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Causes of chronic sinusitis
The nasal cavity and the maxillary sinuses communicating with it are the “gateway” for infection entering the body. It is here that the primary localization and proliferation of ARVI pathogens occurs, which always leads to inflammation, swelling of the mucous membranes and narrowing of the anastomosis. Therefore, if the sense of smell is reduced, weakness and headaches persist for a long time after respiratory diseases, it is always recommended to consult an ENT specialist - the reason may be the development of sinusitis.
Long-term, sluggish processes also develop against the background of:
- Deviated nasal septum
- Pulpitis and periodontitis of the teeth of the upper jaw
- Nasal trauma leading to narrowing of the middle meatus
- Allergies
- Growth of polyps in the nose
In some cases, maxillary sinusotomy can be combined with the elimination of the contributing factor. For example, in the case of an odontogenic form, it is possible to remove a tooth in one intervention and gain access to the sinus through its socket, and in case of a deviated nasal septum, septoplasty and maxillary sinusotomy are performed simultaneously.
Complications of sinusitis
The chronic form often has an undulating course and mild symptoms. Therefore, many patients do not even go to the doctor, attributing malaise and headaches to fatigue, seasonality and magnetic storms. But this can cause serious complications:
- Decreased immunity and increased susceptibility to infectious diseases
- Complications of ARVI, such as pneumonia, bronchopneumonia
- Spread of infection into the brain with the formation of purulent foci
- Involvement of the inner ear in the process with the development of hearing loss
- Often with purulent sinusitis, numerous fistulas are formed that open into the oral and nasal cavities
Timely implementation of bilateral maxillary sinusotomy can protect against such consequences and significantly improve the quality of life, relieving the patient of difficulty breathing, headaches, weakness, drowsiness and other symptoms.
Indications for maxillary sinusotomy
The preferred treatment option is always conservative therapy. Surgery is used only in cases where it is not effective or the disease threatens the patient’s life.
It is often recommended to consult an ENT specialist before implantation. Even after tooth extraction, inclusions due to periodontitis may remain in the maxillary sinus. In this case, maxillary sinusotomy of the cyst and polyps becomes a mandatory step in preparation for the implantation of dental implants.
Indications for performing radical maxillary sinusotomy are:
- Rapid progression Progression of purulent sinusitis with the risk of inflammation spreading to the inner ear and other organs
- Odontogenic sinusitis In this case, a maxillary sinusotomy is performed with tooth extraction and access to the sinus through its socket
- Chronic sinusitis with tissue proliferation Thickening of the sinus mucosa and the formation of polyps in it can lead to blockage of the canal connecting it to the nasal cavity. In this case, the process is aggravated, and maxillary sinusotomy with anastomosis plastic surgery becomes the only effective treatment option
- Detection of foreign bodies in the sinus Most often they get there as a result of dental treatment - pieces of teeth, filling material, fragments of instruments and become the cause of inflammation. In this case, a unilateral maxillary sinusotomy is performed with removal of foreign bodies and rinsing of the sinus with an antiseptic
- Frequent exacerbation of chronic sinusitis If you visit about a pathological process in the sinus more than 2-3 times a year, the doctor may recommend surgery
- Irreversible destruction of structures For example, classic maxillary sinusotomy followed by plastic surgery is recommended when moving the process to bones with their melting
Contraindications
The chronic inflammatory process depletes the immune system and reduces the quality of life, and in some cases even creates a significant threat. It can spread further and affect the inner and middle ear, cause abscesses in the brain, contribute to the development of pneumonia, and so on. Therefore, there are no absolute contraindications to endoscopic maxillary sinusotomy.
But it may be postponed to a later date for some reasons:
- ARVI
- Pregnancy and lactation
- Hypertensive crisis
- Exacerbation of chronic diseases of internal organs
- Bleeding disorder
- Decompensated heart diseases
Nowadays, mostly gentle maxillary sinusotomy is used - an operation that is performed without wide incisions and significant tissue damage. It is well tolerated by patients and does not require long-term rehabilitation.
Main stages
The price of maxillary sinusotomy surgery in Moscow is determined by the experience and qualifications of the doctor, the chosen access option and the protocol according to which it is performed. In this case, preference is almost always given to gentle endoscopic options, which minimize all risks of complications in the postoperative period and require the patient to comply with minimal restrictions.
But with any type of maxillary sinusotomy, the stages of the operation are similar:
- Patient preparation. Includes examination and anesthesia. In most cases, the operation is performed under deep sedation or anesthesia
- Access. It directly depends on the type of pathology and the capabilities of the clinic. Thus, in case of oncology, it is advisable to perform a maxillary sinusotomy according to Caldwell-Luc, and in case of narrowing of the anastomosis - with access through the nose
- Manipulations in the sinus. It is cleared of its contents, if necessary, polyps and epithelial growths are removed, and then washed with antiseptic solutions
- Many patients require packing of the middle meatus in the first 24-48 hours after surgery to prevent bleeding
- When using the classical technique, the operation ends with the application of sutures, which are removed 5-6 days after the maxillary sinusotomy. With endoscopic options this is not required - the puncture heals on its own
Three options for intervention have become the most popular in ENT practice: classic, maxillary sinusotomy through the tooth socket and through the nose with simultaneous plastic surgery of the anastomosis.
The duration of the recovery period and restrictions directly depend on the method of intervention:
- In classical surgery, the patient needs postoperative care and observation for 7-10 days. The rehabilitation course includes antibiotics, anti-inflammatory drugs, and physical therapy. This has a significant impact on the price of maxillary sinusotomy.
- Endoscopic operations do not require a long stay in the clinic - the very next day after they are performed, you can go home and be observed on an outpatient basis. During this period, it is important to pay special attention to oral and nasal hygiene; antibiotics are also prescribed.
You can have a maxillary sinusotomy in Moscow at the K+31 clinic. We use endoscopic equipment that will save you from long-term rehabilitation and unnecessary expenses. Make an appointment with a doctor and he will select the most effective treatment option for you!
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The course and characteristics of chronic sinusitis
According to information collected by the Bureau of Medical Statistics of the Department of Health, 10-15% of the adult population of Russia suffers from chronic sinusitis. Often the disease lasts for years, while traditional methods of conservative treatment lose their effectiveness:
Therefore, for long-term sinusitis, the best option would be radical therapy - opening the sinus and removing its contents.