Perforation of the floor of the maxillary sinus

Sinusitis or maxillary sinusitis is one of the most common types of inflammation of the paranasal sinuses. In most cases, the treatment of this process is conservative, that is, with the use of antibiotics, vasoconstrictor drops and constant washings of the nose and sinuses. However, in some cases, with dishonest treatment or a running process, one has to resort to surgical treatment of sinusitis. In our article, we will discuss indications for operations on the maxillary sinuses, types of operations and their possible consequences.

When is surgery needed for sinusitis?

As already mentioned, not every patient with inflammation in the maxillary sinuses needs surgical treatment. We list the main indications for surgical interventions.

Accumulation of pus in the sinus cavity. In this case, most often, artificial removal of pus is necessary in case of complete closure of the sinus - that is, blockage of the sinus duct into the nasal cavity. Pus, accumulating in a closed bone cavity, presses on its walls and leads to unbearable headaches. With a further increase in the volume of pus, its breakthrough under pressure into neighboring structures is possible: the upper jaw, palate, orbit, meninges.
The presence of chronic sinusitis with frequent exacerbations and a long course. To begin with, it is important to understand that a closed sinus cavity with a tiny excretory duct is very predisposing to the development of chronic inflammation. Therefore, chronic sinusitis is a fairly common pathology of the ENT organs. In the course of constant sluggish inflammation in the mucous membrane of the sinus, various abnormal "plus-tissues" are formed - polyps, adhesions, cystic cavities. These formations, in turn, contribute to the further development and course of chronic inflammation, often additionally blocking the exit from the sinus. It turns out such a vicious vicious circle.
The presence of abnormal formations in the sinus cavity - both congenital and acquired. Congenital formations include pathological bony sinus septa, various tumors and cysts, bone protrusions and ridges that prevent adequate ventilation and outflow from the sinus. Acquired include the structures listed in the previous paragraph, as well as various foreign bodies. Such a foreign inclusion in the maxillary sinus is the smallest toys or their parts, thrust deep into the child's nose and pulled into the sinus cavity when inhaled. Fortunately, these are extremely rare cases. Most often, fragments of dental filling material, bone fragments of teeth or dental appliances that have fallen into the sinus cavity during the treatment of molars of the upper jaw can be observed. Such foreign bodies cause chronic inflammation in the sinus.

Preoperative preparation and examination

Of course, any surgical intervention is not done just like that. The patient should undergo a minimum list of examinations, especially if an open operation is expected.

X-ray of the paranasal sinuses. This is a simple, fast and cheap examination. Unfortunately, its information content in the chronic process is not too high. Infrequently, an x-ray image shows mucosal changes, does not always see abnormal “plus-tissues”. X-ray is rather a method of preliminary diagnosis or an express method in the case of, for example, acute purulent sinusitis.
Computed tomography of the sinuses is a more modern and informative method. With the help of CT, the doctor receives layer-by-layer thinnest sections-images of the sinus of interest. Having restored the picture with the help of computer graphics, you can see the smallest nuances of the cavity - the altered mucosa, polyps and other formations, foreign bodies. It is also important that with the help of CT one can see the relationships of structures inside the cavity. Therefore, it is computed tomography, and not X-ray or clinical examination, that is the gold standard for preoperative examination before elective operations.
General clinical blood tests, urine, bacteriological culture from the nasal cavity and sinus are very important before a planned surgical intervention.

Prerequisites for elective surgery:

The patient must be relatively healthy before performing the surgical procedure. Any acute (tonsillitis, pyelonephritis, etc.) or exacerbations of chronic (decompensation of diabetes mellitus, exacerbation of bronchial asthma) diseases are a contraindication.
It is better to perform planned interventions in the "cold period" of the chronic process - that is, without exacerbation.
Women should also not have a period on the day of surgery.
It is highly undesirable to perform a planned operation during pregnancy or, in case of emergency, to transfer it to the second trimester of pregnancy.

These points do not apply to the acute purulent process associated with the accumulation of pus in the sinus cavity. In this case, the operation in the form of a puncture or sinus puncture is performed in any case.

