Paths of penetration and consequences of filling material entering the maxillary sinus. Operations to remove parasites: video of removing worms from the intestines Extraction operation

Peter Huys. Removing the Stone of Madness. OK. 1545.

Interesting fact: in the Middle Ages, the cause of human stupidity, dementia or insanity was considered to be stones formed in the head. However, depictions of surgical operations to remove these stones can be found exclusively in paintings by Dutch artists, and this plot remained popular until the 17th century.

Removing the stone. Painting by an unknown master, 17th century. Previously attributed to Frans Hals.

It is known that craniotomies were carried out back in the Stone Age and only some of them were of a ritual nature. Archaeological finds prove that most trepanations were carried out with medicinal purposes. And the first detailed description given surgical intervention made by the ancient Greek physician Hippocrates.

In general, surgery in ancient times was at its best, and the doctors of Mesopotamia, Ancient Egypt, Persia, India and China made progress in complex surgical operations. Although, of course, medicine reached its greatest flourishing in Ancient Greece.

Unfortunately, in medieval Europe, surgery suffered a terrible degradation, and only with the beginning of the Renaissance did European healers begin to study and apply the medical knowledge of ancient civilizations.

One can only assume that the extraction of the stones of stupidity, carried out, of course, by charlatans, was the result of misinterpreted ancient Greek or Arabic manuscripts describing surgical operations on the skull.

Hieronymus Bosch. Removing the stone of stupidity. 1475-1480. The first painting in the history of painting dedicated to this operation. Fragment.

Jan van Hemessen. Removing the stones of stupidity. 1545-1550.

Marcellus Coffermans (copy from a painting by Bosch). Removing stones from the head. Fragment. 1550-1599.

Pieter Bruegel the Elder. Cutting out the Stone of Madness, or Head Surgery. OK. 1550. (Copy, original lost).

Pieter Jansz Quast. Stone extraction operation. Around 1630.

Jan Steen. The charlatan retrieves the stone of madness. OK. 1650 – 1660.

It was only later that medical service major Ivan Zorin became scared. “Somehow I felt sorry for my mother, she is a pensioner, I remembered my father, in general, as science fiction writers write: at the last moment, all life is like a film.” And there was a reason.

ON SEPTEMBER 17, in Grozny, militants fired at a Chechen police patrol regiment. Usman Salaev remembers only the flash and pain. It seems your legs are still running, but it seems that they are not yours. This could have been the case if a grenade from an under-barrel grenade launcher attached to an AK assault rifle that hit a policeman in the leg had exploded. But it stuck in my thigh. By the time he was taken to the hospital, he had already lost consciousness. Civilian doctors did not dare to save the policeman: a grenade would explode and the entire squad would fly off. “No, we can’t take that risk,” they said. And they sent him to the hospital of the internal troops.

“I went through the names of all the surgeons who were on site in my memory,” the deputy told AiF. commander medical battalion Internal Troops of the Ministry of Internal Affairs Sergei Sharkov. - This one has two children, this one has a pregnant wife, this one has one with his mother. But Zorin is not married, without children. He should go operate on the mined one.

Ivan Mikhailovich did not argue. He put on a bulletproof vest and a helmet and took the patient to a remote garage. All armored vehicles were driven away from there, and Zorin began the operation. I manually probed the wound, determined where the fuse was, opened the wound and took out the grenade. He was assisted by operating sister Julietta Temirkhanova. And the sappers were already behind them. They knew better than anyone that the grenade could explode at any second. They hastily put it in an iron box with sand, covered it with bulletproof vests and took it to the training ground to destroy it. And Ivan Zorin continued the operation. His hands weren't even shaking. “After I sent him to take this risk, my conscience bothered me,” admits his boss Sharkov. “I went to the garage, stood next to him and prompted him. I’ve done such operations myself more than once.”

