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the Clinical example 2.

The patient To. 38 years, the medical card № 1202 has been referred on hospitalisation in connection with an exacerbation of a chronic genyantritis. About 4 years ago ambassador of treatment of a teeth of the top jaw has noted feeling of discomfort, gravity, morbidity in a projection gajmorovoj sinuses.

At hospitalisation on KT pictures okolonosovyh sinuses in different projections the alien body in a cavity gajmorovoj sinuses, a thickening, a hyperplasia of a mucosa of all walls of the sinus, especially sharply expressed in the field of the bottom wall, century to a contact zone plombirovochnogo materiala.so by a mucosa and in the field of a natural anastomosis with transition to the top wall has been taped. As ' presence of a diffusive thickening - a mucosa of average ' and to a lesser degree bottom ’ paid attention of a nasal concha that is the certificate of disturbance natural ' ventilations and drainages gajmorovoj sinuses in an average nasal course, obstruction of a natural anastomosis and total inflammatory process of a mucosa gajmorovoj a sinus. After passage of a course of antiinflammatory and antibacterial therapy noted time improvement of a condition. From предложенного1 operative treatment the patient repeatedly refused. Against a frigorism or after ORVI annually noted exacerbations of a genyantritis more than 3 times a year with the expressed head, facial pain, sharp disturbance of nasal breath, disturbance of sense of smell, purulent discharges from a nose from amazed gajmorovoj sinuses, a fervescence, a malaise. Last 3 months noted pain intensifying in area gajmorovoj sinuses, disturbance of sense of smell, allocation from the left half of nose, a constant fervescence to 37,4 ° in the evening.

At inspection the consent to operative treatment before which it has been executed KT research okolonosovyh sinuses is received. On the tomogram signs of unilateral chronic inflammatory process of a mucosa gajmorovoj sinuses and nasal cavities, presence of alien bodies (plombirovochnyj a material) in gajmorovoj have been taped

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To sinus, in the sizes 1,0 * 0,5 sm and 0,5 *0,5 high degrees x-ray

Densities, the block of area of a natural anastomosis (rice 24, 25, 26).

Fig. 24 KT a picture okolonosovyh sinuses in a coronary projection before

Operation.

The patient has been executed an endoscopic maxillary sinusotomy at the left on the offered way (access through a facial wall with audit and expansion of a natural anastomosis with a nasal cavity through gajmorovu a sinus) with use antiseptic intraoperatsionnoj processings of a sine and a way of closing of defect in the field of a forward wall of a genyantrum with membrane use "Kollost". Has been removed plombirovochnyj a material, sites of patholologically changed mucosa, polyps, granuljatsionnaja a tissue, caseous masses.

Puc.25. KT a picture okolonosovyh sinuses in sagittalnoj projections before operation.

Fig.

26. KT a picture okolonosovyh sinuses in an axial projection before operation.

The material is referred on histological research. The lumen of a natural anastomosis has been sharply narrowed, at the expense of an edema, mucosa infiltration '

C the help of a bellied probe and mikrohvatalki executes sounding of a semilunar cleft, audit and anastomosis expansion. The mucosa, a viscous purulent discharge are removed from anastomosis area polipoznaja, giperplazirovannaja. The natural report of a genyantrum with a nasal cavity through a natural anastomosis at the expense of expansion of its back edge horizontally kzadi is restored. The postoperative period proceeded without features. Seams on the threshold of a mouth are taken out for 5 days.

In the pictures of a X-ray inspection executed на10 and 17 days after operation, dynamics restoration of a pneumatization left verhnecheljustnogo a sine is established, normalisation of a mucosa of a nasal cavity, restoration of passableness of an average nasal course and a natural anastomosis, remains insignificant puffiness of a mucosa operated gajmorovoj sinuses. Pathological separated, alien bodies in the operated area were not (fig. 27, 28, 29).

