научно-исследовательский клинический институт оториноларингологии им. Л.И. Свержевского» департамента здравоохранения москвы, москва, россия; 2 ГБоУ впо «российский национальный исследовательский медицинский университет им. н.И. пирогова» минздрава россии, москва, россия Цель-изучить распространенность хронического кистозного верхнечелюстного синусита и частоту применяемых хирургических доступов к пораженной пазухе при лечении данной патологии. Материал и методы. проанализирован архивный материал, включающий 12 094 истории болезни пациентов, проходивших хирургическое лечение в пяти крупных Лор-клиниках москвы в течение 2014 г. Результаты. Установлено, что за год было проведено 659 хирургических вмешательств по удалению кисты верхнечелюстной пазухи, что составляет 34,1% от общего числа операций по поводу хронического верхнечелюстного синусита и 4,1% от общего числа хирургических вмешательств на Лор-органах. применялись следующие хирургические доступы: эндоназальный (через средний носовой ход)-в 188 (28,5%) наблюдениях, экстраназальный (через переднюю стенку пазухи)-у 454 (68,9%) пациентов, комбинированный-в 17 (2,6%) случаях. Вывод. отмечена целесообразность разработки рекомендаций по выбору оптимального хирургического доступа при кистах верхнечелюстной пазухи. Ключевые слова: киста верхнечелюстной пазухи, хронический гайморит, медицинский стандарт лечения.
The objective of the present work was to study syntopy of the large neck vessels in relation to the capsule of palatine tonsils with the use of the MRI technology. A total of 109 patients (218 palatine tonsils) presenting with chronic tonsillitis were available for the examination including 64 women and 45 men at the age varying from 15 to 54 years. All of them underwent MRI-guided vascular visualization in the paratonsillar region together with the measurements of the vessels extending to the capsule of the palatine tonsils at the level of the upper and lower poles, and also close to the mid-third of each palatine tonsil. The distance from the external carotid artery to the upper and lower poles of the palatine tonsils was found to be 17.1±1.01 mm and 10.3±0.18 mm respectively and in the mid-third the palatine tonsil 10.7±0.12 mm; the distance from the internal carotid artery to the upper and low poles of the palatine tonsil amounted to 14.5±0.84 mm and 16.8±0.77 mm respectively while that to the mid-third of the palatine tonsil was 15.3±0.07 mm. The branches of the external carotid artery feeding the palatine tonsils are the most frequent sources of bleedings; the following measurements were obtained: the maxillary artery 16.4±0.43 mm (17.4%) - the upper pole 9.6±0.02 mm (46.2%), the mid-third of the palatine tonsil 18.5±0.74 mm (29.5%) - the lower pole; the lingual artery 4.7±0.02 mm (6.8%) - the mid-third of the palatine tonsil, 6.2±0.82 mm (56.8%) - the lower pole; facial artery: 4.2±0.01 mm (0.76%) - the mid-third of the palatine tonsil; the occipital artery 25.6±0.12 mm (19%) - the upper pole; 14.8±0.11 mm (18.9%) - the mid-third of the palatine tonsil 9.56±0.12 mm (3.8%) - the lower pole; the tonsillar artery 1.88±0.01 mm (9.8%) - the upper pole; 2.51±0.01 mm (23%) - the mid-third of the palatine tonsil; 2.12±0.01 mm (11%) - the lower pole. The distance from the internal jugular vein to the capsule of the palatine tonsils in the region of the upper pole of the palatine tonsil was 28.3±1.01 mm, in the lower pole region 26.6±1.54 mm, and in the region of the mid-third of the palatine tonsil 22.7±1.24 mm. It is concluded that the results of the present study may be useful for the planning of the surgical strategy for the treatment of the patients presenting with chronic tonsillitis and for the prevention of hemorrhagic complications of tonsillectomy.
The objective of the present study was to evaluate the effectiveness of the administration of a medication into the middle ear structures during catheterization of the acoustic tube (AT) in the course of the contrast-enhanced X-ray salpingographic investigation. The study included 18 patients (18 ears) presenting with chronic otitis media and the perforated tympanic membrane without the disturbances of the ventilation function of the auditory tube. All the patients were allocated to two groups depending on the type of the Eustachian catheters being used. Group 1 was comprised of 9 patients treated with the use of traditional Giyot's catheter, group 2 was composed of another nine patients who were treated with the use of the Eustachian catheters having an original shape with a specific configuration of its distal part. The X-ray studies were carried out before and after catheterization of the acoustic tube with the administration of 1 ml of the hypaque contrast medium. The study has demonstrated that the X-ray contrast agent did not penetrate into the inner structures of the middle ear of the patients comprising group 1 whereas in the patients of the second group the contrast medium reached as far as the bony portion of the acoustic tube.
The article provides the study of anatomomorphological features of ostiomeatal complex structures condition based on complex examination of 102 patients with chronic cyst sinusitis. The vector analysis of paranasal sinuses СT with the measurement of the ethmoidal infundibulum gleam and diameter of natural anastomosis of the maxillary sinus is made, and histologic research of a mucous membrane of ostiomeatal complex structures is provided. As a result of the research it was determined that the damage of mucous membrane in the area of ethmoidal infundibulum and the natural anastomosis of the maxillary sinus had chronic nature with sclerosis of the genuine plate of mucous membrane and, quite often, hyperplasia and hypersecretion of mucous glands. The gleam of the complex system of the sinus communication with the nasal cavity remains over the whole perios constituting 1.31±0.03 mm – in the area of ethmoidal infundibulum, and 2.09±0.02 mm – in thearea of natural anastomosis of the maxillary sinus (p < 0.01).
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