RU2486876C2 - Method of sinus lifting with simultaneous ablation of retention cyst - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to surgical dentistry, and is intended for application in treatment of maxillary sinusitis with simultaneous ablation of retention cyst. Cut of mucosa is made on the crest of alveolar process of maxilla in lateral part with transition onto transitional fold in the region of premolars. Mucous-periosteal flap is detached in the upper part of sinus in cortical plate. Trepanation 4×4 mm opening, into which rigid endoscope is introduced, is made. Additional 4×4 mm opening for introduction of endoscopic instruments used for ablation of retention cyst from sinus cavity is made. Openings are covered with periosteum. After that, trepanation opening is made in lower part of sinus in cortical plate without breaking integrity of sinus mucosa. Collagen membrane is laid under detached mucosa. Xenotransplant in combination with allobone is laid into formed space. Trepanation opening is covered with collagen membrane, the flap is laid back into the place and sewn.

EFFECT: method makes it possible to reduce terms of rehabilitation of patient with atrophy of alveolar process of maxilla and retention cyst of maxillary sinus due to simultaneous ablation of cyst and increase of bone tissue volume with application of maxillary sinus volume.

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Description

The invention relates to medicine, namely to surgical dentistry, and can be used in the treatment of maxillary sinusitis with simultaneous removal of the retention cyst.

Before installing the implants, it is necessary to prepare the oral cavity, eliminating all the shortcomings that may affect the prosthetics process. This is the presence of neoplasms in soft tissues, such as retention cysts, and loss of bone tissue during tooth extraction.

1. One of the most common diseases in the ENT practice is maxillary sinus cysts. So, retention (true) cysts can form in any part of the ICP in the soft tissues. HFV retention cysts result from blockage of the excretory duct of the glands of the mucous membrane. The cavity of the retention cyst is not connected with the roots of the teeth.

Methods of endoscopic removal of the cyst by puncture of the sinus with a trocar in the region of the anterior wall or lower nasal passage have become traditional. There is also a method for removing the cyst membrane through an enlarged anastomosis in the middle nasal passage. At the same time, the question of choosing the optimal surgical approach for various cyst localizations has not been sufficiently developed. Controversial is the question of the advantages and disadvantages of various methods. It is known that the opening of the ICP through the anterior wall is often accompanied by paresthesias and postoperative neuralgia of the branches of the trigeminal nerve; in turn, a wide opening of the ICP through the middle nasal passage by removing the edges of its natural anastomosis for a rather long period violates the mechanism of sinus self-cleaning due to the deterioration of mucociliary clearance.

In those cases when the natural opening of the hf was passable, but had a diameter of less than 4 mm, the posterior fountainella method was used to remove the cyst, which consists in longitudinal dissection of the posterior fountains posterior to the natural opening for 10 mm using a sickle-shaped scalpel (US Pat. RF № 2142745).

Known methods for removing tumors from the sinus - a radical operation according to Caldwell-Luc (Textbook edited by T.G. Robustova. - 3rd ed., Revised. And add. - M .: Medicine, 2003.). Disadvantages are inherent in this method: a high invasiveness, a long period of postoperative rehabilitation, and damage to the sensitive ends of the trigeminal nerve are characteristic of radical surgery.

2. As a result of tooth loss, massive atrophy of bone tissue occurs, which creates complex anatomical conditions for both the manufacture of removable prostheses and the installation of implants. Anatomical formations in the upper jaw, such as the maxillary sinuses, also complicate the task. Lack of bone tissue in the area of the proposed installation of implants can lead to various kinds of complications in the long term. In order to avoid possible failures, various methods have been proposed for increasing the volume of bone tissue of the alveolar process.

To eliminate the lack of bone tissue, bone grafting is used (sinus lifting). There is an open and closed sinus lift - these are standard osteoplastic operations to change the contour of the maxillary sinus.

Most often, with significant atrophy of the bone tissue of the alveolar process of the upper jaw, an open sinus lift operation is performed - an osteoplastic operation to change the contour of the maxillary sinus with the creation of an access window. The essence of the operation is the creation of a bone window on the lateral wall of the maxillary sinus, lifting the inner shell, filling the cavity with bone-plastic material, closing the window with a membrane (Dental Market. 2007, No. 1 p. 66-67. Dentistry. 2006, No. 3, p. 35-39 )

The closest technical solution is a method of sinus lifting, including an incision of the mucous membrane in the oral cavity along the crest of the alveolar process of the upper jaw, detachment of the mucosal-periosteal flap, creating a trepanation hole in the cortical plate in the lower sinus without compromising the integrity of the mucous membrane of the sinus, laying under the exfoliated mucous membrane collagen membrane and xenograft in combination with allocost, closing the trepanation hole with the collagen membrane, then mucus hundred-periosteal flap (Dental Market. 2007, №1 s.66-67, Dentistry. 2006, №3, s.35-39).