Types of operations for sinusitis

The patient, who is assigned to this or that manipulation in the sinuses, always worries and thinks: how is the operation done for sinusitis? In this section, we describe the main methods of surgical treatment of sinusitis.

Puncture or puncture of the sinus

This type of surgical treatment rather belongs to the category of manipulations, since it is quite simple and less traumatic. In the vast majority of cases, with acute purulent sinusitis with accumulation of pus in the sinus cavity. With the help of a puncture, pus is evacuated and the sinus cavity is washed with antiseptics. Another advantage of the puncture is that it can be used under aseptic conditions to take sinus discharge for bacteriological analysis, that is, to identify the causative agent of sinusitis and determine its sensitivity to antibiotics for adequate selection of further treatment.

The essence of the operation:

Before the immediate start of the manipulation, the nasal passages and the sinus cavity are washed with an antiseptic solution from mucus, pus and other contaminants.
Vasoconstrictor drops are instilled into the nasal passages to reduce mucosal edema and prevent bleeding.
A special ENT examination is carried out, the walls of the nose are examined, and the injection site is chosen.
Local anesthesia is carried out with solutions or sprays of lidocaine.
A thick needle makes a puncture. In simple terms, they penetrate into the sinus cavity by breaking through its side wall, bordering the wall of the nose. The bone plate in this place is quite thin, and the needle passes easily.
With the help of a syringe or an aspirator, pus is removed and the sinus cavity is repeatedly washed with antiseptic solutions.

Operation on the maxillary sinus according to the Luke-Caldwell method

This open sinus surgery has been used for over a hundred years. Its name is formed by two names of completely different surgeons who independently described the technique of the operation. Thanks to open access, the surgeon has a large space for manipulations and the ability to qualitatively remove all unnecessary formations.

The essence of the operation:

Preoperative preparation is carried out similarly to that for nasal punctures.
Anesthesia can be local or general - the person will fall asleep and wake up after the operation is completed.
The main essence of the operation is to penetrate into the sinus cavity. In the case of the Luke-Caldwell operation, the site of access is a point on the maxilla or maxillary fossa. It is in this natural recess that it is convenient to create a hole.
To do this, the mucous membrane of the upper jaw is removed with a kind of flap, exposing the surface of the bone. Further, using special tools - a chisel, a drill, a drill, the doctor opens the bone plate, penetrating into the sinus.
Further, with the help of similar instruments, the sinus cavity is cleaned, all “plus-tissues”, bone ridges and protrusions, and foreign bodies are removed.
The cavity is repeatedly washed with antibiotic solutions.
Most often, in the case of a long course of chronic sinusitis, the natural sinus outlet can not cope with the cleansing of the sinus. Therefore, the doctor can additionally form an artificial channel on the inner wall of the sinus, which goes into the nasal cavity, or try to restore the patency of the natural fistula.
Next, the inlet is again closed with a soft tissue flap.

Intranasal antrostomy

A peculiar modification of the Luke-Caldwell operation is intranasal antrostomy. The goals of the operations are similar - to clean the sinus as much as possible from abnormal formations and sanitize its cavity. The difference between the operations lies in the access point. For intranasal antrostomy, access to the sinus is not through the upper jaw, but through the inner side wall of the nose.

Endoscopic surgery

Surgical interventions using the finest instruments equipped with a camera and a fiber optic system are the gold standard for maxillary sinus surgery.

Such modern methods have a number of advantages:

Complete preservation of the physiology and anatomy of the sinuses, since in the vast majority of cases the access point to the sinus is its natural fistula.
Minimally invasive and bloodless.
The possibility of repeating the procedure as needed.

The disadvantages of the method include:

The high cost of the procedure due to the high cost of optical systems and their maintenance.
Lack of trained doctors, as such techniques require constant improvement of knowledge and skills.

Unfortunately, there are very few ENT departments in public health institutions equipped with such equipment.

Postoperative period

After surgery on the maxillary sinus, the rehabilitation phase begins. This is a very important period in the recovery of the patient. All procedures and manipulations on the operated sinus must be clearly agreed with the attending physician. Any self-medication is unacceptable!

