METHOD FOR MINIMALLY INVASIVE INTRASINUSOUS ELIMINATION OF DEFECTS AND DEFORMATIONS OF MAXILLARY SINUS UPPER WALL AND ENOPHTHALMOS

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to maxillofacial surgery. First stage involves spiral computed tomography of upper jaw and orbit. Results of the tomography are used to determine the shape and size of an orbital floor defect. Enophthalmos value and a degree of peripheral tissue prolapse into the maxillary sinus, a maxillary sinus size and shape are assessed. According to the results of spiral computed tomography, a cylindrical titanium rod is made, which is equal to the vertical size of the maxillary sinus, one end of which is smooth without thread, tapered at angle of 45 degrees, and other end has external thread, on which nut is screwed. Mucous-gingival line is incised mucous membrane with periosteum from 2 to 5 teeth, muco-periosteal flap is shifted upwards, skeleton of maxillary sinus front wall. Milling hole is formed in an anterior wall with size of 15 by 10 mm, a Schneiderian membrane is detached from the anterior, upper and lateral walls of the maxillary sinus. Endoscopic support is used to visualize the upper wall of the maxillary sinus, assessing the defect value of the upper wall of the maxillary sinus, comparing with the data obtained by tomography. It involves reposition and / or removal of bone fragments. Then, perforated hole 4 mm in diameter is formed in the middle one-third of a malaralveolar ridge, a biodegradable plate of polylactic acid with thickness of 1 mm is formed, in size larger than defect by 2 mm along the perimeter, and laid on the defect. Inserting into the perforation hole an end of a cylindrical titanium rod with diameter of 3 mm, which is bevelled at angle of 45 degrees, the biodegradable plate is pressed and fixed with a cylindrical titanium rod, rod is fixed with nut inside bay of malaralveolar ridge. Then Schneiderian membrane is returned into place, wound is closed, sutures are removed on 7th day. In the second stage, 3 months later, after resorption of the biodegradable plate, X-ray control is performed, then a cylindrical titanium rod is removed under local anesthesia.;EFFECT: method enables performing the surgical intervention with minimal traumaticity, avoiding incisions on the face, eliminating bone defects of the upper wall of the maxillary sinus and enophthalmos, makes it possible to distribute more uniformly load over a greater bone area of the upper wall of the maxillary sinus, to enable removal of the structure after the treatment by a non-invasive method.;1 cl, 7 dwg, 1 ex