Loburets A. Prognosis and prevention of stenosing of frontal ostium at surgical treatment of patients with chronic frontal sinusitis

The thesis is concerned with actual problem such as efficacy of surgical treatment of patients with frontal sinusitis by modified endonasal frontal sinus surgery and postoperative management. 137 patients were involved in the investigation who suffered from chronic frontal sinusitis and they received complex clinical and instrumental investigation and treatment. They were divided into 4 groups depending on the type of surgical treatment and peculiarities of postoperative management of patients and such tactics gave an opportunity to compare clinical efficacy of the use such medical substances as sodium hyaluronate (2А, 2B) with isotonic sodium chloride solution as liquid for cleansing of frontal sinus and nasal cavity (1А, 1B), and modified frontal sinus surgery with plastics of frontal and nasal canal (1B, 2B) and with traditional endonasal frontal sinus surgery (1А, 2А). Changes of local aerodynamic impedance of nasal cavity in the area of frontal ostium were investigated based on CT data and posterior active rhinomanometry and it gave an opportunity to evaluate the results of treatment of principles of traditional medicine. Computer planning and prognosis of functional rhinosurgical interventions during chronic inflammation of frontal sinus and other disorders of intranasal structures was clinically proved. The methods of surgical treatment of patients with chronic frontal sinus surgery by the use of the development of surgical treatment with plastics of frontal ostium were improved. Such method decreases the defect of mucous membrane of nasal cavity from surgical trauma in the area of frontal pocket and frontal ostium and it assists in repair and reduce the possibility of cicatrical sinus obliteration and recurrence of the inflammatory process. The efficacy of local use of drugs of sodium hyaluronate in the complex treatment of patients with chronic frontal sinusitis was proved based on biochemical data of lavage of frontal sinus. The use of sodium hyaluronate drugs during surgical treatment of patients with chronic frontal sinusitis assists in general antitryptic activity, decrease of general proteolytic activity, inhibition of oxidative stress in patients who suffer from chronic frontal sinusitis that determines the significant decrease of the content of thiobarbituric acid-reactants (TBC-reactants), the content of oxidative modification of proteins (OMP) and molecules of average mass (MAM) in lavages from frontal sinus based on the activity of catalase in comparison with intraoperative indices received during treatment of patients with traditional therapeutic therapy. At dynamic examination of patients during 1,5 years the relapse of frontal sinusitis in 1А group was 19,35%, and in the group 2B was 7,14%. Practical significance of the research paper defines that the way of surgical treatment can be used in ENT specialist practice during endonasal frontal sinus surgery and the way of planning of rhinosurgery can be used during preoperative frontal sinus surgery.