Усовершенствование тактики оказания лечебно-диагностической помощи при сочетанных травмах верхнечелюстной пазухи.
Polypoid rhinosinusitis is quite common, but oddly enough, poorly understood pathology of the nasal cavity and paranasal sinuses. The very name "polyp" (from the Greek poly - many and pus -leg) is a collective term used to refer to pathological formations of various origins, towering above the surface of the mucous membranes of the gastrointestinal tract, respiratory and urinary tract, and uterus. Polyps represent a rather variegated picture of a wide variety of diseases, far from homogeneous in etiological, pathogenetic and morphological terms from benign tumors to hyperplastic formations of an allergic or inflammatory nature. Therefore, it makes no sense to look for any analogies in the etiology and pathogenesis of polyps of the paranasal sinuses and, for example,the gastrointestinal tract or urinary tract. Polypoid rhinosinusitis is a completely independent disease, in no way associated with polyps of other localizations, neither etiologically, nor morphologically, nor pathogenetically. Polyps of the nasal cavity and paranasal sinuses have nothing to do with the group of benign tumors, although sometimes they are mistakenly placed in the textbooks in the section "Benign nasal tumors". In the presence of a large number of polyps, the term "polyposis" is used, although the border between the concepts "multiple polyps" and "polyposis" is arbitrary. According to most researchers, the term "polyposis" should be used when the number of polyps is more than 10 - 20. Sometimes you can find the term "polyposis of the nose", which is not entirely correct grammatically or "nasal polyposis", like tracing paper with "nasal polyposis", the most the designation of this disease common in the English-language literature. But still, from our point of view, the most legitimate name for this etiopathogenetic form will be "polyposis rhinosinusitis", since it is the paranasal sinuses and, first of all, the cells of the ethmoid labyrinth that are the place of localization of this process.
X-Ray of (PNS) in standard projections was performed in all patients admitted to the clinic with suspected orbital complications of rhinosinusitis (except for small children under 3 years of age).CT data in establishing the final diagnosis of sinusitis were informative in 94.1% of cases. Ultrasound helped to reliably differentiate non-purulent and purulent inflammatory processes in the eyelids, as well as to determine with sufficient accuracy the presence of inflammatory changes in the region of the bony walls of the orbit and periosteum. According to clinical data, postseptal orbital complications of both purulent and non-purulent nature, such as phlegmon of the orbit and periostitis of the orbit, are the worst diagnosed by various specialists. These complications were revealed with instrumental methods of investigation (CT of the paranasal sinuses and orbit, ultrasound of the orbit).
Анализ отечественной и зарубежной литературы показывает, что при сочетанной челюстно-лицевой травме необходимо использовать различные методы остеосинтеза, сфера их применения определяется как объективными показаниями (состояние пациента, локализация и характер перелома), и субъективные факторы (медицинские алгоритмы, принятые специалистом, ручные навыки в отношении того или иного метода остеосинтеза).