“What am I? I’m okay! I’m so happy with life now, you can’t imagine,” says Ivan. “Nope, I don’t feel like a hero. I went to defend my homeland 6 years ago. So I’m defending.” This is roughly what he told his parents who live in Rostov. They have long been accustomed to their son’s actions. The very decision to become a doctor was unexpected for them. My parents, and then my older brother and sister, worked in factories, a real working-class family. And then suddenly there was a medical institute, then a military institute and hospitals in Vladikavkaz and Grozny.

We will nominate the team of doctors for awards. “They are heroes,” he reported without a shadow of a doubt. chief surgeon Internal Troops of the Ministry of Internal Affairs Pyotr Koltovich.

And junior sergeant Usman Salayev is now feeling well. They saved his leg. He will run. He believes that he now owes the doctor the rest of his life, which hung by a thread for both of them a few days ago.

Moisov Adonis Alexandrovich

Orthopedic surgeon, doctor highest category

Moscow, Balaklavsky prospect, 5, metro station "Chertanovskaya"

Moscow, st. Koktebelskaya 2, bldg. 1, metro station "Dmitry Donskoy Boulevard"

Moscow, st. Berzarina 17 bldg. 2, metro station "Oktyabrskoye Pole"

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Education and professional activity

Education:

In 2009 he graduated from Yaroslavl State Medical Academy specializing in general medicine.

From 2009 to 2011, he completed clinical residency in traumatology and orthopedics at the base clinical hospital ambulance medical care them. N.V. Solovyov in Yaroslavl.

Professional activity:

From 2011 to 2012, he worked as an orthopedic traumatologist at Emergency Hospital No. 2 in Rostov-on-Don.

Currently working in a clinic in Moscow.

Internships:

May 27 - 28, 2011 - Moscow- III International Conference “Foot and Ankle Surgery” .

2012 - training course on Foot Surgery, Paris (France). Correction of forefoot deformities, minimally invasive surgeries for plantar fasciitis (heel spurs).

February 13 -14, 2014 Moscow - II Congress of Traumatologists and Orthopedists. “Traumatology and orthopedics of the capital. Present and future."

June 26-27, 2014 - took part in V All-Russian Congress of the Society of Hand Surgeons, Kazan .

November 2014 - Advanced training "Application of arthroscopy in traumatology and orthopedics"

May 14-15, 2015 Moscow - Scientific and practical conference with international participation. "Modern traumatology, orthopedics and disaster surgeons."

2015 Moscow - Annual international Conference.

May 23-24, 2016 Moscow - All-Russian Congress with international participation. .

Also at this congress he was a speaker on the topic "Minimally invasive treatment of plantar fasciitis (heel spurs)" .

June 2-3, 2016 Nizhny Novgorod - VI All-Russian Congress of the Society of Hand Surgeons .

In June 2016 Assigned. Moscow city.

Scientific and practical interests: foot surgery And hand surgery.

Surgery to remove metal structures after osteosynthesis of fractures

Removal of metal structures is planned operation which is carried out after the consolidation (fusion) of the fracture, the formation of a complete callus, this happens after about 8-12 months. There is quite a lot of debate about whether it is worth removing the metal structure afterward if it does not interfere?

A few reasons:

• In any case, this is a foreign body and no one can predict how the metal will behave in a few years, even though it is a high-tech titanium alloy. This includes metallosis, and suppuration of metal structures, up to such complications as osteomyelitis.
• If the metal structure begins to interfere after 3 or more years, then the callus will “grow” over the plate or screws, or the rod, so that it will be very difficult to technically remove it. Therefore, implants should be removed routinely approximately one year after installation.

Another thing is that removal of structures from the pelvic bones is often accompanied by heavy bleeding, extensive tissue damage, risk of injury pelvic organs. As a result, implants should only be removed when absolute readings— complications, signs of implant rejection, etc. Only the structures that fix the symphysis pubis can be removed as planned; with this operation, extensive trauma can be avoided.

