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EXPERIENCE IN THE TREATMENT OF ODONTOGENIC SINUSITIS, TAKING INTO
ACCOUNT FEATURES OF MICROFLORA
Z.T. Nasretdinov, A.G.Doliev
Department of Surgical Dentistry of ASMI
In case of odontogenic sinusitis, the presence of a message between the bottom of the sinus and the
oral cavity or an exacerbation of the closed process is the reason for hospitalization. [1,4,6].
With perforated sinusitis, the doctor has two tasks:
1. Elimination of the inflammatory process in the maxillary sinus.
2. Closing the communication between the sinus and the oral cavity.
Without eliminating the active inflammatory process, it is impractical to close the perforation.
However, the use of traditional methods of treating odontogenic sinusitis is often accompanied by
various complications and relapses of the process in a certain group of patients. [3,4,6].
According to some authors, this is due to the treatment without taking into account the
characteristics of the sinus microflora and the local use
of short-acting antiseptics. [ 2,3,7].
The purpose of this report is to present our experience in the treatment of odontogenic perforated
sinusitis using a complex of therapeutic measures that have a prolonged etiopathogenetic effect.
[3,7].
Materials and methods:
From 2009 to 2011, 40 patients with odontogenic sinusitis were comprehensively examined and
treated at the Maxillofacial Surgery Clinic at TASHIUV. 9 of them had an acute form of sinusitis,
while the rest had a subacute course. The diagnosis was established on the basis of clinical,
radiological, laboratory and bacteriological studies.
During the examination, it was noted that in most cases the "causal " teeth were _6_!_6__. 31 out of
40 patients had an open form of sinusitis, i.e. perforation of the sinus floor.
and 9 has a closed one. Considering the sensitivity of the anaerobic microflora to oxygen vapors
and the long-term antiseptic effect of eludril. We have proposed an improved complex of local
antibacterial therapy. [2,3,7].
ELUDRIL: it is an antiseptic, anti-inflammatory analgesic and wound healing solution,
Ingredients: Chlorhexidine digluconate: 0.10%, Chlorbutanol: 0.50%.
Sodium docusate ..The filler is alcohol +++42.8%. Essence of mint oil 90 ml.in a bottle.
The method involves rinsing the sinuses with an eludril solution at the rate of four teaspoons per cup
of boiled water and oxygenation with ethyl alcohol vapor for 30 minutes at a pressure of 0.7 atm 4-8
l/min using a special device
(rat. proposal No. 147 dated 02/15/1995, Tashiuv.). Sinus lavage with eludril solution was combined
with oxygenation with ethyl alcohol vapor for three days before and after surgery in all patients.
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As a comparison group, a retrospective analysis of the medical histories of 203 patients with
odontogenic sinusitis treated in the traditional way was performed.
The results of the study. According to the results of the bacteriological examination, the patients of
the main group were divided into two groups. In 12 patients, pure anaerobic culture was sown, and
in the remaining 28, along with aerobic microflora, non-clastic anaerobic microflora was also sown.
It should be noted that in these 12 patients with an obvious anaerobic infection, the course of the
disease was much more severe than in patients with an aerobic infection, i.e. purulent discharge had
a fetid odor, marked div temperature and severe pain on the affected side. The research results
showed that on the day of admission, suppression of the leukocyte system by toxic products was
noted (2.9±0.92, especially in patients with anaerobic microflora and a decrease in phagocytic
activity of FAN neutrophils-48.5±0.6).
After washing the sinuses with a solution of eludril and local oxygenation with ethyl alcohol vapors,
the general and local manifestations of the disease were eliminated much faster than in the control
group. In the first hours after the application of oxygenation with ethyl alcohol vapors, patients
showed a significant decrease in soft tissue edema, foul odor, and headaches, as well as pain in the
upper jaw, and improved nasal breathing. In patients with odontogenic sinusitis, sinus suppuration
decreased faster than in the control group: after 3.27±0.09 and 5±0.15 days, respectively. The
clinical recovery of patients in the main group occurred after 9.28±0.25 days, i.e. 4.28±0.25 days
earlier than in the control group (13.5±0.22 days). The data obtained are statistically reliable
(p<0.001).
The results of a retrospective analysis of patients in the control group showed that improvements in
nasal breathing, a decrease in local and general signs of sinusitis and headaches occurred at a later
date – after a day or more.
