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Society and innovations
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Improvement of diagnostics and complex treatment of
rhinosinusogenic orbital complications in children
Nilufar KHUSHVAKOVA
1
Shukhrat ULASHOV
2
Gulrux DAVRONOVA
3
Samarkand State Medical Institute
ARTICLE INFO
ABSTRACT
Article history:
Received February 2021
Received in revised form
20 February 2021
Accepted 15 March 2021
Available online
5 April 2021
The article discusses ways to improve the diagnosis and complex
treatment of rhinosinusogenic orbital complications in children. It also
covers the scientific and theoretical work of scientists studying the
diagnosis and complex treatment of rhinosinusogenic orbital
complications in children, as well as recommendations for improving
the diagnosis and complex treatment of rhinosinusogenic orbital
complications in children.
2181-1415/© 2021 in Science LLC.
This is an open access article under the Attribution 4.0 International
(CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/deed.ru)
Keywords:
rhinosinusogen in children,
orbital complications,
diagnosis,
pediatrics,
complex therapy,
diagnosis and complex
treatment.
Болаларда риносинусоген орбитал асоратларни ташхислаш ва
комплекс даволашни такомиллаштириш
АННОТАЦИЯ
Калит сўзлар:
болалардаги
риносинусоген,
орбитал асоратлар,
ташхис, ташхис ва
комплекс даволаш,
болалар касалиги,
комплекс даволаш.
Мазкур мақолада болалардаги риносинусоген орбитал
асоратларни
диагностикаси
ва
комплекс
даволашни
такомиллаштириш
йўллари
ёритилган.
Шунингдек,
болалардаги
риносинусоген
орбитал
асоратларни
диагностикаси ва комплекс даволашни ўрганган олимларнинг
илмий-назарий
ишлари
ёритилган.
Бундан
ташқари,
болалардаги
риносинусоген
орбитал
асоратларни
диагностикаси ва комплекс даволашни такомиллаштириш
йўллари бўйича таклифлар берилган.
1
Professor of Samarkand State Medical Institute. Samarkand, Uzbekistan.
E-mail: nilumedlor@mail.ru.
2
Assistant of Samarkand State Medical Institute. Samarkand, Uzbekistan.
3
Assistant of Samarkand State Medical Institute. Samarkand, Uzbekistan.
E-mail: davronova.gulrux@mail.ru.
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Issue – 1 (2021) / ISSN 2181-1415
297
Совершенствование диагностики и комплексное лечение
риносинусогенных орбитальных осложнений у детей
АННОТАЦИЯ
Ключевые слова:
риносинусоген у детей,
орбитальные осложнения,
диагностика, детские
болезни, комплексная
терапия, диагностика и
комплексное лечение.
В статье рассматриваются пути совершенствования
диагностики и комплексного лечения риносинусогенных
орбитальных осложнений у детей. Он также охватывает
научно-теоретические
работы
ученых,
изучающих
диагностику и комплексное лечение риносинусогенных
орбитальных осложнений у детей, а также рекомендации по
совершенствованию диагностики и комплексному лечению
риносинусогенных орбитальных осложнений у детей.
INTRODUCTION
Over the past decades, the method of computed tomography (CT) has become firmly
established in practice as the most significant and effective in the diagnosis of pathology of
the paranasal sinuses and the cranial cavity (Voronkin V.F. et al., 1998; Deryugina O.V. et
al., 2002; Lebedeva M.A. et al., 2005). Therefore, it becomes necessary to analyze and
systematize the computed tomographic signs of intracranial complications and sinusitis.
During the surgical treatment of the primary focus of infection in the paranasal sinuses,
most otolaryngologists prefer a wide extranasal opening of the affected sinuses
(Volfkovich M.I., 1963; Pal-chun V.T. et al., 1977). But with a severe condition of the patient,
massive surgical intervention can aggravate the patient's condition. Therefore, the
question of the use of sparing methods of operative sanitation of the paranasal sinuses in
case of rhinosinusogenic intracranial complications is relevant [1].
When carrying out antibiotic therapy, it is extremely important to create an optimal
and constant level of drug concentration in the blood and cerebrospinal fluid, which can
be achieved by intra-arterial administration of drugs. In accordance with the set objectives
of the study, we developed a thematic map for each patient, in which passport data,
complaints, medical history, results of clinical and objective research, a description of the
endoscopic picture of the nasal cavity, data of special functional and laboratory studies
were entered. All patients with suspected intracranial complications underwent
otorhinolaryngological, neurological, laboratory and X-ray examinations. Consultations of
a neurosurgeon, ophthalmologist, immunologist, pediatrician, resuscitation specialist and
other specialists were prescribed as needed. Also, if necessary, a lumbar puncture was
prescribed. The laboratory research concerned generally accepted indicators of the
inflammatory process, hemostatus, as well as parameters functioning of the organs and
systems concerned. All patients, in addition to performing anterior and posterior
rhinoscopy, underwent endoscopic examination of the nasal cavity using rigid endoscopes
from Storz or Eleps with 0, 30, 70 optics. For all patients, we performed a general
X-ray of the paranasal sinuses in the noso-chin and lateral projections, computed
tomography of the paranasal sinuses [2].
