DEVELOPMENT OF THE DIAGNOSTIC AND PREVENTION ALGORITHM OF COMPLICATED SUBANTRAL PLASTIC SURGERY

Abstract

The aim of the study. Development of an algorithm for clinical and radiological examination of patients with atrophy of the alveolar process of the upper jaw when using dental implants and the need for subantral plastic surgery. Materials and methods of research. The work was performed at the Department of Maxillofacial Surgery, implantology and Periodontology of Dnipro State Medical University. CT scans of 72 patients of the State Medical University Medical Center were analyzed. The patients ranged in age from 48 to 69 years, including 39 men and 33 women. The role of anatomical factors diagnosed by Cone-Beam computed tomography in the development of perforation of the maxillary sinus mucosa during subantral plastic surgery is determined. The role of the type of pneumatization of the maxillary sinus in residents of the Dnipropetrovsk region was determined, and the relationship between intraoperative complications and the frequency of postoperative sinusitis was established. It was found that in 67 % of cases of sinusitis, pathologies of the structures of the nasal cavity and the bone marrow complex were detected. In addition, it was found that a violation of the structure of the anatomical structures of the nasal cavity and the ostiomeatal complex of the corresponding operating side can cause obstruction of the natural sinus mouth in the postoperative period and lead to a violation of mucociliary clearance. When comparing cone-beam computed tomography data with surgical protocols and postoperative observations, the association between anatomical risk factors and intra-and postoperative complications was determined. Conclusions. According to the retrospective analysis of the archival material of the Department of Oral Surgery, Implantology and Periodontology of the Dnipro State Medical University over 3 years, the frequency of complications of subantral plastic surgery using the lateral window technique is influenced by the presence of pathologies of the structures of the nasal cavity and the ostiomeatal complex, as well as the peculiarities of the structure of the maxillary sinus itself – the angle between and, to a lesser extent, the thickness of the mucosa lining of the sinus. It was established that the frequency of perforation of the mucous membrane was 31.9 %, while it occurred in 50 % of cases in patients with a thin mucous membrane and an angle of less than 60 degrees. In the group of patients who had a thick mucous membrane and the angle between the walls in the treated area was more than 60 degrees, perforation of the mucous membrane did not occur. At the same time, comparing different combinations of these factors, it was found that a larger angle value reduces the probability of perforation by 3 times with an equally thin sinus mucosa. It was established that in 67 % of cases of sinusitis, pathologies of the structures of the nasal cavity and osteomeatal complex were detected. Comprehensive preoperative diagnosis of a group of patients who are scheduled to undergo subantral plastic surgery should include an oral cavity examination by a dentist-surgeon, cone-beam computed tomography, examination and consultation by an otorhinolaryngologist.