Emergency removal of metal structures

Indications for emergency removal I can be:

• deep suppuration,
• intolerance to the material from which the implant is made,
• unstable fixation,
• formation of a false joint,
• no signs of callus formation over time.

Technically, removal of osteosynthesis is a simple operation, if the metal structure is installed correctly, according to the accepted methodology. When the spokes are located externally, simple mechanical removal is performed. With intraosseous fixation using pins, nails, screws, a full-fledged operation is performed under conduction anesthesia or anesthesia. As a rule, this is an intra-articular implementation. Skin dissection occurs with excision of the primary scar, or without excision. The joint capsule is opened, the structure is mechanically removed with special instruments, followed by suturing of the capsule, soft tissues, and skin.

To determine the condition of the implant, a control radiography is performed immediately before the operation to determine possible migration of screws or wires. Also the use of computed tomography.

Removal of metal structures after osteosynthesis.

Removal of implants from the femur, lower leg, shoulder and forearm, and clavicle is usually performed routinely after the formation of a complete callus and reliable consolidation of the fracture site. Indications for emergency intervention occur infrequently, but the patient still requires regular examination.

Removal of wires after surgery

Kirschner wires are mainly used to fix small bones and joints (toes and hands, metatarsals and metacarpal bones). Immobilization is usually carried out for 4-6 weeks after surgery. Faxing can be either external, i.e. the end of the needle is located above the surface of the skin, and the inner one, i.e. the wire is completely submerged under the skin to reduce the risk of infection and patient discomfort. Used for temporary fixation. There is also submersible osteosynthesis with knitting needles and wires for osteosynthesis of larger bones according to Weber, for example, for:

• fracture of the patella;
• rupture of the acromioclavicular joint;
• fracture of the olecranon process.

In these operations, the pins and wires are removed 8-12 months after the operation, since the fusion of these bones requires more time and more stable fixation.

Removing the plate after surgery

Almost any bone can be fixed with plates and screws human body. This is a very reliable and convenient method of osteosynthesis. Today there are a huge number of plates various shapes, sizes and modifications for certain type fracture The most common examples of plate osteosynthesis are:

• Osteosynthesis of the clavicle;
• Osteositis of the humerus
• Osteosynthesis of the external ankle;
• Osteosynthesis of tibia fractures;
• Osteosynthesis of metacarpal and metatarsal bones;
• Osteosynthesis of the radius and ulna.

The plates are usually removed 8-12 months after surgery.

Removal of the rod (pin) after surgery

Intraosseous (intramedullary) rods with locking screws or, as they are also called, pins are used to fix fractures of tubular bones, and in particular transverse and helical fractures with a small number of fragments and splinters. Also, preference for intraosseous osteosynthesis is given due to the speed of the operation, minimal invasiveness and low traumatic nature of the operation. It is worth saying that the fixation with the rods is very good and dosed loads on the operated limb can be given after just a few days.

After successful operation and fracture union, typically remove the dynamic screw and increase the load on the limb to achieve complete healing of the fracture. 1 year after surgery, when the fracture has completely healed, the screws and rod are routinely removed.

Almost always, the operation to remove the rod does not take more than 30 minutes. Removal occurs using similar tools as during installation.

Difficulties may arise when removing the rod; it is installed incorrectly. Or the threads and screw heads are broken. In this case, you will need to drill out the screws and rod.

Removal of the pin-rod apparatus, Ilizarov apparatus after surgery

Removing the Ilizarov apparatus is not difficult, since the needles and rods are located above the skin. After general or regional anesthesia is performed, the wires are “bitten” and removed from the bone. If there are rods, they unscrew. Wounds are treated with antiseptic solutions and aseptic dressings are applied.

Our clinic performs removal of all types of metal structures.

The cost of removing a metal structure depends on the complexity of the operation and the location of the implant, as well as on the type of anesthesia that is required for removal.

