OPTIMIZATION OF POWER-ASSISTED ADENOIDECTOMY IN CHILDREN USING SHAVER TIPS OF VARIOUS MODIFICATION.

OBJECTIVE: The aim: To study the efficacy of surgical treatment of patients with adenoid vegetations by implementing a differential method for choosing a tip for endo-scopic power-assisted adenoidectomy in children depending on dentition. PATIENTS AND METHODS: Materials and methods: We investigated the presence of nasal air emissions in 127 children (2-12 years old) before and after the operation. We excluded 12 patients due to the presence of nasal air emission before the operation. All patients were divided in 2 groups: I - children with aging primary dentition (55 children), II- children with mixed dentition (60 children). Depending on tips, that were used for the operation, we divided patients into two subgroups: A - 40˚ and B- 60 ˚. RESULTS: Results: In 9,4% of patients have the presence of nasal air emissions before the operation. The use of 40˚ tips does not allow removal of lymphoid tissue in "hard-to-reach" areas of the nasopharynx (perichoanal and peritubular sections) in 30% of children with aging primary dentition and 42.9% with mixed dentition. CONCLUSION: Conclusions: The use 40˚ tips for the adenoidectomy is accompanied by a higher risk of velopharyngeal insufficiency in children with mixed dentition compared to children who underwent the intervention with a tip with a larger bending angle and a longer working part (60°). In patients with temporary dentition, it is recommended to use a standard tip for adenoidectomy, except when correction of tubal lymphoid tissue is planned (it is necessary to use a tip with a rotating window). In patients with mixed dentition, it is recommended to use a 60° tip.

MODERN APPROACHES TO CHOOSING SHAVER BLADE FOR ENDOSCOPIC SURGERY OF THE NASOPHARYNX AND PARANASAL SINUSES USING 3D MODELING.

OBJECTIVE: The aim: To determine the effectiveness of the use of 3D printed templates of shaver blades for choosing the optimal blade shape for endoscopic surgery of the nasopharynx and paranasal sinuses. PATIENTS AND METHODS: Materials and methods: The shaver blade templates with bending angles of 40º, 60º, 90º and 120° for powered endoscopic sinus surgery were made according to the manufacturer catalog using the Asiga 3D printer and Dental TOOTH material. There were examined 100 patients who underwent endoscopic powered sinus interventions (50 - adenoidectomy, and 50 - removal of the maxillary sinus cysts). The patients with each type of intervention were divided into subgroups of 25 people. The subgroups differed by the approach to choosing shaver blades: using 3D templates - in the main subgroup, and traditional -in the control. RESULTS: Results: The average number of shaver blades used for adenotomy in patients of the main group was 1.04±0.04, and in the control group - 1.36±0.09 (p<0.05). In patients of both subgroups, the 40º shaver blade, which is standard for adenotomy and recommended by most manufacturers, was most often used. In the control subgroup, it was used significantly more often. The frequency of the use of other shaver blades - 60º and 90º in both subgroups did not differ significantly and amounted to 40.0% (CI 95% 21.8; 61.1) and 36.0% (CI 95% 18.7; 57.4). CONCLUSION: Conclusions: The use of 3D templates for choosing a shaver blade reduces the number of blades used in adenoidectomy by 23.5%, for maxillary sinus cysts operation - by 18.2%.

Antimicrobial resistance of staphylococcus aureus causing of surgical site infections in ear, nose and throat surgery.

OBJECTIVE: Introduction: Staphylococcus aureus is one of the major pathogens that causes of surgical site infection (SSI). Scant information is available on the occurrence and antimicrobial susceptibility of S. aureus in patients with SSI in Ear, Nose and Throat (ENT) surgery. The aim: To assess the activity of antimicrobials against S.aureus, isolated from patients with SSI by the ENT departments of Kyiv hospitals. PATIENTS AND METHODS: Materials and methods: A total of 516 S. aureus isolates from of patients with SSI in ENT surgery. Antimicrobial susceptibility of S. aureus were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). RESULTS: Results: The most active antibiotics found in the study were linezolid and tigecycline, showing growth inhibition of 100% strains tested. Susceptibility to the other antimicrobials was also on a high level: 98,4% of strains were found susceptible to nitrofurantoin, 98.1% - to trimethoprim/sulphamethoxazole, 97.6% - to fusidic acid, 97.1% - to mupirocin, 95.9% - to teicoplanin, 94.7% - to vancomycin and fosfomicin, 90.6% - to moxifloxacin, 89.1% - to tobramycin, 87.3% - to gentamycin. Susceptibility to rifampicin (85.5%), cefoxitin (84.6%), levofloxacin (84.3%), erythromycin (82.6%), tetracycline (76.3%), and clindamycin (75.4%) was observed to be some lower. Resistance to oxacyllin S.aureus (MRSA) came up to 21.1%. CONCLUSION: Conclusions: S. aureus in ENT departments to be a serious therapeutic and epidemiologic problem. The constant monitoring of antimicrobials resistance in every hospital is required. Antibiotics application tactics should be determined in accordance with the local data of resistance to them.