DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE.
UKRAINIAN MEDICAL STOMATOLOGICAL ACADEMY, POLTAVA, UKRAINE.
Wiad Lek. 2021;74(4):906-910.
The aim: To provide clinical evaluation of the effectiveness of anesthesia for cystectomy of radicular cysts that have grown into the maxillary si-nus or nasal cavity using different techniques of endonasal block-ade of the nasopalatine nerve.
Materials and methods: Clinical observations were conducted on 52 patients of different age and sex. These patients were diagnosed with large radicular cysts (more than 3.0 cm in diameter) that had grown into the maxillary sinus (33 cases) or into the nasal cavity (19 cases). The surgical excisions of cysts (oroantral cystectomies) were performed un-der local potentiated anesthesia. Patients were divided into two clinical groups, depending on the methods used for endonasal blockade of the nasopalatine nerve: the main and the control group. Patients in the main group underwent endonasal blockade of the nasopalatine nerve at the point of its emergence from the pterygopalatine ganglion. In the control group, the neural blockade was performed at the entry of this nerve into the incisive canal. Pain sensitivity and perception in patients were studied using subjective and objective methods. The data was analyzed by means of the Pearson's chi - square tests.
Results: During the enucleation of radicular cysts that grew into the inferior nasal meatus and maxillary sinus in patients of the main group there was no pain observed. There were no manifestations of pain-induced stress neither from the side of autonomic system, nor physical or emotional manifestations of pain, which confirmed the effectiveness of nasopalatine nerve anesthesia. In patients of the control group during similar operation the full effect of local anesthesia was achieved in 56.0% of cases (χ2 - 9,270, р = 0,003). The rest of the patients during cystectomies showed some signs of pain-induced stress from the side of autonomic system or in the form of physical or emotional manifestations.
Conclusions: Endonasal blockade of the nasopalatine nerve at the point of its emergence from the pterygopalatine ganglion invariably provided a complete analgesia during enucleation of radicular cysts that have grown into the maxillary sinus or nasal cavity. Anesthesia of the nasopalatine nerve at its entry into the incisive canal allows pain-less cystectomy of radicular cysts that have spread to the front of the inferior nasal meatus from the front teeth.
提供使用不同鼻内神经阻断技术治疗上颌窦或鼻腔内根源性囊肿的麻醉效果的临床评估。
临床观察了 52 名不同年龄和性别的患者。这些患者被诊断为大型根源性囊肿（直径大于 3.0 厘米），已长入上颌窦（33 例）或鼻腔（19 例）。囊肿切除术（口腔上颌窦囊肿切除术）在局部增强麻醉下进行。患者根据鼻内神经阻断方法分为两组：主要组和对照组。主要组患者在翼腭神经节处进行鼻内神经阻断。在对照组中，神经阻断在该神经进入切牙管的入口处进行。使用主观和客观方法研究患者的疼痛敏感性和感知。使用 Pearson χ²检验对数据进行分析。
在主要组患者的下鼻道和上颌窦内根源性囊肿切除过程中，未观察到疼痛。既没有自主神经系统疼痛应激的表现，也没有疼痛的身体或情绪表现，这证实了鼻腭神经麻醉的有效性。在对照组患者中，在类似手术中，局部麻醉的完全效果在 56.0%的病例中达到（χ²-9.270，p=0.003）。其余患者在囊肿切除过程中表现出自主神经系统疼痛应激的一些迹象，或表现为身体或情绪疼痛。
在翼腭神经节处进行鼻内神经阻断可始终为上颌窦或鼻腔内根源性囊肿切除提供完全的镇痛效果。在切牙管入口处进行鼻腭神经麻醉可实现对前牙前扩散的根源性囊肿的无痛囊肿切除术。
