Клініко-експериментальне обґрунтування та порівняльний аналіз малоінвазивних втручань на верхньощелепних пазухах

Merkulov A. Uy. Clinical and experimental grounds and comparative analysis of minor invasive interventions at maxillary sinuses. - Manuscript.

Dissertation for searching the scientific degree of Candidate of Medical Sciences according to specialty 14.01.19 - otorhinolaryngology. Institute of otolaryngology named after Prof. O.S.Kolomiychenko of Academy of Medical Sciences of Ukraine, Kyiv,2006.

The dissertation concerns the problem of increasing of efficiency in diagnosis of chronic proliferative maxillary sinusitis and optimization of minor invasive interventions at maxillary sinuses in the patients with chronic maxillary sinusitis.

The complex investigation of interrelation of the variants in anatomic structure of nasal cavity septum, ostiomeatal complex and inferoorbital ethmoidal Haller cells with chronic inflammatory proliferative diseases of maxillary sinuses mucosa has been carried out; it included histological confirmation of X-ray alterations in maxillary sinuses mucosa (spiral computed tomography findings) which are characteristics for chronic proliferative maxillary sinusitis. According to the studied sufficient X-ray material (448 patients and 110 controls) a significant correlation (p< 0.05) has been identified only at some variants of nasal cavity septum deformations and chronic maxillary sinusitis as well as at definite variants of nasal cavity septum deformations and maxillary sinuses cysts. As for the rest cases, the etiological role of ostiomeatal complex structures in the development of chronic maxillary sinusitis should be considered only from the point of view of their influence on the conductivity of natural co-ostium of maxillary sinuses.

The carried investigation of the thickened maxillary sinuses mucosa X-ray density findings at the computed tomograms it was established that this data could not be considered as a verified criterion in differentiated diagnosis for reversible and irreversible (proliferative) thickened maxillary sinuses mucosa of inflammatory genesis.

The computed topography of nasal cavity and paranasal sinuses at non-complicated chronic maxillary sinusitis is recommended to be performed within the period of remission while inflammatory process as in this case the efficiency of diagnosis of proliferative inflammatory changes in paranasal sinuses mucosa increases.

It has been established that adequate local anesthesia is a necessary condition for a true minor invasive surgical intervention on maxillary sinus. Minor invasive volume in this case is considered from the point of view of surgical stress level.

According to the results of experimental investigations performed on the volumetric highly precise models of nasal cavity and paranasal sinuses, developed on the basis of the new elaborated technology , the capacities of endoscopic minor invasive surgery at maxillary sinuses depending on the method of surgical access to the maxillary sinuses been established.

It has been established that surgical endoscopic interventions on maxillary sinuses made with the usage of wide-frame rhinoscopes (diameter of 2.7 mm, visual field angles of 45ъ and 70ъ ) and curved rhinological instruments (working part diameter of 3.5mm) allow to minimize the area of the removed parts of the walls of maxillary sinuses while the process of surgical approaching up to 21 mm2.

Key words: chronic proliferative maxillary sinusitis, spiral computed tomography, X-ray density of the thickened mucosa of maxillary sinuses, ostiomeatal complex, minor invasive endoscopic sinus surgery, surgical stress.

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