The following clinical case also visually shows, that degree of the pathological changes occurring in a mucosa verhnecheljustnogo of a sine at a long finding plombirovochnogo of a material, demands audit and sanation of all departments amazed with pathological process gajmorovoj a sinus, restoration of natural mechanisms of a drainage and ventilation of the sinus, full excision of alien bodies which can be in different departments of a sinus.

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Fig. 27. KT a picture okolonosovyh sinuses in a coronary projection to 17 day after operation.

Fig. 28. KT a picture okolonosovyh sinuses in sagittalnoj projections to 17 day after operation.

Puc.29. KT a picture okolonosovyh nose sinuses in an axial projection to 17 day after operation.

Clinical example 3.

The patient With. 33 years, the medical card № 1142 has been referred on hospitalisation in connection with the phenomena of an exacerbation of a chronic genyantritis. About 6 years ago ambassador of treatment of a teeth of the top jaw has noted feeling of discomfort, morbidity in a projection gajmorovoj a sinus and a teeth of the top jaw on the right. Addressed to the doctor to the stomatologist, after passage of a course of conservative therapy noted condition normalisation. In 2 years again noted genyantritis relapse on the right. It was treated conservatively, operative treatment refused. Gradually noted deterioration of nasal breath, sense of smell, periodic allocation from a nose, a pain, feeling of gravity in area gajmorovoj sinuses, especially after the transferred catarrhal disease, the general delicacy. On KT pictures okolonosovyh sinuses in 6 years from the disease beginning presence of an alien body in a cavity gajmorovoj sinuses (plombirovochnyj a material) at level of an average nasal has been taped

Course the sharp thickening, a hyperplasia of a mucosa of all walls gajmorovoj is closer to a medial wall of a sinus, than a sinus, total disturbance of a pneumatization of a sinus. Attracted attention presence of a diffusive thickening of a mucosa of average and bottom nasal conchas that is the certificate of disturbance of natural ventilation and a drainage gajmorovoj sinuses in an average nasal course, obstructions of a natural anastomosis and total inflammatory mucosa process gajmorovoj sinuses (rice 30, 31).

Puc 30. KT a picture okolonosovyh sinuses of patient S before operation

In a coronary projection.

The special attention was deserved by the reason of occurrence of a surveyed case. Certainly, principal causes are medical errors at endodonticheskih interventions. Absence of the radiological control concerns their number at treatment stages, use of instruments without the rubber terminator of length, work without a ruler and an apeks-locator, unreasonable use of some
Materials and methods for sealing of root channels (Resorcinum -

Formalin admixture, Natrii phosphas-cement).

Puc 31. KT a picture okolonosovyh sinuses of patient S before operation in an axial projection.

Unreasonable use of out-of-date methods of passage of root channels and machine ways of sealing also leads to deducing of root hermetic for limits of the root channel. Unfortunately, there are experts whom professors E.V.Bohr under the art remark, still are supporters «active zaapikalnoj» therapies [20, 21]. Doctors-stomatologists not always take into consideration age and anatomic factors, for example, at sealing of root channels «for an apex» at patients with not finished apeksogenezom. Besides, tactics of doctors-stomatologists at detection plombirovochnogo materila, deduced in verhnecheljustnoj a sine, also is not always justified, and is sometimes simply erroneous. It concerns those cases when without the sufficient bases a "causal" teeth leaves. Tactics of the doctor in relation to "causal"

IOO

To tooth can depend only on quality spent endodonticheskogo treatments and should be referred on its conservation. In other cases references for excision of an alien body gajmorovoj a sinus and elimination of the dontogenous centre of an infection in a sinus are not given in due time. Expectant tactics in which result there are condition radical changes verhnecheljustnogo a sine, a mucosa not only gajmorovoj sinuses, but also other sinuses and a nasal cavity often is accepted.