The main activities in the postoperative period:

Regular visits to the ENT doctor and monitoring the condition of the sinus.
The use of a whole arsenal of medicines: antibiotics, anti-inflammatory drugs, special nasal drops. Regular rinsing of the nose with saline and antiseptic solutions is very important.
Using methods: laser, ultrasound, magnetotherapy and others.
The utmost care for the patient's health. It is important to prevent hypothermia, avoid colds, often and a lot of walking in the fresh air.
Sanatorium treatment, vitamin therapy.
Quit smoking and alcohol.

The maxillary sinus is a cavity located in the maxillary bone. Has a message with the middle nasal passage. Due to this, with neglected inflammatory processes, inflammation of the sinus may occur, accompanied by the accumulation of purulent exudate in it.

Treatment of this condition, in especially severe cases, requires surgical intervention - maxillary sinusectomy.

Sinusectomy is a surgical intervention in which the sinus is opened and the pathological contents are subsequently removed from it. It can be not only pus, but also polyps or foreign bodies.

Indications and contraindications

There are certain indications for the procedure, namely:

maxillary sinus cyst;
polyposis;
cysts and tumor formations;
foreign body;
lack of effect from other therapeutic measures.

It is impossible to carry out an intervention if there are:

exacerbation of the infectious process;
heart pathology;
kidney disease;
lung diseases;
impaired blood clotting;

If one of these problems is present, the intervention cannot be carried out, since this can lead to a number of complications of the underlying disease. A relative contraindication is the exacerbation of diseases of the upper respiratory tract. In this case, the appropriateness of the intervention is determined by the attending physician.

The most common problem is sinusitis. This is an inflammation of the maxillary sinus, accompanied by severe headache, nasal congestion and fever. However, surgical treatment is resorted to only in extreme cases. For example, if conservative therapy does not give any effect.

Types of procedure

Depending on the severity of the patient's condition and the cause of the disease, the doctor may choose several methods of surgical treatment, each of which has its own characteristics.

There are two main types of operation:

endoscopic maxillary sinusectomy;
radical sinusectomy.

Microgeneral sinusectomy is also distinguished, which is carried out with a minimum amount of intervention and is necessary to remove polyps, foreign bodies, or to take material from the maxillary sinus for examination.

radical method

The radical method is carried out according to the classical Caldwell-Luc method. The course of the operation consists of several stages:

Making an incision in the mucous membrane of the upper lip.
Tissue displacement to the side.
Drilling a hole in the wall of the sinus.
Insertion of drainage or other instruments into the sinus.
Removal of exudate.
Cavity washing.
Packing.
Suturing the incision.

After 2 days, the doctor removes the tampon, after which the patient needs to go to wash the sinus, and also use vasoconstrictor drops. The stitches can be removed after about 7 days. Puffiness of the face persists for up to 12 days.

Endoscopic method

Endoscopic maxillary sinusectomy is more popular than the radical technique. This comes with a number of benefits:

low level of traumatism and blood loss;
intervention at the outpatient level;
short recovery period;
no external defects.

The intervention is performed under local anesthesia using endoscopic instruments. The procedure often takes no more than 25 minutes.

The peculiarity and main difference from the radical method is that the specialist does not need to make an incision, the instruments are inserted through natural openings. To get into the sinus, makes a small puncture.

There are several types of surgery, depending on the sinus access chosen:

through the nasal passages;
through the wall of the sinus;
through the maxillary tubercle.

The most natural access is through the middle nasal passage. The puncture itself during the intervention does not reach a size of 5 mm. The doctor inserts a camera into the sinus, which allows you to carefully examine it from the inside. Further, all the necessary manipulations are carried out.

The duration of the intervention is 30 minutes. The use of this technique makes it possible to make the postoperative period of maxillary sinusotomy less long. The patient will need to stay in the hospital for no more than 4 days. In some cases, outpatient intervention is allowed.

Of the drugs used, it is worth highlighting:

prozerin;
B vitamins;
dibazol.

In addition to the use of drugs, it is recommended to conduct a course of UHF, as well as electrophoresis.

Complications

As with any intervention, some consequences may develop. The most serious of them is trauma to the trigeminal nerve. So, with such a complication, a violation of facial expressions occurs, the occurrence of a pronounced pain syndrome on the side of the lesion. In addition, the following problems may occur:

fistula formation;
bleeding;
recurrence of inflammation of the sinus.

