Abstract
Introduction: One of the most common types of fractures in the jaw and face area is the mid-face area and cheek bone fractures, in which the anterior wall of the sinus is involved in most of these fractures. Following the fracture of the front wall of the sinus, soft tissue prolapse, sinusitis, rhinitis, pain and tenderness can occur when touching the area. The purpose of this study was to investigate the effectiveness of reconstruction of the anterior wall of the maxillary sinus in patients with wall fracture using absorbent membranes. Materials and methods: 42 patients were included in the study after checking the entry and exit conditions. All patients signed the informed consent form. In 21 patients, reconstruction of the anterior wall of the sinus along with covering the defect area using absorbable membrane (study group) and bone reconstruction was not done in the rest of the patients (control group). In order to investigate changes in the maximum width of the bone defect area and soft tissue prolapse, CBCT radiographs were obtained from the patients at the end of surgery and 6 months after surgery. Also, in the 6-month follow-up, patients were examined for sinusitis, tenderness, pain, and infection. Data were analyzed by SPSS software version 11.0 with a confidence interval of 95%.
Results: 18 patients in the study group and 20 patients in the control group completed the study. There was no significant difference between the width of the area immediately after surgery between the two groups (P-value >0.05). But 6 months after surgery, this rate in the study group was significantly lower than the control group (P-value <0.05). In terms of the presence of pain, secretions and sinusitis, there was no statistically significant difference between the two groups (P-value >0.05). However, the prevalence of tenderness to touch and soft tissue collapse was significantly higher in the control group than in the study (P-value <0.05).
Conclusion: The use of absorbable membranes can improve the complications caused by the fracture of the anterior wall of the maxillary sinus, while it does not have the problems of using titanium meshes.
Key words: sinus Maxilla, fracture of the anterior wall of the sinus, absorbable membrane.
(1-1) Preface
One ??of the most common types of fractures in the jaw and face area is the fractures of the mid-face and cheekbones, in which the anterior wall of the sinus is involved in the majority of these fractures (1).
The cause of wall involvement The anterior part of the sinus is because it is thin because it is not located at the place of application of functional forces, and it breaks in all kinds of fractures in the middle region for this reason, which in addition to the destruction of the anterior part of the sinus, also involves the mucosa covering the sinus (1). The effect on the shape of the face, the formation of scars due to the repair process that may endanger the nudge into the nasal cavity, the prolapse of the soft tissue into the sinus and the subsequent reduction in the volume of the sinus, which can cause infection and rhinitis (1-3). According to the problems mentioned, the reconstruction of the anterior wall of the sinus after mid-facial fractures seems to be necessary, and efforts have been made for this purpose. Although the best way to reconstruct the anterior wall of the sinus is with the same pieces of the wall itself, but many times it is not possible due to the fragmentation of this area, and harvesting from other areas increases the problems of the bone donor area. Therefore, reconstruction of the anterior wall of the maxillary sinus after its fracture is studied using absorbent and non-absorbent membranes (1-3). rtl;"> The maxilla bone is the largest facial bone after the mandible, and every person has two of these bones that are connected together. Each of the two maxilla bones are located on the border of three cavities; The roof of the mouth, the floor of the eye cavity, the side wall and the floor of the nasal cavity (4).
Each bone consists of a body and four appendages, including the cheek, frontal, alveolar and palatal appendages (4).
Body:
The maxilla body has a wide cavity called the sinus.
Body:
The body of the maxilla has a wide cavity called the maxillary sinus. The four levels of the trunk are:
Anterior level: In this level, a series of protrusions related to the roots of the teeth in the upper jaw can be seen. Outside of this appendage, a deeper depression called the bite depression can be seen. Above the canine depression, there is a hole under the eyeball, which is the exit of the blood vessels and nerves under the eyeball. Just above this hole, the lower edge of the eye socket is located. On the inner side, the outer surface is limited by the nasal notch. This incision ends in front and below to the anterior nasal spine. This surface is pierced by superior posterior alveolar vessels and nerves. The lower part of this surface is prominent and round and is called tuberosity (image 1) (4). In the anterior part of this surface, there is a depression called the depression under the eyeball, which is the place where the blood vessels and nerves pass under the eyeball. In the anterior margin of this surface, there is a notch, which is called the lacrimal notch (picture 1) (4).
Nasal surface: a hole is seen in its central part, which is the entrance to the maxillary sinus. This hole is the place through which sinus secretions are drained into the middle cavity.