Currently, operations to remove cysts and restore bone tissue are performed separately from each other, depending on the time of their occurrence and the severity of the processes.

The purpose of the invention: Improving tactical approaches to eliminate the defect in bone tissue of the upper jaw with simultaneous removal of soft tissue cysts. The combination of simultaneous removal of the cyst and bone tissue extension is advisable to combine with the surgical correction of pathology in the nasal cavity.

The advantages of the proposed technique is to reduce the time of rehabilitation of the patient with adentia in the lateral parts of the upper jaw due to the reduction in the number of operations and the healing time, as well as minor injuries of the operation. Convenient access to the retention cyst located in the lower part of the maxillary sinus.

This goal is achieved through the use of the sinus lifting method with the simultaneous removal of the retention cyst, in which the mucous membrane is cut in the side of the alveolar process of the upper jaw in the lateral section with the transition to the transitional fold in the premolar region, and the mucosal-periosteal flap is peeled in the upper section sinus in the cortical plate create a trepanation hole 4 × 4 mm, into which a rigid endoscope is inserted, laterally create an additional hole 4 × 4 mm to enter the endosk optical instruments with which the retention cyst is removed from the sinus cavity, the opening is closed with the periosteum, then in the lower part of the sinus in the cortical plate without creating a violation of the integrity of the sinus mucosa, a trepanation hole is created, a collagen membrane is placed under the exfoliated mucous membrane, a xenograft is placed in combination with allost, the trepanation hole is closed with a collagen membrane, the flap is laid in place and sutured.

In the cyst removal option proposed by the authors, the endonasal method was used without resorting to opening the sinus through the anterior wall and without significant injury to the edges of the natural anastomosis. There were no postoperative complications. The obtained results show that endonasal access is justified when removing cysts located on the posterior, upper and lateral walls of the ICP.

A technical result was achieved using the proposed technical solution - simultaneous removal of retention cysts of the maxillary sinus and an increase in bone volume using the volume of the maxillary sinus (sinus lift).

The invention is illustrated by the following examples.

Studies have been conducted on various techniques to increase bone volume without using the maxillary sinus volume and using the maxillary sinus volume (sinus lift). We studied the features of the anatomical structure of the maxillary sinus based on the analysis of computer tomograms of patients. We studied the quantity and quality of the resulting bone tissue after a sinus lift operation for subsequent dental implantation. Clinical, radiological, and laboratory examinations of 50 patients were performed, which are shown to conduct operations for insufficient volume of bone tissue of the alveolar process of the upper jaw for the placement of dental implants.

Example 1. Sinus lifting with endoscopic removal of the retention cyst of the left maxillary sinus:

Under local anesthesia with sedation, an incision of the mucous membrane in the oral cavity is made along the crest of the alveolar process of the upper jaw in the lateral region with the transition to the transitional fold in the premolar region. The triangular mucous - periosteal flap is reclined. In the cortical plate in the upper part of the sinus, a 4 × 4 mm trepanation hole is made, into which a rigid endoscope is inserted, an additional 4 × 4 mm hole is laterally made to insert endoscopic instruments with which the retention cyst is removed from the sinus cavity through this hole. The holes are closed periosteum. A trepanation hole of the cortical plate in the lower part of the sinus is made with a milling cutter without violating the integrity of the mucous membrane of the sinus, a collagen membrane is placed under the exfoliated mucous membrane, a xenograft is combined with allocost, a trepanation hole is closed with a collagen membrane. The flap is put in place and sutured.

The essence of the operation is to increase the bone in the distal parts of the upper jaw by adding bone-plastic material between the lower wall of the maxillary sinus and the inner surface of the alveolar process of the upper jaw.

The proposed method can be used in surgical dentistry departments of polyclinics and clinical diagnostic centers, in stationary departments of maxillofacial surgery.

The present invention will allow for the comprehensive treatment of patients with adentia and atrophy of the alveolar process of the upper jaw, which will increase the efficiency of bone augmentation in the upper jaw and the effectiveness of the prevention of possible complications, shorten the time and improve the quality of treatment, conduct adequate rehabilitation of the patient after surgical treatment.

Claims (1)

A method of sinus lifting with simultaneous removal of the retention cyst, in which the mucous membrane is cut in the side of the alveolar ridge of the upper jaw in the lateral section with the transition to the transitional fold in the premolar region, the mucosal-periosteal flap is exfoliated, and the trepanation is created in the upper part of the sinus a 4 × 4 mm hole into which a rigid endoscope is inserted, an additional 4 × 4 mm hole is created more laterally for introducing endoscopic instruments with which to remove a retention cyst from the sinus cavity, the holes are closed by the periosteum, then a trepanation hole is created in the cortical plate in the lower part of the sinus without violating the integrity of the sinus mucosa, a collagen membrane is placed under the exfoliated mucous membrane, a xenograft in combination with allocity is placed, the trepanation hole is closed membrane, the flap is laid in place and sutured.