In general, complications after endoscopic intervention are much less. This is due to less intervention. That is why most experts prefer this technique.

In order to avoid complications after the operation, it is important to follow certain recommendations:

exclusion of physical activity;
use of saline solutions for washing;
the use of vasoconstrictor drops;
taking antibiotics;
proper oral hygiene;
exclusion of alcohol and consumption of spicy food;
control of the attending physician.

Sinusectomy should only be used when necessary. Before resorting to surgery, it is important to use conservative treatment, if possible. Only in this case, an invasive technique will be justified.

The maxillary sinus (its other name is the maxillary sinus) is located in the thickness of the bone tissue of the upper jaw. It is separated from the oral cavity by the alveolar process of the upper jaw, which forms its bottom. The volume of such a sinus is large enough, and in adults it can reach 10 centimeters cubic.

In the photo: the roots of the teeth at the bottom of the maxillary sinus

Such a sinus, or sinus, is not airtight. It communicates with the nasal cavity through a narrow slit.

Usually perforation of the maxillary sinus occurs in the region of its bottom. Some of its features contribute to this:

The proximity of the roots of molars and premolars. In some cases, the thickness of the bone layer between the dental roots and the bottom of the maxillary sinus can be relatively large - up to 1 cm, but in some people the bone border between these formations is very thin - no more than 1 mm.
Sometimes the roots of the first and second molars are located in the sinus cavity itself, separating from it with just a layer of mucous membrane.
Rapid thinning of the bone layer in the presence of acute or chronic inflammatory diseases: periodontitis, periodontitis, cysts.
Relatively thin bony trabeculae in the maxillary tissue.

All this predisposes to the occurrence of perforation during dental procedures, even if the treatment technique was not violated, and the doctor did not apply significant traumatic force.

Causes of perforation of the bottom of the maxillary sinus

The etiology of maxillary sinus perforations is always associated with any dental procedures. Perforation can occur:

when removing teeth;
in endodontic treatment;
during root resection.

When removing teeth, damage to the bottom of the maxillary sinus can be the result of both rough actions of the dentist or non-compliance with treatment tactics, and the result of the anatomical features of the patient himself (for example, when tooth roots are located directly in the sinus cavity).

In the photo: the tooth root is in proximity to the bottom of the maxillary sinus, which increases the likelihood of perforation when removed

When conducting endodontic treatment, one of the complications is the perforation of the tooth root, which is often combined with damage and perforation of the bottom of the maxillary sinus. This happens when the root canals are too wide, when brute force is used when inserting pins or sealing the filling cement. With this variant of perforation of the maxillary sinus, the filling material or root fragments almost always penetrate into its cavity.

If perforation occurs at the time of insertion of a dental implant (it can be an implant of any brand, for example, Mis, Nobel, Xive, etc.) or during root canal filling, insertion of pins into the tooth root, then it is always a therapeutic error physician tactics.

Damage to the bottom of the maxillary sinus is a serious complication when implanting artificial roots into bone tissue during prosthetics. This is due to the fact that after tooth extraction, the bone tissue undergoes dystrophy processes very quickly. And as a result, there is a decrease in the height of the alveolar process of the jaw. If the doctor does not take this point into account and incorrectly prepares before implantation, and also incorrectly selects the size of the implant, then the risk of sinus perforation is very high.

Resection of the tooth root is a method of treatment in the presence of cysts in the region of its apex. If the patient is underexamined, when the doctor does not know the exact size of the bone plate that separates the bottom of the sinus from the cyst wall, and if a large volume of the jawbone is required to be removed, then perforation of the maxillary sinus is not a rare phenomenon.

Perforation symptoms

If the perforation of the sinus occurred at the time of tooth extraction, then its symptoms will be quite specific:

The appearance in the blood released from the tooth socket, small air bubbles, the number of which increases with a sharp forced exhalation through the nose.
The appearance of bloody discharge from the nose on the side of the perforated maxillary sinus.
Change in the timbre of the patient's voice, the appearance of "nasal".