Thus, when using eludril solution and local sinus oxygenation with ethyl alcohol vapors in the
complex treatment of odontogenic sinusitis, general and local manifestations of the disease (tissue
edema, purulent discharge, pain) were eliminated much faster.
After surgical treatment, rapid wound healing was noted in patients of the main group than in the
control group. The LII decreased to 1.90±0.45, and the FAN to 75.6±1.1, i.e. increased by (26.1%)
(see Table No. 1
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Group
LII, conl. ed
ФАН, %
Healthy, n=15
1,01±0,10
50,5±0,2
Traditional therapy
(control group), n=203
2,9±0,92
2,1±0,3
48,5±0,6
54,8±3,1*
(6,3%)
Traditional therapy: eludril rinse + oxygenation with
ethyl alcohol vapor, n=40
2,9±0,92
1,90±0,45
49,5±1,5
75,6±1,1*
(26,1%)
Note: * p<0.05 compared to healthy individuals. % of FAN growth in parentheses.
Microbiological studies revealed a decrease in the microbial contamination of the sinuses. The
release of anaerobes stopped while maintaining aerobic microorganisms (on the 7th day after
surgery in 35.7±12.8%). Comparative bacteriological studies have shown a significant difference in
the quantity and quality of microflora between the main and control groups in the pre- and
postoperative periods, which once again confirms the effectiveness of the proposed treatment
method.
An analysis of the materials of a retrospective examination of 203 patients showed that after
traditional treatment, postoperative complications were observed in 10% of patients
Clinically, in the postoperative period, one patient in the main group had a divergence of two flap
sutures, an increase in div temperature to 38 * and headaches. After the continuation of
appropriate local and general therapy, the complication (2%) was eliminated.
Discussion of the research results
Literature data show that the cause of complications and relapses in odontogenic sinusitis is
complex treatment without taking into account the characteristics of the microflora and the local use
of short-acting antiseptics.
The results of clinical, radiological and bacteriological studies show that anaerobes in monoculture
or in association with aerobes can cause inflammation of the maxillary sinus.
Clinically, odontogenic sinusitis of anaerobic etiology has a more severe course than banal ones.
The use of an improved method of local therapy has a long-term etiopathogenetic effect on the
pathological process and leads to a faster elimination of clinical signs of inflammation compared
with the group of patients who received traditional treatment.
The data from laboratory and
bacteriological studies at various stages of complex treatment show an improvement in PHAN
indicators, a decrease in LII, as well as the elimination of anaerobic microbes. All of the above
confirms our assumption that neutrophils are activated under the influence of eludril and ethyl
alcohol vapors, which leads to the complete destruction of anaerobes and their associations.
Conclusion
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Thus, the combination of flushing the sinus cavity with eludril and subsequent oxygenation with
ethyl alcohol vapors has a long-term etiopathogenic effect on anaerobes and its associations, leading
to a decrease in the number of complications in the complex treatment of odontogenic sinusitis.
Literature:
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bodies of the maxillary sinuses // Dentistry. 1991. No. 5. pp. 10-11.
1.2.Bazhenov L.G. Isolation and identification of strictly anaerobic microorganisms in purulent-
inflammatory processes: Dis. ... Candidate of Medical Sciences. Tashkent, 1987.
3. Jabbarov A.K. Mirazizov K.D. Improving the effectiveness of conservative and surgical treatment
of odontogenic purulent sinusitis // Stomatologiya, 2001, No. 1, pp. 15-18.
4. Malakhova M.A. Complex treatment of patients with chronic odontogenic perforated maxillary
sinusitis.//Dentistry.2004.No. 4, pp.24-26.
5.Piskunov S.Z., Lazarev A.I., Bykanova T.G. Conservative and surgical treatment of odontogenic
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6. Semaan Abi-Khalil Georges.Evaluation of the results of surgical treatment of patients with
chronic odontogenic sinusitis.Prevention of complications and new treatment methods : Abstract of
the dissertation Candidate of Medical Sciences. Saint Petersburg, 1992 -19c.
7. Khudoyarov I.A., Makhmudov Yu.I. Anaerobic infection of the maxillofacial -
facial area (etiopathogenesis, diagnosis, clinic and treatment): Method. recommendation. – Tashkent,
1984. – 18 p.
