КОМПЬЮТЕРНАЯ ДИАГНОСТИКА В ЛЕЧЕНИИ ПАТОЛОГИЙ РИНОСИНУСОТУБАРНОЙ ЗОНЫ

This article presents the capabilities of computer tomography in the diagnosis and treatment algorithm combine pathology (acute sinusitis, acute otitis media, Eustachian tube dysfunction).В статье представлены возможности компьютерной томографии в диагностике и алгоритм лечения патологии риносинусотубарной зоны

К ВОПРОСУ ОБ АЛГОРИТМЕ ЛУЧЕВОЙ ДИАГНОСТИКИ ПЕРЕЛОМОВ СРЕДНЕЙ ЗОНЫ ЛИЦА, СОПРОВОЖДАЮЩИХСЯ ПОВРЕЖДЕНИЕМ ВЕРХНЕЧЕЛЮСТНОЙ ПАЗУХИ

The X-ray and spiral computed tomography pictures of patients with zygomatico-orbito-maxillary coplex fractures accompanied by damage of the maxillary sinus walls were analyzed. Residual displacement and emergence of hemosinus after close reduction and after open reduction with internal fixation were compaired. Radiography could be used as a screening for detection of indication for surgery. Computed tomography should be a regular method of postoperative diagnostic to evaluate sinus pneumatisation and anomalies of ostio-meatal unit.Изучены данные лучевой диагностики у пациентов с переломом скуло-орбитально-верхнечелюстного комплекса, сопровождающимся повреждением верхнечелюстной пазухи. Проведен анализ качества сопоставления костных отломков, а также частоты возникновения гемосинуса после закрытых и открытых методов хирургического лечения переломов по данным рентгенографии и компьютерной томографии. Сделан вывод о возможности использования рентгенографии в качестве скрининга для выявления показаний к хирургическому лечению и необходимости выполнения компьютерной томографии в послеоперационный период для оценки пневматизации верхнечелюстной пазухи и состояния остио-меатального комплекса

ВОЗМОЖНОСТИ ЭЛЕКТРОМАГНИТНОЙ НАВИГАЦИОННОЙ СИСТЕМЫ В ЭНДОСКОПИЧЕСКОЙ ХИРУРГИИ ОСТЕОМ ЛОБНЫХ ПАЗУХ

The article presents the possibility of an electromagnetic navigation system during endoscopic endonasal removal of the frontal sinus osteomas, the possibility of intraoperative monitoring of doing surgery, and postoperative analysis.В статье представлены возможности электромагнитной навигационной системы при эндоскопическом эндоназальном удалении остеомы лобной пазухи, возможности интраоперационного контроля ведения оперативного вмешательства, а также анализ послеоперационных данных

КОМПЬЮТЕРНАЯ ТОМОГРАФИЯ В ДИАГНОСТИКЕ ОСТЕОМ ОКОЛОНОСОВЫХ ПАЗУХ

The article presents the possibility of 3D-computer tomography in the diagnosis of the paranasal sinuses osteoma, the results of surgical treatment in 34 patients.В статье представлены возможности 3D-компьютерной томографии в диагностике остеом околоносовых пазух, представлены результаты оперативного лечения у 34 пациентов

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Minimally Invasive Maxillary Sinus Approach

Maxillary sinus (MS) opening is one of the most common surgical procedures. For rhinological situations endonasal sinus intervention is more preferable. Microscopes and endoscopes can be used endonasaly, intervention can be performed trans middle meatus or rarely via inferior meatus with artificial window formation. Last years number of patients with dental indications for MS surgery highly increases. Most of these patients have no rhinological complains. CT examination made prior to tooth implantations and sinus lifting often detected pathological changes in maxillary sinus floor. These changes can be not significant for rhinology but important for implantology. In such cases, trans middle meatus approach is traumatic and technically difficult. Also this surgical strategy leads to destruction of physiological function of osteomeatal unit. Last 7 years we prefer inferiour meatus temporary approach without artificial window formation for maxillary sinus endoscopic surgery. Intervention can be performed in most cases under local anesthesia. After Hassner valve is identified, area of incision can be chosen and be performed with elevator. Osteo mucosal flap preparation depends on situation with prevention of lacrimal pathways damage and bony walls retraction. For maxillary sinus examination and removal of pathological tissues we use different angled endoscopes, or with changeable view directions. Required angle of instruments depends on situation. At the end of surgical procedure flap can be returned back to close gap of temporary approach and if necessary mucosa can be fixed by sutures. Postoperative period and care is easy, surgery can be performed in the office. Our experience shows the advantages of this approach as one of minimally traumatic methods of MS surgery.Der Erstautor gibt keinen Interessenkonflikt an