Assessment of the functional state of the nasal mucosa, its excretory and absorption
functions, mucociliary clearance was carried out using a polymeric water-soluble film of
hydroxypropyl methylcellulose (OPMC) containing saccharin and methylene blue. In
everyday clinical practice, we used the Rhinomanometer PC 200 computer
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rhinomanometer (ATMOS, Germany), which allows anterior active rhinomanometry
(PARM). A group of patients was examined blood to determine the parameters of the
immunological aspect of the anti-infectious resistance system[3]. The sections of the
mucous membrane removed during endoscopic interventions were subjected to
histological examination. To determine the microflora of the nasal cavity and paranasal
sinuses, bacteriological inoculation of the contents of the nasal cavity was performed.
LITERATURE REVIEW
Acute inflammatory diseases of the paranasal sinuses (SNP) are an urgent problem
in the practice of a pediatric otorhinolaryngologist. Orbital complications of acute sinusitis,
especially severe forms (subperiostal abscess, retrobulbar abscess, phlegmon of the orbit)
can not only lead to irreversible changes in the organ of vision, up to blindness, but also
cause life-threatening conditions (sepsis, intracranial complications). This determines the
need for timely diagnosis of this pathology, as well as intensive, adequate, individualized
treatment tactics (Dobromylsky F.I., Shcherbatov I.I., 1961; Budilov Yu.K., 1978;
Soldatova V.V., 1985; Kruchinina I.L., 1985, 1989; Garashchen-ko T.I., 1989, 1996) [4].
Conventional surgical methods for the treatment of orbital complications are aimed
primarily at opening the affected paranasal sinuses and are very effective. However, they
are not without drawbacks. Any endonasal intervention on SNP is performed in the
immediate vicinity of such vital structures as the base of the skull, orbit, optic nerves, large
vessels, therefore, it is associated with a certain risk of iatrogenic complications.
Back in 1929, H.P. Mosher called endonasal ethmoidectomy the most “blind” and
dangerous operation in surgical practice. The likelihood of such consequences as rhino
liquorrhea, meningitis, profuse bleeding and blindness is constantly discussed in
rhinological literature (Freedman N.M., Kezn E.V., 1979; Maniglia AJ. Et al., 1981; Kane K.,
1993; Hosemann WG et al., 2000)[5]. All these circumstances limit the actions of the
surgeon and often lead to insufficient rehabilitation of the focus. In addition, with
complicated forms of acute sinusitis, extranasal polysinusotomies and orbitotomies are
still widely used, including in children (Mann W. et al., 1997; Reddy SC et al., 1999;
Deryugina O.B, Chumakov F.I., 2001; Syrtlanov A.R., 2001), which leads to significant
cosmetic defects, and in some cases to impaired growth and development of the facial
skeleton (Yakushenkova A.P. et al., 2002) [6].
The introduction of endoscopic techniques into practice radically changed the
approach to the diagnosis and treatment of sinusitis (Garashchenko T.I., 1986; Khutsiev
A.M., 1989; Andzhaparidze Z.N., 1991; Piskunov G.Z., Lopatin A.S., 1992; Piskunov S.Z.,
1995; Kozlov BC, 1995). In recent years, the methods of performing endoscopic
interventions have been significantly modified, the indications for their use have
expanded, including in pediatric practice (Kruchinina I.L., 1984; Shevrygin B.V., 1990;
Sergeev S.V., 1990; Garashchenko T. H., 1996; Wolf G. et al., 1993) [7].
RESEARCH METHODOLOGY
The research used grouping, comparison, analysis, synthesis, induction, deduction,
horizontal, vertical and factor analysis methods. In particular, the comparison method is
the most basic method of improving diagnostics and complex treatment of
rhinosinusogenic orbital complications in children tal analysis, which is also used in the
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analysis of financial results. In addition, the complex treatment of rhinosinusogenic orbital
complications was analyzed in pediatric analysis using scientific approaches.
