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Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
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01
Pages:
20-25
SJIF
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FACTOR
(2020:
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(2021:
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OCLC
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ABSTRACT
Inflammatory pathology of the ENT organs accounts for 87% of all visits to the otorhinolaryngologist, in the last decade
the incidence of paranasal sinusitis (PNS) has increased, and the proportion of hospitalized patients with this
pathology has increased almost 3 times every year. The problem of timely diagnosis and treatment of PNS is currently
quite relevant, despite the emergence of new modern methods of conservative and surgical treatment. According to
various authors, PNS currently ranks first among inflammatory diseases of the upper respiratory tract. The paranasal
sinuses (SNS) are a single morphological and functional system with similar etiological factors and mechanisms for the
development of diseases, therefore, when studying the epidemiology of the PNS, it is necessary to assess the
prevalence of diseases not only of each sinus separately, but also of their combined lesions.
KEYWORDS
Inflammation, rhinosinusitis, paranasal sinuses, sinusitis.
INTRODUCTION
S.Z. Piskunov, G.Z. Piskunov believe that SNPs are
unique anatomical formations that are reserve
protective elements of the upper respiratory tract, eye
socket and brain [1-3]. This protective function must be
understood in the broadest sense of the word, taking
into account the mucociliary system, temperature
Research Article
SURGICAL METHODS FOR THE TREATMENT OF CHRONIC PURULENT
RHINOSINUSITIS: A REVIEW OF THE LITERATURE
Submission Date:
January 07, 2022,
Accepted Date:
January 17, 2022,
Published Date:
January 27, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue01-03
U.Sharipov
Tashkent State Dental Institute, Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
21
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
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01
Pages:
20-25
SJIF
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FACTOR
(2020:
5.
286
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(2021:
5.
64
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OCLC
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1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
constancy, aerodynamic patterns and other factors.
The primary focus of SNP lesions, as a rule, are changes
in the anterior and middle cells of the ethmoid sinuses,
causing a violation of ventilation and mucociliary
cleansing of the maxillary and frontal sinuses. In the
anterior sections of the middle nasal passage, the
inhaled air changes its direction, which contributes to
the deposition of particles suspended in it, including
microbes and allergens, and if any obstacles appear in
the area of the osteomeatal complex, it disrupts all
these functions and forms the primary focus of the
inflammatory process. A special area is the North
Caucasus, which is the most unfavorable in terms of
climatic conditions and, due to the formation of
secondary immunodeficiency in many residents [8], is
characterized by an increased level of human exposure
to harmful factors of the external urbanized
environment, which is also detected in other industrial
zones [9, 10]. These factors contribute to an increase in
the number of PNS, including frontal sinusitis with
complications, in the Rostov Region and the Stavropol
Territory [11, 12]. Of all SNPs, the inflammatory process
most often develops in the frontal sinuses and
manifests itself in many patients with severe pain in the
brow area and, somewhat less frequently, nasal
discharge. The anatomical prerequisites for the
formation of frontal sinuses are not only changes in the
area of the ostiomeatal complex, but also structural
features of the frontal sinuses themselves [13].
An analysis of spiral computed tomography performed
in a large group of patients showed that the anatomical
features of the frontal sinuses are the prerequisites for
the formation of frontal sinusitis [14], which coincides
with the data of our objective studies of the structural
parameters of radiographs of people of different age
groups [15]. The frontal sinuses lack frontoethmoidal
cells and have a large number of bays and semi-
partitions, reducing the possibility of frontal sinusitis.
At the same time, deformation or abnormal
development of the structures of the ostiomeatal
complex often leads to narrowing of the frontonasal
canal and, as a result, to the formation of frontal
sinusitis [16]. Streptococcus pneumoniae, Hemophilus
influenzae, Staphylococcus epidirmidis, Streptococcus
pyogenes, Moraxella catarrhalis currently play a
leading role in the etiology of acute rhinosinusitis. The
development of chronic frontal sinusitis is dominated
by
Staphylococcus
aureus,
Streptococcus
pneumoniae, Hemophilus influenzae, Moraxella
catarrhalis [17]. The etiology of modern PNS has
changed significantly in favor of the formation of
various associations of microorganisms, which were
first described by A. E. Essel et al. [eighteen]. In the last
two decades, the clinical picture of modern frontal
sinusitis began to change towards the appearance of
erased and latent forms of the course of the disease.
