Lower Nasal Passage Research Articles

Endonasal sinus lift as a new way of augmenting the alveolar process of the upper jaw

Aim to develop a new method of endonasal augmentation of the alveolar process of the upper jaw to reduce postoperative risks.
 Material and methods. The study involved 10 patients during the period of December, 2019, and June, 2021. The examination methods were: computed tomography of the nose and paranasal sinuses, upper and lower jaw, and video-endoscopy of the nasal cavity. The patients received the indonasal sinus inlay with the use of allogenic bone chips.
 Results. The surgical access through the lower nasal passage, under the lower nasal concha, allows to expose the maxillary sinus floor with preservation of mucous membrane integrity and to fill in the space between them with the allogenic bone material. Formation of a bone window in the lateral nasal wall using a piezotome prevents the rupture of the sinus mucous membrane. A bony fragment of the lateral nasal cavity wall transferred into the cavity of the maxillary sinus as one block with the mucosa creates additional protection for the Schneiderian membrane. Allogenic material introduced by endonasal method is substituted by the own organotypic tissue, restoring the lost volume of the maxillary sinus alveolar process.
 Conclusion. The endonasal method of alveolar augmentation may be used in clinical practice as an alternative to the classic methods.

MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

Оптимізація місцевого знеболювання під час проведення операції радикальної гайморотомії у стоматологічних хворих

The purpose of the study was to give a clinical evaluation of the effectiveness of endonasal blockade of the nasopalatine nerve in different ways during radical maxillary sinusotomy in dental patients. Materials and methods. Clinical observations were performed in 50 patients diagnosed with chronic odontogenic maxillary sinusitis. Radical maxillary sinusotomy was performed under local potentiated anesthesia. All patients underwent anesthesia on the maxilla according to classical methods. Patients, depending on the methods of endonasal blockade of the nasopalatine nerve, were divided into two clinical groups: the main (24 people) and the comparison group (26 people). Patients of the main group underwent endonasal blockade of the nasopalatine nerve at the site of its branch from the pterygopalatine ganglion. In patients of the comparison group, the blockade of this nerve was performed before its entry into the incisal canal. The effectiveness of anesthesia was evaluated for clinical and autonomic manifestations of pain stress. Results and discussion. During the removal of polyps and pathological granulations from the mucous membrane of the maxillary sinus in patients of the main group there was no pain, no emotional-motor and autonomic manifestations of pain stress, which confirmed the effectiveness of the endonasal method of anesthesia of the nasopalatine nerve. In patients of the comparison group during similar surgical manipulations the full effect of local anesthesia was achieved in 50.0% of cases (χ2 – 8.065, р = 0.005). These were patients who had hypopneumatized or moderately pneumatized types of maxillary sinuses. The rest of the patients during the operation had emotional – motor and autonomic manifestations of pain stress during the removal of pathologically altered mucous membrane located on the medial wall of the maxillary sinus. Conclusion. Complete anesthesia of the mucous membrane, maxillary sinus, regardless of the degree of its pneumatization is achieved during the usage of endonasal blockade of the nasopalatine nerve at the site of its branch from the pterygopalatine ganglion during radical maxillary sinusotomy in dental patients. Anesthesia of the nasopalatine nerve in the lower nasal passage, before its entry into the incisal canal, allows painless surgery only in patients with hypopneumatized maxillary sinuses and in most patients with moderate pneumatization

About specific endonasal extraction of cysts of the maxillary sinus

Maxillary sinus cysts most often result from a blockage of the mucus-secreting gland and swelling of the mucous membrane. The method of choice in the treatment of patients with a cyst of the maxillary sinus remains surgical. In rhinology, sparing methods of surgical interventions are increasingly used, the atraumatic nature of which practically does not affect the further formation of the anatomical structures of the nose, paranasal sinuses and their physiological functions. We applied the technique of sparing endonasal removal of the cyst of the maxillary sinus through the lower nasal passage, with intact structures of the ostiomeatal complex, using a port guide. The gentle surgical intervention we have proposed is easier to tolerate than radical surgery on this sinus. Patients stayed in the hospital for 2 to 5 days

Modification of the method for closing the defect of the medial wall of the maxillary sinus

Is to evaluate the effectiveness of the method of restoring the medial wall of the MS with an autograft - a quadrangular cartilage of the nasal septum using the butterfly technique (Patent Application No. 2018140468, priority of 11/19/2018). The study included patients who underwent septoplasty, endoscopic surgery on the MS with plasty of the medial wall of the MS (1st, main group, n=136), as well as patients who underwent surgery according to Caldwell-Luc with the formation of persistent nasoantral anastomosis in the lower nasal passage (2nd, control group, n=56). The criteria for the inclusion of patients in the study were as follows: the presence of MS fungal body; inverted papilloma with lesions of the MS; cysts and/or a foreign body of the MS with localization in the alveolar bay without involving the natural anastomosis in the pathological process; concomitant 3rd or 4th, or 5th or 6th types of curvature of the nasal septum according to R. Mladina (1987). An objective assessment of the condition of the patients was carried out using the SNOT-22 clinical questionnaire, and for analysis the state of aerodynamics of the nasal cavity and MS in patients of various groups after surgical treatment used the method of computational aerodynamics. In patients with nasoantral ostium in the lower nasal meatus, the pathological maxillary sinus aeration one was observed. It is recommended to close the nasoantral ostium to prevent violations of the aerodynamics of the nasal cavity and the maxillary sinus during surgery through the lower nasal meatus. Our proposed method for closing a defect in the lower nasal passage is effective. The autograft is well established, contributes to the speedy restoration of normal sinus aerodynamics.