ANALYSIS AND RESULTS
The data obtained on endoscopic diagnosis and semiotics of diseases of the
paranasal sinuses expand the understanding of the relationship between age-related
structural features, as well as various anatomical anomalies of intranasal structures with
the frequency and severity of acute sinusitis, including those with orbital complications, in
children. In a large group of children, the incidence of complicated acute sinusitis was
assessed, and the structural distribution of various types of orbital complications in terms
of age was shown.The studies carried out have shown the high efficiency of the use of
endonasal endoscopic methods of treatment, which at the same time have a number of
significant advantages over conventional interventions: safety, functionality,
purposefulness, sufficient volume.It is shown that the technique of surgical intervention in
the treatment of orbital complications depends on the child's age, structural features of the
nasal cavity, the type and nature of the complication.Algorithms for antibacterial therapy
of complicated acute sinusitis have been developed depending on age, form of
complication, severity of the process and previous treatment[8].The use of endoscopy for
diagnostic purposes showed a higher incidence of complicated sinusitis in the presence of
various anatomical anomalies of the intranasal structures, which allows this category of
patients to be identified as a risk group for the development of a complicated course of the
inflammatory process and to plan reconstructive minimally invasive interventions in the
nasal cavity in order to prevent recurrence of paranasal diseases. sinuses.
It has been shown that the use of endoscopic techniques in surgical interventions
for orbital complications of acute sinusitis makes it possible to carry out more functional
and less traumatic interventions, avoiding external access operations. Visual control
significantly reduces the risk of iatrogenic complications, and allows full sanitation of the
pathological focus. The types of endoscopic surgical interventions in children with
sinusogenic orbital complications in different age groups have been developed.In the
process of surgical intervention, for a sufficient and lasting effect, the altered intranasal
structures are corrected, therefore, the risk of recurrence of the development of
inflammatory diseases of the paranasal sinuses is reduced.An algorithm for stage-by-stage
antibiotic therapy of complicated acute sinusitis in children has been created, which allows
the use of individualized treatment regimens, taking into account the child's age, the type
of complication, the severity of the process, previous therapy.The use of the developed
algorithms will allow not only to carry out complex treatment of complicated acute
sinusitis at the modern level, but also to reduce the risk of generalization of the infection,
to help prevent the development of chronic forms of the disease.Rational use of
antibacterial drugs will not only improve the quality of treatment, but also achieve a large
pharmacoeconomic effect in the treatment technology of this category of patients.An
isolated epidural abscess was diagnosed in one patient. In one case, a patient was observed
with a combination of epidural abscess and encephalitis of the right frontal lobe of the
brain. A sign of an epidural abscess on a computed tomogram was a limited formation of
increased density with clear edges, lenticular shape, adjacent to the bones of the skull[9].
Meningoencephalitis occurred in five patients in the form of isolated forms of
intracranial complications. In all patients, meningoencephalitis developed against the
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background of acute diffuse inflammation of the paranasal sinuses. The duration of the
disease, according to the anamnesis, ranged from 4 days to 2 weeks. The computed
tomographic sign was the presence of a zone of reduced density of the brain substance
without clear boundaries, mainly in the frontal lobes of the brain. These data, characteristic
of isolated encephalitis, were combined with the presence of meningeal symptoms in the
clinical picture in all patients. Cavernous sinus thrombosis occurred in 10 patients. In five
patients, thrombosis of the cavernous sinus was isolated, in the rest of the patients there
was a different combination of intracranial complications. All patients underwent
computed tomography. The duration of the disease varied according to the anamnesis
from 3 days to 2 weeks. There was no clear evidence of cavernous sinus thrombosis on CT.
Among the indirect signs, edema and infiltration of the retrobulbar cells were determined.
lesions, dilatation of the orbital veins, mainly of the superior orbital vein, which
were noted by CT in all patients with cavernous sinus thrombosis.The main provisions for
the defense[10]:
1.
Diagnostic endoscopy for complicated acute sinusitis allows to detail the
rhinoscopic picture, to carry out the correct diagnosis and to determine the adequate
individualized tactics of conservative and surgical treatment.
2.
The age-related features of endoscopic surgery in complicated acute sinusitis
make it possible to carry out safer, targeted and functional interventions with maximum
efficiency, taking into account the growth and development of the nasal cavity and
paranasal sinuses.
3.
The algorithm for antibacterial therapy of sinusogenic orbital complications is
compiled taking into account the child’s age, the extent of the lesions of the paranasal
sinuses and the orbit, the likelihood of intracranial complications.
CONCLUSIONS AND SUGGESTIONS
1)
In conclusion, improvement of diagnostics and complex treatment of
rhinosinusogenic orbital complications in children developed the following proposals for
development:
2)
the main etiopathogenetic factor in the development of rhinosinusogenic
intracranial complications is purulent widespread inflammation of the paranasal sinuses;
3)
the complex use of computed tomography and endorinoscopic techniques at the
diagnostic stage is decisive for the treatment tactics of managing patients with
rhinosinusogenic intracranial complications;
4)
the developed diagnostic and therapeutic algorithm makes it possible to increase
the effectiveness of the treatment of intracranial rhinosinusogenic complications;
5)
intra-arterial administration of antibiotics and heparin in the complex treatment
of rhinosinusogenic intracranial complications has a high therapeutic effect.
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