Intraoperative prevention of silent sinus formation after extranasal operations on the maxillary sinus

Full Text

RELEVANCE
Among the entire pathology of the ENT organs, chronic inflammation of the maxillary sinus is one of the most common and accounts for 7-12% of all diseases related to surgical infection. The problem of treatment of this pathology remains relevant to the present time [1].
According to both Russian and foreign literature, the effectiveness of the results of minimally invasive treatment of maxillary sinusitis does not exceed 25%, and the number of relapses of the disease ranges from 20 to 60% of cases [1, 2]. In this regard, the need for radical surgery on the maxillary sinus is increasing.
The bone defects of the anterior wall of the maxillary sinus resulting from the operation can lead to the "silent sinus" syndrome. With the aforementioned syndrome, the walls of the sinus collapse, which leads to changes in the shape of the facial skeleton: the cheek on the affected side droops, the eyeball shifts into the orbit, the lower edge of the orbit droops, retractions of the upper lip, and in the postoperative period, epithelialization of the sinus walls is accompanied by fibrosis and scarring of the sinus lumen [3].
The most important problem in the treatment of chronic rhinogenic maxillary sinusitis is the restoration of bone tissue and ciliated epithelium after a radical operation according to Caldwell and Luke. In this regard, many methods are being developed to close the burr hole and improve the regeneration of damaged epithelium. The use of auto-, xeno-, lyophilized transplants, the use of synthetic materials has been proposed. The choice of one or another method of influencing a bone wound has its own clear indications and is not without certain drawbacks.

GOAL
To study the possibility of using platelet-rich fibrin to close a postoperative bone defect in the anterior wall of the sinus and stimulate regenerative processes in the mucous membrane of the affected sinus.

METHODS

Study Design
The objects of the study were 8 patients with a diagnosis of chronic recurrent purulent-polypous maxillary sinusitis. The study plan included the study of case histories, analysis of the course of the operation, as well as observation of patients in the postoperative period. In order to evaluate the results of the treatment, the patients were divided into two clinical groups of 4 people in each, according to the treatment plan, they underwent a traditional radical operation on the maxillary sinus according to Caldwell and Luke, however, the representatives of the main group completed the surgical intervention with the introduction into the burr hole anterior wall of the sinus platelet-rich fibrin (PAF). The results of the study made it possible to draw appropriate conclusions and conclusions.

Eligibility Criteria
The criterion for inclusion in the study was the presence of significant chronic recurrent purulent-polypous maxillary sinusitis in patients. Verification of the diagnosis was based on endoscopic examination of the ENT organs and computed tomography of the paranasal sinuses, as well as the result of a morphological study of the material obtained during the surgical treatment. All patients agreed to cooperate with the research team.

Terms and Conditions
The study was carried out on the basis of the otorhinolaryngological department of VOKB No. 1.

Study duration
The duration of the study, namely the collection of anamnesis, the study of clinical and instrumental laboratory data, as well as the evaluation of the results of surgical treatment, was 4 months. A detailed analysis of the case histories of patients was carried out, namely, the observation diaries of patients who were in the hospital from 09/21/21 to 01/28/2022 on the basis of VOKB No. 1 of the Otorhinolaryngology Department.

Description of medical intervention
Upon admission to the hospital, all patients underwent endoscopic examination of the ENT organs and computed tomography of the paranasal sinuses, which showed a total proliferation of polyposis-altered mucous membrane of the maxillary sinus, and all clinical and laboratory studies necessary for surgical intervention were carried out.
To evaluate the results of treatment, patients were divided into two clinical groups of 4 people each. According to the treatment plan, all patients underwent traditional radical surgery on the maxillary sinus according to Caldwell and Luke.
In patients of the first (main) group, the surgical intervention was completed by introducing into the burr hole of the anterior wall of the sinus a platelet-rich fibrin clot (PFC), obtained by centrifuging the patient's whole blood in a laboratory centrifuge SM-6M at a speed of 1300 rpm for 8 minutes, without adding anticoagulants and fibrinolysis activators, in special tubes. After that, the wound was sutured tightly.
Patients of the second group underwent traditional surgical treatment in the volume of classical radical surgery according to Caldwell and Luke. The diagnosis of chronic purulent-polypous maxillary sinusitis was confirmed by

About the authors

Ekaterina Vladimirovna Bushneva

ФГБОУ ВО «Воронежский государственный медицинский университет имени Н.Н. Бурденко» Министерства здравоохранения Российской Федерации

Author for correspondence.
Email: ekaterina.mitkovskaya@mail.ru
ORCID iD: 0000-0001-5545-7807
SPIN-code: 1627-0518
Russian Federation, г. Воронеж, ул. Студенческая, д. 10

References