярной бухты пазухи гиперплазирована.On the day of receipt of the complaint, specific for sinusitis were absent. When examining the alveolar bone in the region

1 x 0.8 cm oroantral message was found, filled with a thickened, hypermediated sinus mucosa. In the first days, the washings contained mucopurulent clots. An endoscopic examination revealed that the mucous membrane of the alveolar sinus bay is hyperplastic.

 In the preoperative period, a course of fractional dialysis and intra-sinus electrophoresis was carried out for 10 days with a 2.5% KI solution in a 3% solution of dimethyl sulfoxide / DMSO /, lasting from 15 to 25 minutes, a current of 1.5 μA, daily, 7 sessions.

 After completing the course of conservative treatment, the washings became clean, an increase in sinus volume due to a decrease in mucosal edema was found endoscopically.

 An operation was performed to close the fistula using plastic with local tissues to remove the pathologically changed sinus mucosa adjacent to the fistula. The postoperative period was uneventful. The healing is smooth, primary tension. Immediate results are good.

 Example 2

3,6 месяца назад удален

зуб, перфорация пазухи не было распознана. Через месяц после перенесенной ОРВИ появилось гнойное отделяемое из левой половины носа. Был дважды проведен курс общепринятого противовоспалительного лечения с санацией пазухи. Обнаружен свищ в области

больная направлена для хирургического лечения к стоматологу. При поступлении жалобы, характерные для гайморита, отсутствовали, на альвеолярном отростке в области

обнаружен тонкий свищевой ход в пазуху, промывные воды чистые. Рентгенологически обнаружено равномерное снижение пневматизации левой верхнечелюстной пазухи.Patient G., 35 years old, was admitted to the hospital with a diagnosis of chronic, genital sinusitis, fistula in the area

3.6 months ago deleted

tooth, sinus perforation was not recognized. A month after the acute respiratory viral infection, a purulent discharge from the left half of the nose appeared. A course of conventional anti-inflammatory treatment with sinus rehabilitation was twice conducted. Fistula detected in the area

the patient is referred to the dentist for surgical treatment. Upon receipt of the complaint, characteristic for sinusitis were absent on the alveolar process in the region

a thin fistulous course in the bosom was detected, washings are clean. A uniform decrease in pneumatization of the left maxillary sinus was found radiologically.

 A course of intra-sinus electrophoresis was carried out with a 5% solution of aspirin in a 3% solution of dimethyl sulfoxide, a current of 2.0 μA, a duration of 15-20 minutes, the number of procedures 5, daily. An operation was performed to close the fistula with local tissues to remove a pathologically altered sinus mucosa adjacent to the fistula. The healing is smooth, primary intention.

 Immediate results are good.

 Using the proposed method of treatment can improve the effectiveness of treatment of patients with chronic odontogenic sinusitis, reduce the number of relapses of the disease. The effect of drugs using electrophoresis provides a deeper penetration into the mucous membrane, which in chronic sinusitis is often thickened, hyperplastic, contributes to the reverse development of pathological changes in the mucous membrane, which helps prevent a relapse of the disease. The proposed method of intra-sinus electrophoresis is atraumatic, relatively simple, because it does not require sinus puncture for insertion of an electrode, which eliminates the need to attract a doctor daily for electrophoresis, as well as the availability of special tools. Intra-sinus electrophoresis can be carried out by a nurse in a dental clinic.

Claims (1)

 A method for the treatment of odontogenic sinusitis with oroantral communication by washing the maxillary sinus with solutions of medicinal substances and closing the fistula with local tissues, characterized in that they additionally carry out intra-sinus electrophoresis with a 1 - 3% solution of dimethyl sulfoxide through an oroantral opening with a gradual increase in exposure from 15 to 25 minutes, current strength 1 - 3 μA, 5 - 7 sessions.