Sometimes the patient begins to complain about the passage of air through the hole after tooth extraction, as well as a feeling of heaviness or pressure in the projection of the maxillary sinus.

The photo shows the perforation of the bottom of the maxillary sinus after tooth extraction

If perforation of the maxillary sinus occurs during implantation or during endodontic treatment, then the doctor may suspect it by:

the characteristic failure of the instrument or implantable element after applying some effort to advance it;
changing the position of the instrument in the wound;
the appearance of small air bubbles in the blood.

If the perforation of the maxillary sinus for any reason was not diagnosed and treated immediately, then infection of its cavity occurs with the development of a clinic of acute sinusitis or sinusitis, which is characterized by such symptoms as:

severe acute pain in the region of the maxillary sinus;
swelling of the nasal mucosa on the corresponding side with impaired breathing through the nose;
the appearance of purulent discharge from the nose.

The appearance of general symptoms of intoxication is also characteristic: headaches, chills, high fever, weakness.

Diagnostics

Diagnosis of perforation of the bottom of the maxillary sinus during tooth extraction is based on a typical clinical picture. In doubtful cases, as well as when such a complication is suspected during implantation or endodontic manipulations, it is necessary to use instrumental diagnostic methods:

Probing the socket of an extracted tooth or a perforated canal with a thin probe. This allows you to determine that there is no bone bottom in the wound. In this case, the instrument passes freely through soft tissues and does not encounter obstacles in its path.
X-ray of the sinus area. In the pictures in this case, one can detect both the darkening of the cavity due to the accumulation of blood in it, and fragments of tooth roots, implants or filling material. Sometimes it is advisable to conduct radiography with contrast, when a contrast agent is injected into the cavity through a perforated fistula.
CT scan, which allows you to determine the perforations and the presence of foreign bodies in the sinus with maximum accuracy.
If old perforations are suspected, general clinical blood tests, the result of which may indicate the presence in the body of an active focus of infection.

Treatment

Treatment of perforations of the bottom of the maxillary sinus depends on what changes are in the sinus cavity itself.

Treatment without surgery is possible only in cases where perforation occurred during tooth extraction and was detected immediately, and according to radiography, there are no signs of infection of the sinus cavity or the presence of even minor foreign bodies in it. With this option, the doctor's tactics are to preserve the blood clot formed in the hole as carefully as possible, as well as to prevent its infection. To do this, a small gauze swab soaked in iodine solution is inserted into the lower part of the hole. Usually, it is tightly fixed on its own in the wound cavity, but sometimes suturing of the gum is required. Such treatment with iodine lasts at least 6-7 days - until the formation of full-fledged granulations and the closure of the defect. In this case, the swab is not removed from the well, so as not to damage the blood clot.

It is also possible to temporarily close the defect with a small plastic plate, which is fixed on adjacent teeth with clasps. It separates the oral cavity and sinuses, which contributes to the healing of the perforation.

At the same time, a course of preventive measures is prescribed to prevent the development of inflammatory complications. It includes taking antibiotics, anti-inflammatory drugs, drops with a vasoconstrictive effect. Such a course is carried out on an outpatient basis or at home.

If, during perforation, foreign bodies penetrated into the sinus (implant, filling material, fragments of the tooth root), then treatment is carried out only in a hospital. In this case, an operation is indicated with opening the cavity of the maxillary sinus, removing the foreign body and non-viable tissues, followed by plastic closure of the perforated defect.

old perforations

If the perforation of the sinus of the upper jaw was not detected and eliminated in a timely manner, then after 2-4 weeks the stage of acute manifestations will subside, and a fistula will form in the area of the defect, connecting the sinus cavity with the gum surface.

This process is simultaneously accompanied by symptoms of chronic sinusitis:

constant dull pain in the sinus area with irradiation to the orbit, temple;
nasal congestion on the side of the lesion;
purulent discharge from the nasal cavity, as well as from the fistulous opening;
sometimes patients have swelling of the cheek on the side of the damaged sinus.

Most patients also complain of a sensation of air moving through the fistula when talking or sneezing, difficulty in pronouncing certain sounds, and liquid food from the mouth to the nasal cavity.