To understand how the filling composition ends up in the maxillary sinus, we should remember the structure of the maxillary bone. And the fact that it is not a monolithic formation, but contains in its thickness the maxillary cavity (sinus), according to the author, also called the maxillary cavity. But this cavity is not the only one available in upper jaw.

The bone forms a process called alveolar, literally translated: cellular. And its “honeycomb” cells are designed to accommodate tooth roots. The roots, located in cavities exactly corresponding to their shape and length - dental or alveolar cells, keep the teeth from being pulled out and falling out of the jaw.

The system of cavities in the upper jaw is similar to a duplex - an apartment on two levels. Upstairs there is a spacious, empty hall maxillary cavity. Below it there are many narrow vertical alveolar cavities. These are not end-to-end channels, but rather holes with limited depth (height). The teeth live here, densely filling the spaces of the holes with their upward-growing roots.

But sometimes the roots of the tooth are too long, and, having passed through the entire thickness of the jaw, they can end up in the maxillary cavity. For its bottom (floor) is at the same time the ceiling for the dental cells of the upper jaw. This is equivalent to the case where the lower level tenant is too tall, breaking through the ceiling with his head, found himself in the room above.

Routes of penetration

Teeth with roots that either penetrated into the “upper room” or stopped under the “carpet” on its floor (under the mucous membrane maxillary sinus), can become inflamed. And then they require treatment by a dental specialist.

To cure, the doctor must not only remove the tooth pulp (pulp) from the cavity-chamber located in its depths. He must cleanse the canals of the dental roots from it, passing through them to the apex. Then the passed canals are sealed - filled with a filling compound, and very tightly, tightly, so that there are no cavities or voids left in the canals.

Since the filling material is introduced under pressure, part of it through the apical canal (ending with a hole at the apex of the tooth root) is able to penetrate into the maxillary sinus.

The entry of foreign particles into the maxillary cavity (or sinus) is also possible during an operation to introduce bone-building material into the jaw with subsequent installation of an implant.

Symptoms of the presence of a foreign body

With a small volume and complete sterility of the filling composition that has entered the sinus of the upper jaw, it is not capable of causing irritation and inflammation on the part of its mucosa. In this case, his presence there, revealed exclusively X-ray method, does not require measures for its extraction.

In the case when inflammation does begin, symptoms of sinusitis appear - irritation of the mucous membrane caused by an attempt to expel the foreign body from the cavity.

It is expressed:

But if ordinary sinusitis can go away from taking medications, then the presence foreign body, which causes and maintains inflammation in the nasal sinus, requires its removal without fail.

Consequences of a foreign body in the sinus

If filling material is left in the maxillary sinus, complications may develop in the form of:

• chronic sinusitis - the appearance of a lesion microbial infection and a source of constant intoxication of the body;
• osteomyelitis of the jaw;
• fistula formation – messages from oral cavity(as a result of the pressure of the filling mass on the bottom of the sinus).

Given the proximity maxillary sinus to the orbit and eustachian (auditory) tube, inflammation in it can cause:

• otitis - microbial damage to the structures of the middle and inner ear with loss of hearing and sense of balance;
• damage to the structures of the organ of vision.

The most dangerous complication of sinusitis (when infection spreads from the maxillary sinus to other paranasal sinuses nasal cavity when sneezing, coughing) is an infection of the cranial cavity with the development of:

• meningitis;
• encephalitis.

How to diagnose?

Often the patient, without connecting the development of sinusitis with dental manipulation, seeks advice from an ENT doctor, who confirms the existence of the disease using rhinoscopy or endoscopy of the nasal cavity and paranasal sinuses.

But reveal the real reason sinusitis - the presence of a foreign body in the maxillary sinus, these methods are not capable of. Due to their significant density, the compositions used in filling teeth are radiopaque, which allows them to be seen in the image as shadows more intense than the tissue of the teeth and jaw bones.