The patient has been executed an endoscopic maxillary sinusotomy on the offered way (access through a facial wall with audit and expansion of a natural anastomosis with a nasal cavity through gajmorovu a sinus) with application of a way intraoperatsionnoj aseptic processing of a sine and a way of closing of defect in the field of a forward wall of a genyantrum with membrane use "Kollost". Has been removed plombirovochnyj a material, sites of patholologically changed mucosa, polyps, granuljatsionnaja a tissue, caseous masses. The material is sent on histological research. The lumen of a natural anastomosis was not defined. C the help of a bellied probe and mikrohvatalki executes sounding of a semilunar cleft, audit and anastomosis expansion. The mucosa, a purulent discharge are removed from anastomosis area giperplazirovannaja, a site of an osteal wall at expansion of back edge of an anastomosis is horizontal kzadi. The natural report of a genyantrum with a nasal cavity in the field of an average nasal course is restored. The postoperative period proceeded without features.

In the pictures of a X-ray inspection executed for 10 and 17 days after operation, dynamics of restoration of a pneumatization right verhnecheljustnogo a sine, normalisation of a mucosa of a nasal cavity, restoration of passableness of an average nasal course and a natural anastomosis with conservation of insignificant - puffiness MUCOUS ’ covers operated gajmorovoj sinuses is established. Pathological separated, alien bodies in the operated area were not (fig. 32, 33).

Rice 32. KT a picture okolonosovyh sinuses of patient S in a coronary projection to 17 day after operation.

Recover sick in the given cases became possible thanks to an operative measure on the offered advanced method of an endoscopic maxillary sinusotomy with full excision plombirovochnogo a material from a sine, all pathological masses (polipoznoj to a tissue, sites giperplazirovannoj mucous, granuljatsionnoj to a tissue in the field of the bottom wall gajmorovoj sinuses), razblokirovaniju and to restoration of passableness of a natural anastomosis with a nasal cavity.

In result, in the postoperative period the natural pneumatization and a drainage of the operated sinus was restored, the mucosa condition gajmorovoj sinuses and nasal cavities was normalised, functioning mukotsiliarnogo transport was restored.

In the remote postoperative period patients of complaints did not show, relapses of inflammatory process in the operated sinuses has not been noted.

Rice 33. KT pictures okolonosovyh sinuses of patient S in the axial

Projections to 17 day after operation.

Clinical example 4.

There are clinical situations when the provoking factor of an exacerbation of a chronic dontogenous genyantritis is the odontectomy of the top jaw on the party gajmorovoj sinuses with chronic inflammatory process. Thus the semiology of an exacerbation of a genyantritis can be incorrectly regarded as odontectomy complication.

As an example it is resulted following clinical observation.

The patient To. 30 years, the medical card № 3012 has addressed with complaints to a sharp pain at nakusyvanii on the sixth tooth of the top jaw at the left, irradiatsiju pains in ear and temple area, feeling of an "evolved" tooth. From the anamnesis: the tooth is earlier treated concerning a pulpitis. After treatment the patient repeatedly noted a painful symptom at chewing in the treated tooth. At a palpation the transitive cord in the field of 25, 26 teeth is smoothed, painful. On the basis of complaints of the patient and additional research - aim roentgenography in the field of 26 teeth, the doctor - the stomatologist was

103 the diagnosis is made: a chronic granulating periodontitis 26 teeth, in an exacerbation stage. The ex-traction 26 teeth is executed.

However, the condition of the patient after an odontectomy has worsened. There were complaints to the general delicacy, a malaise, a fever; a fervescence to 38,5 degrees ^ a headache with irradiatsiej in temporal areas at the left, disturbance of nasal breath, allocation from the left half of nose with: blood streaks, asymmetry of the person; an edema of soft tissues in area, the top jaw at the left; the expressed pain at = nakusyvanii on a teeth of the top jaw at the left: After: executed

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Scientific source ZEKERJAEV Rashid Sultanovich. the COMPARATIVE ESTIMATION of ENDOSCOPIC METHODS of TREATMENT SICK of the CHRONIC DONTOGENOUS GENYANTRITIS CAUSED by DEDUCING PLOMBIROVOCHNOGO of the MATERIAL In VERHNECHELJUSTNOJ the SINE. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences.

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