The treatment of such chronic perforations with fistulas presents some difficulties, since the presence of a chronic focus of inflammation in the maxillary sinus significantly reduces the effectiveness of therapy and quite often leads to recurrence and re-formation of the fistulous canal.

Such patients are shown surgery, which includes opening the maxillary sinus with the removal of all non-viable tissues and foreign bodies from its cavity, excision of the fistula and plastic closure of the defect. Antibiotics after removal of the fistula are prescribed for a course of 10-14 days with the simultaneous administration of anti-inflammatory and antihistamine drugs, the use of physiotherapeutic methods of treatment.

Consequences of perforation

Perforation of the sinus of the upper jaw is a rather serious pathology that often has to be treated in a hospital. Attempts to self-treat it with folk remedies at home without medical participation can lead to the development of serious and dangerous consequences:

The development of a pronounced inflammatory reaction in the sinus cavity with the transfer of infection to the surrounding bone tissue and the formation of foci of osteomyelitis of the upper jaw.
The spread of inflammation to other sinuses of the skull (frontal, sphenoid and ethmoid).
Loss of healthy teeth located in the area of untreated perforation.
The formation of purulent foci (abscesses, phlegmon).

Due to the proximity of the maxillary sinus and the brain, after perforation, infection may spread to the meninges with the development of meningitis or meningoencephalitis that threatens the patient's life.

Preventive actions

Prevention of perforation of the bottom of the maxillary sinus is:

in a full examination of the patient before complex dental procedures;
in the correct assessment of the anatomical and topographic features of each person;
in exact observance of technology of medical manipulations.

Timely detection of signs of perforation and its adequate treatment is the key to a favorable outcome for the patient. Incorrect therapeutic tactics or self-medication can aggravate the course of such a complication and cause the development of severe negative consequences.

Good day. My problem is about 6 years old. It all started with pain in the root of the nose on the left side. They were quite peculiar and appeared when climbing to a height, after alcohol with allergic reactions in the future with any disease. It was characteristic that the pain intensified for about 2 hours to unbearable, then a characteristic squeak was heard, and the pain instantly passed, there was a feeling that air was passing through the entire sinus. The next stage of the disease was a constant pressing pain in the same place. Ethmoiditis was diagnosed. For 2 years, during exacerbations, he was successfully treated with cuckoo and antibiotics, but since November, after the flight, an exacerbation began again. It proceeded for 3 months and nothing helped, not a 3-week course of amoxiclav, cedex, cuckoo, etc. It was customary to undergo an operation in Germany. Pansinusitis was diagnosed in Germany. Sinus surgeries were performed. Below is the diagnosis and what they did to me). They also said that anatomically very narrow anastomoses. J32.4 Chronic pansinusitis j34.3 Turbinate hypertrophy surgical procedure note/procedure catalog text 5-215.00 Turbinate caustics 5-222.0 Left infundibulotomy 5-223.5 Frontal sinus surgery, endonasal surgery protocol preparation: thorough cleaning, shaving of nasal passage and disinfection. Extensive reduction of edema of the nasal mucosa and middle meatus by application of alpha-sympathomimetic-moistened swabs and endoscopic 10-fold infiltration with xylocaine 1% in combination with adrenaline, in the area of the septum, ethmoid ridge and middle concha for hydrodissection, control of bleeding during surgery, and also for reduction of pain in the postoperative period. The course of the operation: repeated reduction of mucosal edema in the middle nasal passage on both sides with a cotton ball soaked in adrenaline. Operation on the ethmoid bone on the right: first, surgical treatment of the right paranasal sinus system. Careful endoscopic entry into the middle meatus without damaging the concha, circumcision at the margins, and resection of the uncinate process with a sickle knife. Opening of the ethmoid bladder and removal of bone fragments. Step by step expansion of the cells of the ethmoid bone with inflammatory changes to the back of the ethmoid bone under close observation of the base of the skull. Recurrent bleeding and narrow structure complicate anatomical orientation and endoscopic examination. Removal of smaller bony septa on the bony part of the base of the nose with nasal forceps blakesly 45°. Frontal sinus surgery on the right: endoscopic image and opening of the frontal process after removal of the ethmoid ridge # of cells. Suction of the secret from the frontal sinus. Operation on the right maxillary sinus: expansion of the natural mouth of the right maxillary sinus with a puncture biopsy in the opposite direction. Removal of polypous material from the alveolar ridge under visual control, followed by washing and suction of the cloudy secretion. The introduction of curaspon (curaspon) into the pocket of the ethmoid bone. Fundamentally similar actions on the left side. There is also poor visibility and recurrent bleeding. Caustics: after reducing the swelling of the inferior concha, caustics of the head of the nasal concha is performed on both sides. Repeated thorough endoscopic hemostasis. Remove all tampons. After the operation, there were pains on the right and on the left. Then everything seemed to be gone. But after arriving home, I fell ill. There was some purulent discharge on the right side, the temperature was 37.4, and pressing pain appeared again on the left side, 4 days after the onset of the disease. The pain is not permanent, I always feel pressure, and the pain is either stronger or weaker. After waking up, symptoms appear after half an hour or an hour. He began to drink antibiotics, the condition became better, the snot passed, the temperature too, but the oppressive feeling remained. It has been 3 weeks since the operation (dull pressing pain in the root of the nose on the left side) and the headache has not gone away. Feels like before the operation. Is this normal after this operation? Could it be swelling after surgery or something else? And why is everything wonderful on the right side?