Therefore, the use of radiography is prerequisite quality control of fillings, sinus lifts and other interventions in the area adjacent to the maxillary sinus.

An even more informative way to diagnose this problem is the computed tomography method.

Extraction Operations

Talk about opportunity purely conservative treatment during development this complication there is no need for dental intervention - without removing the filling substance that maintains the sinus mucosa in an irritated state, there will be no effect.

An operation to remove a foreign body from the maxillary sinus is possible using one of the following techniques:

• opening the front wall of the cavity from the side;
• creating access through the alveolar canal of the problematic tooth.

Small foreign bodies are removed using an endoscope; larger ones require a larger scale of operation. If purulent detritus is present, it is removed from the cavity by suction, followed by repeated washing with an antiseptic solution.

The intervention is performed under X-ray control, using an adequate method of anesthesia in an outpatient setting (if the operation is of minor complexity) or in the department of maxillofacial surgery.

Conservative treatment

It applies both during the preparation period surgical intervention, and immediately after its implementation and is designed to minimize the activity of the local inflammatory process.

If it is impossible to delete filling material from the maxillary sinus immediately therapeutic treatment is a method of containing microbial aggression until a time favorable for surgery is reached.

Reasons to postpone surgery include:

• the onset and course of pregnancy;
• development of an acute inflammatory (including infectious) process;
• immunity deficiency;
• disorders of blood clotting mechanisms;
• intolerance to certain drugs.

The set of measures includes the use of medications with the following effects:

• antibacterial – suppressing the development of pathogenic microbial flora;
• anti-inflammatory – reducing the activity of tissue destruction, adapting the body to this level metabolism;
• antihistamine – reducing swelling and preventing hyperproduction of mucous gland secretions, as well as the appearance of allergic reactions on the antibiotics used;
• local antiseptic - helping to remove excess mucus from the sinus when washing it.

Prevention

In order to prevent filling compounds from entering the maxillary sinus, it is necessary to improve application skills dental appointments this stage of tooth processing.

In addition to tactile control of the process, X-ray control is required for all manipulations on the upper jaw (in addition to the filling compound getting into the maxillary cavity, there is a possibility of a tooth root fragment being pushed into it due to the fragility or deterioration of its tissues).

Dental equipment must be in good working order and fully comply with its purpose. Speaking about the responsibility of a dental specialist, one cannot help but touch upon the interest in the successful outcome of the treatment of the patient himself.

Bringing teeth and jaws to an emergency condition is not necessarily a consequence of chronic debilitating diseases and congenital characteristics of the tissues of the oral cavity. Neglect of personal hygiene standards, ignoring the needs of teeth for treatment, refusal of prosthetics is the soil on which subsequent problems with the oral cavity are cultivated, requiring both emotional and financial costs.

Cost of the operation

The price of this service in St. Petersburg, taking into account the low level of trauma used in dental clinics city ​​of endovideosurgical equipment is about 10 thousand rubles. The specific price of an operation to remove filling material from the maxillary sinus depends on the degree of complexity of the case and the scale of the intervention.

The cost of an initial consultation with an endovideo surgeon is 1 thousand rubles, the price for a CT scan ( computed tomography) one (upper) jaw in 3-D version is 1200 rubles (with free recording received data to disk).

For a repeated examination within 30 days, the cost of a consultation with a specialist doctor is 2 thousand rubles. For video endoscopic examination of any natural cranial cavity, an amount of 1,800 rubles is charged.

For a unilateral maxiotomy (opening of the sinus), about 21 thousand are debited from the patient’s account; when removing a foreign body through a natural anastomosis with the nasal cavity under endoscopic control - about 19 thousand rubles.

Only a dentist can competently answer the entire range of questions related to dental health (and ill health). Therefore visit dental office at least once a year should become not just one of the standards of personal hygiene, but a preventive measure to avoid subsequent expensive and morally costly treatment.