The local pain symptom in frontal sinusitis often loses
its leading clinical significance, and the data of
additional research methods give an error in 20–30% of
cases for various reasons [19]. In doubtful cases, it is
necessary to conduct additional diagnostic methods,
such
as
rheofrontography,
flowometry,
thermography, etc.
The main tasks in the treatment of uncomplicated
frontal sinusitis:
•
Rapid relief of local pain;
•
Restoration of the normal functioning of the
fronto-nasal canal;
•
Removal of pathological contents from the lumen
of the frontal sinus;
•
Stimulation of reparative processes of the sinus
mucosa.
In the treatment of inflammatory diseases of the
frontal sinuses, some clinicians [18] use only
conservative treatment, based on the assumption of
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Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
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VOLUME
04
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"gravitational" drainage of the sinuses - under the
influence of the earth's gravity, they empty themselves
from pathological contents. This theory raises
considerable doubts, especially if there is a block of the
fronto-nasal canal in one of its sections or in the frontal
pocket. Some bewilderment is the assertion that the
control radiography of the SNP, carried out on the 5-
7th day of treatment, revealed a "recovery of
pneumatization" of the sinuses, which occurred in 48
out of 50 patients. Probably, we are talking about the
restoration of the transparency of the images of the
sinuses, but it is known that the restoration of the
transparency of the sinus affected by the inflammatory
process on the radiograph occurs no earlier than 30–35
days after the start of treatment [7-15].
We previously considered probing of the inflamed
frontal sinuses, which was performed using curved
catheters of our design, as one of the elements of the
complex sparing treatment of frontal sinusitis.
Subsequently, the effectiveness of this method was
doubted, taking into account the fact that the mucous
membrane of the fronto-nasal canal is one of the
thinnest human mucous membranes and has a
significant tendency to scarring. Many clinicians agree
with this statement, considering probing to be
contraindicated for the treatment of frontal sinusitis. A
number of authors do not agree with this provision and
successfully use probing for the treatment of
inflammatory diseases of the frontal sinuses. The
principle of a sparing attitude to operated organs and
tissues, professed by our teachers in the diagnosis and
treatment of ENT pathology, has been maintained in
the Rostov ENT Clinic throughout its existence. Our
desire to preserve the sparing nature of the treatment
of frontal sinusitis has led to the use of
trepanopuncture (TP).
LT of the frontal sinus is the most sparing operation in
the treatment of uncomplicated frontal sinusitis, which
excludes trauma to the mucous membrane of the
frontonasal canal and, in particular, the most
vulnerable secretory formations at its mouth.
Extranasal LT is considered as the imposition of a small-
diameter hole in the anterior or lower walls of the
frontal sinus, followed by constant drainage of its
lumen through the burr canal [16]. TP of the frontal
sinuses by the vast majority of devices is carried out in
several stages: - the imposition of a hole in the wall of
the frontal sinus; - extraction of a drilling tool from it; –
installation of an adapter into the formed bone burr
canal; – introduction through the adapter into the
lumen of the frontal sinus of a device for its long-term
drainage – a cannula. TP refers to an instrumental
method of treating a disease, in which devices for
intervention and cavity drainage play a significant role.
With the progress of science and technology, devices
for performing TP of the frontal sinuses have also been
improved. After refusing to treat patients with
probing, the intervention was carried out by a device
for LT produced by the domestic industry, in which we
made various technical improvements. Most devices
for LT produced in different countries have common
shortcomings in the production of intervention: - multi-
stage operation; - penetration of purulent exudate into
the diploetic layer of the bone of the anterior wall of
the sinus or into the soft tissues of the frontal region,
which leads to the formation of osteitis, subperiosteal
abscess, as well as osteomyelitis of the frontal bone; –
entry of bone chips formed during trepanation into the
lumen of the frontal sinus. We have developed and put
into practice an original device for LT of the frontal
sinuses, which provides: – rigid fixation of the
instrument on the bone wall of the frontal sinus,
preventing it from moving; – one-stage and rapid
intervention; – patient safety due to the technical
23
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
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Pages:
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SJIF
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FACTOR
(2020:
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64
)
OCLC
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METADATA
IF
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7.569
Publisher:
The USA Journals
features of the cannula, which limit the depth of
trepanation; - isolation of the pathological contents of
the frontal sinus from the tissues of the frontal region
by the formation of threads on the walls of the burr
canal and their adhesion, while filling the diploetic layer
of the bone; - removal of bone chips formed during
trepanation.