Sinusitis is a very common problem in ENT practice. In one form or another, a tenth of the adult population suffers from it. And half of the cases among all the pathology of the nose is sinusitis - inflammation of the maxillary sinus. Given the mass of unpleasant moments that the disease delivers to patients, increased attention is paid to its treatment. But often conservative methods are powerless, and the issue can only be resolved surgically. What kind of operations are there, when they are carried out, how exactly and what they give later - these are the main questions that should be discussed.

The maxillary sinuses are paired sinuses that communicate with the nasal cavity. They are the largest among the rest, occupying almost the entire volume of the upper jaw. From the inside, the sinuses are covered with a mucous membrane and filled with air. The main functions of the sinuses are: participation in nasal breathing, warming the air, creating resonance (voice formation).

If their mucous membrane of the sinus becomes inflamed, then a disease develops - sinusitis. It occurs with the participation of the microbial factor and against the background of related problems (anomalies in the structure and injuries of the nose, pathology of the dentition, a decrease in the body's immune reactivity). Exudate (often purulent) begins to accumulate inside the cavity, or hyperplastic processes form. This leads to a violation of all sinus functions and the appearance of a number of unpleasant symptoms:

Difficulty in nasal breathing.
Discharge from the nose.
Headache.
Temperature rise.
Weakness and malaise.

Such signs are characteristic of an acute process or an exacerbation of a chronic one. And in a state of remission, the clinical picture becomes not so bright, although nasal congestion and discharge persist. Sinusitis can occur with complications, in which the inflammatory process passes to neighboring areas (otitis media, frontal sinusitis), infectious pathology of other organs (pneumonia) and neurovegetative reactions develop.

Indications and contraindications

Inflammation of the maxillary sinus can be treated conservatively. Antibiotics, vasoconstrictor nose drops are prescribed, drained and washed with antiseptics using a special catheter (YAMIK-therapy), physiotherapy is used. And the surgical treatment of sinusitis is used when the above remedies have shown their ineffectiveness. In addition, indications for surgery include:

Chronic sinusitis (polypous, caseous, necrotic, cholesteatoma or mixed forms).
Secondary purulent complications (orbital, intracranial).
Structural anomalies of the sinuses or nasal cavity (with a violation of the outflow of exudate).
Foreign bodies in the nasal passages and sinuses.
Odontogenic nature of the inflammatory process (problems with the dental system).

Each case is considered individually. The doctor forms the most optimal treatment program for the patient, which will suit him, taking into account all the characteristics of the body. After all, it should be understood that surgical intervention has certain limitations. Contraindications to surgical manipulations can be:

General infectious diseases.
Refractory arterial hypertension.
Blood diseases (coagulopathy).
Immunodeficiencies.
Diseases of internal organs in the stage of decompensation.
Endocrine disorders (severe diabetes mellitus).