ЛІКУВАННЯ ПАЦІЄНТІВ З КІСТОЮ ВЕРХНЬОЩЕЛЕПНОЇ ПАЗУХИ ОДОНТОГЕННОГО ГЕНЕЗУ

Кісти верхньощелепної пазухи є достатньо поширеною патологією системиприносових пазух, яка має мультифакторну етіологію, що продовжує активнодосліджуватися. Протягом останніх років особлива увага дослідників сконцентрована на роліхронічного запалення коренів зубів, які безпосередньо прилягають до нижньої стінкимакзилярного синусу, і відповідно втягують в патологічний процес навколишні структури.Одним із об’єктивних показників вираженості запалення є рівень матрикснихметалопротеїназ, зокрема матриксної металопротеїнази 9 (ММП9). Таким чином, метоюроботи є вивчення ефективністі лікування пацієнтів з кістою верхньощелепної пазухиодонтогенного генезу у віддаленому періоді. Матеріали і методи. У дослідження ввійшло 150пацієнтів. Група 1 – 125 осіб (вік 20-69 років, чоловіки - 58, жінки – 67), група 2 - 25 пацієнтів(вік 21-59 років, 11 чоловіків і 14 жінок). Всім пацієнтам з обстежуваних груп було проведенохірургічне лікування - видалення кісти верхньощелепної пазухи через нижній носовий хід, зподальшим консервативним лікуванням; пацієнтам першої групи в післяопераційному періодібуло проведено ревізію каналів зубів верхньої щелепи з заміною пломбувального матеріалу, апацієнтам другої групи дане втручання не проводилося. Критерій включення – підвищення рівняММП9 у слині. Критеріями виключення стали наявність гострого захворювання за 3 місяці дооперації, лікування у стоматолога за 3 місяці до хірургічного втручання, нормальний рівеньММП9 у слині. У процесі передопераційної підготовки, всім пацієнтам було проведено КТнавколоносових пазух, ендоскопічне дослідження порожнини носа і носоглотки,ринопневмометрію, визначення показника мукоциліарного кліренсу, активності ММП-9 в слині.Дослідження активності ММП-9 в слині проводилося з використанням ELISA kit.Статистична обробка даних виконувалася з використанням ПЗ IBM SPSS Statistics 22.Результати. Рівень ММП9 у слині пацієнтів першої групи склав 1347 (± 328) нг / мл, другої -1410 (± 220) нг / мл. Кількість рецидивів кісти в/щ пазухи у групі 1 була 8 випадків, що склало6,4% від загальної кількості. Серед інших ускладнень: міцетома в/щ пазухи - 4 ороантральнанориця - 1, хоанальний поліп - 2. . Кількість рецидивів кісти в/щ пазухи у групі 2 була 9 випадків(36%), міцетома в/щ - 3 випадки, ороантральна нориця - 1, хоанальний поліп - 1. Висновок.Отримані результати свідчать про вищу імовірність розвитку рецидиву кістиверхньощелепної пазухи за відсутності наступної ревізії коренів зубів і навколокореневихділянок, що безпосередньо межують із нижньої стінкою пазухи.

Retention cysts: a new approach to treatment

In 2017-2018, the authors examined and operated on 35 patients aged 20 to 39 years (19 women, 16 men) with cystic maxillary sinusitis. The study included patients who were diagnosed with retention cyst of the maxillary sinus, located on the lower walls of the maxillary sinus and dealing with no more than 2/3 of the maxillary sinus volume, according to CT of the paranasal sinuses. The operation was performed using the following method: two punctures of the sinus were performed simultaneously in a typical place in the lower nasal passage - using a Kulikovsky needle and using a 2.8 mm trocar. The fiber of the Ho-laser was inserted into the Kulikovsky needle, and an endoscope was inserted into the trocar in parallel with the 0, 30 or 45°. Then, under the control of the endoscope, the fiber was inserted into the cyst and given a series of impulses before its 'explosion'. The parameters Ho:YAG-radiation had the following values: power - 14.4 W, pulse energy - 1.2 Jol, pulse frequency - 12.0 Hz. All patients were discharged from the hospital on the 2nd day. In the long-term period (up to 14 months), according to the endoscopic examination, an objective examination and CT of the paranasal sinuses showed no recurrence of the cyst in any patient, no pathological changes were recorded in the area of the lower nasal passage.

