Shkorbotun Y. Clinical and Morphological Substantiation of Minimally Invasive Periosteum Preservation Surgical Technologies in Treating Patients with Maxillary Sinus Pathology

The thesis provides a theoretical generalization and a new solution to the actual problem – increasing the efficacy of surgical treatment of patients with maxillary sinus disease, who will undergo planned dental implantation, by clinical and morphological substantiation of periosteum preservation approach in endoscopic rhinosurgery and improvement of preoperative management of these patients. It has been established that a full-thickness trauma of periosteum of the nasal cavity leads to the formation of dense adhesions with the adjacent bone, which worsens the prognosis for successful subantral bone augmentation. The presence of changes in the mucoperiosteum of the sinuses in the form of cysts and its thickening in patients undergoing subantral bone augmentation is accompanied by an increased risk of Schneider membrane perforations. The proposed periosteum preservation approach in maxillary sinus lavage consists in choosing the optimal surgical access based on 3D-modeling, which provides full visualization of the sinus lumen during the intervention; avoiding excessive trauma to the periosteum during access formation by taking into account the predicted boundaries of the alveolar recess area, which can potentially be involved in subantral bone augmentation; using an impact minimization technique in regard to the periosteum when removing the pathologically changed mucous membrane of the sinus. Endoscopic rhinosurgery of maxillary sinus in compliance with the principles of periosteum preservation in patients with chronic rhinosinusitis with nasal polyps, fungal bodies and cysts of the maxillary sinus provides effective sinus lavage which is manifested by a low rate of recurrence of the pathological process and significantly improves the results of sinus lifting in these patients. Thus, the total number of complications compared to traditional endorhinosurgery decreased from 25.0% (CI 95% 15.63; 37.22) to 13.01% (CI 95% 8.21; 19.82) (p < 0.05), among which the frequency of Schneider membrane perforation – from 21.21% (CI 95% 13.89; 30.81) to 9.59% (CI 95% 5.54; 15.86) (p < 0.05).