But these conditions are relative, because after the appropriate correction of violations, the intervention does not pose a danger to the body. But in any case, you need to carefully evaluate the benefits and risks, making an informed decision.

When conservative correction of sinusitis is ineffective, a decision is made on surgical intervention.

Methods

There are several techniques that can be recommended to patients. What kind of operation for sinusitis is necessary in a particular case, only the doctor decides. But the general essence is the same - the cleansing of the maxillary sinuses from pus and pathological growths, the elimination of anatomical defects and the normalization of the outflow of natural secretions. All invasive interventions can be divided into internal (endonasal) and external (extranasal) methods.

Sinus puncture

Semi-surgical methods include puncture of the maxillary sinus. It remains a widespread and effective treatment for sinusitis. Before the procedure, the puncture site (the side wall of the middle nasal passage) is lubricated with a local anesthetic for pain relief. Then the doctor makes a hole with a puncture needle, penetrating into the sinus.

The contents are aspirated and taken for examination, and the sinus is washed with antiseptic solutions (furacillin, Dimeskid, Chlorophyllipt). Additionally, broad-spectrum antibiotics (Augmentin, Cedex) are injected into it, if the exudate is thick, then proteolytic enzymes (trypsin, chymotrypsin), and with severe edema, glucocorticoids (dexamethasone, hydrocortisone). In total, no more than 7-8 punctures are recommended. If the purulent discharge persists, then a more radical treatment of sinusitis is required.

Endoscopic method

The maxillary sinus can be penetrated through endoscopy. Then the wall of the sinus of the nose is not disturbed, everything happens through natural openings. The endonasal method is the most gentle and is carried out through the use of modern fiber-optic technology, long-focus microscopes and special instruments. To cleanse the sinuses, various nozzles are used: a coagulator, a shaver, forceps, etc. The operation is carried out under constant visual control, which allows you to remove pathological formations within healthy tissues without causing major damage, which reduces the risk of adverse consequences.

Within two weeks after the endoscopic operation on the maxillary sinus was performed, the patient should be observed by an ENT doctor. He will prescribe a prophylactic course of antibiotics and will monitor how the healing is going. To improve the discharge of crusts and secretions, the maxillary sinuses can be washed with antiseptics and saline. And within six months, you will have to instill drops with topical corticosteroids to prevent the inflammatory process.

Traditional operation

The most radical method of surgical treatment is the traditional operation for sinusitis (according to Caldwell-Luc). It is performed in a hospital under local or general anesthesia. Access for maxillary sinusectomy is carried out from the vestibule of the oral cavity, above the alveolar process of the upper jaw (right or left). In this place, a small hole is made through which the sinus cavity is inspected and the pathological formations are eliminated.

In chronic sinusitis, the cells of the ethmoid labyrinth are also changed, which are also removed. For adequate drainage, an anastomosis is applied between the sinus and the lower nasal passage, and a gauze swab moistened with an antiseptic or antibacterial ointment is left in the cavity. A day later, it is removed. With odontogenic sinusitis, the operation may be accompanied by a plastic defect in the lower wall of the sinus. The patient stays in the hospital for a week. He is given washings, antibiotics, anti-inflammatory and antihistamines are prescribed.

Radical surgery gives more freedom to surgeons and allows you to clean the sinuses well, but at the same time it is more traumatic for the patient.

Effects

When deciding on a surgical intervention, one should be prepared for its consequences. But it is not at all necessary that they will occur. It all depends on the technique of performing the operation, preparation for it, rehabilitation measures, qualifications and experience of the doctor. The most common complications are the following:

Bleeding.
secondary infection.
Loss of sensation in the nose and upper lip.
Decreased sense of smell.
visual disturbances.
Fistula formation.

To avoid negative consequences after surgery, it is important to follow the doctor's recommendations in everything. Great importance is given to oral hygiene and rinsing with antiseptics (especially with radical maxillary sinusectomy). In addition, it is necessary to take all prescribed medications and be on time for examination.

Thus, operations for sinusitis can be different. What treatment is indicated in a particular case, only the doctor will say. After an appropriate examination, he determines the type and extent of surgical intervention in order to cure sinus inflammation as efficiently and with minimal risks.