CLINICAL CASE OF ODONTOGENIC MAXILLARY SINUSITIS

Aim - to show the clinical observation of the development of odontogenic maxillary sinusitis in case of entering the sinus of the root of the tooth. Materials and methods. The results of the study - video endoscopy of the nasal cavity and CT of the paranasal sinuses - were evaluated. The obtained data pointed to the foreign body that caused not only an inflammatory process with subsequent development of the mycetoma, but also destruction of the medial wall of the maxillary sinus, the inferior nasal concha. Access to the maxillary sinus was discussed, and surgical intervention was performed. Conclusions. The root of the tooth was extracted through the developed defect of the medial wall of the maxillary sinus communicating with the lower nasal passage.

Certain morphometric characteristics of the normal maxillary sinus

Maxillary sinus is more than any other paranasal sinuses amenable to various pathological conditions that may require the surgical treatment. The objective of the present work was to study the age-related and the individual specific anatomical features of the walls of the maxillary sinus and to develop the principles of sinus surgery based on the results of the anthropometric studies. We analyzed the cone-beam CT scans obtained from 586 patients at the age varying from 5 to 60 years who were allocated to six different groups. The measurement of different anthropometric indicators of the maxillary sinus was undertaken. The study has demonstrated the feasibility of using boron as a means to obtain the access to the maxillary sinus for the purpose of the external surgical intervention. The maxillary sinuses having the thickness of the anterolateral wall of more than 1.5 mm most frequently occurred in the patients under 12 years of age. The surgical access to the maxillary sinus through the lower nasal passage having the medial wall thickness greater than 1 mm proved to be limited; this feature was found to be characteristic of the patients at the age below 12 years. It is shown that the depth of the lower lateral wall in the nasal passage did not depend on the age of the patients; the same was true of the angle formed between this wall and the bottom of the nose. Taken together, the obtuse angle (more than 100°) and the depth of the lateral wall of the inferior nasal meatus of more than 5 mm facilitated the surgical access to the maxillary sinus through the inferior meatus.

Surgical management of cross-bites in orthognathic surgery: Surgically assisted rapid maxillary expansion (SARME) versus two-piece maxilla

PurposeThe surgical treatment of cross-bites includes surgically-assisted maxillary expansion (SARME) or maxillary-bipartition during bimaxillary surgery. This study evaluates and compares the changes in the teeth and lower nasal passage, as well as the stability of the expansion. Patients and methodsThe measurements were performed on the cone-beam computed tomography (CBCT) scans of 32 patients with transverse (width) deficiencies of the maxilla. To expand the maxilla, 12 patients underwent the two-piece maxilla method, while 20 patients received SARME. ResultsThe mean distraction width for SARME was 6.8 mm (SD 3.7), while that for the two-piece maxilla was 4.1 mm (SD 1.6). The expansion with SARME was over the entire length of the maxilla, from anterior to posterior, whereas the expansion of the two-piece patient group was only in the posterior part of the maxilla. The segments of the maxilla opened nearly parallel in SARME, while they were reverse V-shaped in the two-piece maxilla, from anterior to posterior. ConclusionA key point in the planning of combined orthodontic-orthognathic therapy with surgical correction of a cross-bite is the precise determination of the area where the width needs to be increased, and the amount of correction needed to treat the patient using minimal surgical procedures.

Maxillary sinus dissection variants in silent sinus syndrome

The purpose of research to improve the quality of examination and treatment of patients with sinus syndrome silent. Subjects and methods. The authors analyzed the clinical, radi-ological and endoscopic features of the maxillary sinuses in the syndrome of silent sinus in 8 patients. Used three variants of opening infected maxillary sinuses: through canine fossa, the middle or the lower nasal passage. Conclusion.The optimal approach is endo-nasal dissection; choice of opening the sinus determined by the degree of destruction and infraorbital wall prolapse into the lumen of the contents of the orbit of the sinuses.

Filtration of particulates in the human nose.

This report reviews the current theories on the deposition of inhaled particulates in the human nose. The inhalation of particulates represents a challenge to the upper respiratory tract. The concentration of airborne particulates and pollutants varies between occupational and nonoccupational exposure. Regional deposition of potentially hazardous inhaled material determines the local and systemic toxicity. In vitro experiments using casting and molding techniques with water dye models or laser Doppler anemometry indicate that nasal airflow is determined by the size of the nasal valve and the turbinates. The main airstream during inspiration passes through the lower nasal passage. Filtration capacity of the human nose can be expressed mathematically or experimentally. In vivo experiments applying monodisperse or polydisperse aerosols during single or multiple respiratory cycles have shown by using microscopic or laser-optic identification that particles larger than 3 microm have a maximum deposition in the anterior part of the nose (nasal valve). Particles smaller than 3 microm and larger than 0.5 microm are filtered by the nasal mucosa and transported by cilia propulsion to the nasopharynx. The filtration for particles smaller than 0.5 microm is low. They seem to pass easily into the lower respiratory tract. This knowledge has an impact on nasal septal surgery and rhinoplasty. By influencing the structure of the nasal valve and the lower turbinates, the filtration capacity of the nose can be significantly decreased.