The design and use of this device prevent all possible
intra- and postoperative complications described in the
literature, and we have been improving the complex of
devices for many years [17]. The therapeutic effect on
the inflamed mucous membrane of the frontal sinus
was performed through a cannula by introducing drugs
into the lumen of the sinus, very often in combination
with physiotherapy procedures - direct exposure to
laser irradiation and with dialysis of drugs [18] -
restoring the patency of the fronto-nasal canal by 2–
3rd day after TP. Some clinicians have experimentally
proven that the effect of administering a drug that is
absorbed by the mucous membrane of an inflamed
SNP is more than 100 times greater than the effect of
parenteral administration of the same amount of this
drug. This is confirmed by a number of studies and is
consistent with the opinion of other authors expressed
in different years and completely unrelated to each
other. Of no small importance is the period of
postoperative treatment, which does not exceed 5-7
bed-days, after which the patient returns to a normal
social life, without further treatment for this disease.
We [39], on the basis of significant experience in the
treatment of patients with uncomplicated frontal
sinusitis, made an attempt to assess the nature of
improving the instrumentation and methods of
performing LT of the frontal sinuses. It has been clearly
shown that over the past 30–40 years, progress in
improving the devices and methods for performing LT
is extremely insignificant and even in some cases is
complicated and extremely traumatic. But, there is also
a positive direction in the treatment of uncomplicated
frontal sinusitis by a combination of LT with sanitizing
endonasal interventions, which gives a positive
therapeutic effect [19].
Relapses of the disease in the treatment of patients
with uncomplicated acute and chronic AFL frontitis
using a device of our design in the ENT clinic of Rostov
State Medical University for more than 35 years of
observation are less than 0.001% of the entire group of
patients, which is not comparable with the rather
significant figures given by a number of clinicians. Since
1994, we have not had complications or recurrence of
diseases after treatment of patients with frontal sinus
LT. Once again, it should be noted that the possibility
of developing complications in LT associated with the
penetration of a drill into the anterior cranial fossa with
damage to tissues inside the skull, which European
authors often refer to [20], is excluded when using a
tool of our design.
A minor cosmetic soft tissue defect in the brow area
after LT becomes hardly noticeable after 6–7 months,
the burr canal in the anterior wall of the frontal sinus in
most patients is filled with newly formed bone tissue
after 1–1.5 years (depending on age). LT is the most
effective and sparing of all surgical methods for the
treatment of uncomplicated frontal sinusitis. The basis
for such a statement is the experience of carrying out
about 2500 interventions in compliance with these
principles and using instruments of our design. It
should be noted that none of the works, from 1921 to
the present, devoted to the treatment of patients with
frontal sinusitis with the help of LT, analyzes such a
number (in the works of some authors no more than
300 cases are analyzed) of patients treated with any
devices with a number of complications and relapses
of the disease. A large number of works are devoted to
24
Volume 04 Issue 01-2022
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VOLUME
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Publisher:
The USA Journals
optimizing the surgical treatment of PNS and their
complications using endonasal endoscopic surgery,
but at the same time, RR Orlandi, DW Kennedy [12]
believe that inflammation of the frontal sinus after
functional endoscopic intervention can become
permanent, iatrogenic disease due to insufficient skills
and technical errors of surgeons in a narrow frontal
pocket. R. Weber and R. Keerl [60] indicate that the
total duration of the healing process in the nasal cavity
after endonasal interventions ranges from several
weeks to months or more. The literature describes a
fairly large number of complications after endonasal
surgery, including frequent bleeding from vessels of
various sizes and locations, liquorrhea, meningitis,
intraorbital hematomas, orbital emphysema [20], and
blindness. Rare complications include carotid-
cavernous
fistula,
brain
damage,
intracranial
hemorrhage, pneumatocephalus, brain abscess,
malignant hyperthermia, and death as a result of
cardiac arrhythmias caused by general anesthesia [21].
CONCLUSION
In our opinion, trepanopuncture excludes various
complications of frontal sinusitis and is the most
sparing type of surgical intervention on the frontal
sinuses in the absence of organic changes in the mouth
area or in the fronto-nasal canal itself.
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