And whether you know...
Fistula, fistula (this word is translated from Latin as "tube") is a channel which connects among themselves or to external environment hollow bodies or connects a tumor to a cavity or a body surface. As a rule, fistula looks as the narrow channel covered with an epithelium.
It is accepted to distinguish fistulas which developed as an effect of certain pathological processes, and also fistulas, as a result of the surgical intervention which is carried out to take away contents of a certain hollow body.
Fistula on a gingiva
Fistula on a gingiva is a complication of chronic periodontitis which meets especially often. If to estimate that illness from the point of view of its weight, then it is considered the most dangerous, rehabilitation after this illness lasts long very much, besides it is important to find out what provoked its manifestation.
Progressing of an illness provokes granulation growth. It is connecting fabric of high-quality character which breaks healing process. In this place bacteria because of what pus begins to be emitted breed. If to begin therapy of an illness in an initial stage, then it is possible to get rid of an illness rather quickly.
But in the absence of adequate timely treatment fistula on a gingiva provokes destruction directly of a gingiva around tooth, and after those soft tissues which are located nearby. At development of fistula pus, and also liquid with blood is plentifully emitted. At the same time granulations burgeon under an alveolar shoot (the bone bed of tooth so is called). Afterwards in this place there is a disturbance of a mucous membrane, and fistular pass as a result appears.
The main danger of this illness is the possibility of defeat of soft tissues of the person. In the absence of adequate treatment there is a germination of fistula outside: generally it leaves through a cheek. As a result the person has a noticeable defect of the person.
One more reason of development of fistula on a gingiva at the person – bad quality of treatment of caries.
When the stomatologist intends to seal up tooth, it has to clean carefully a carious cavity, clean all sites of tooth which were struck with caries and to carry out disinfection. If any operation was performed poor, afterwards the infection gets in tooth which was sealed up. Microorganisms actively develop, and the person suffers from pain and the subsequent inflammatory process around a gingiva.
Diagnosis of fistula on a gingiva is carried out by the dentist. But for more detailed inspection of features of a disease it is necessary to conduct X-ray inspection. During visual survey it is not always possible to define, the illness, and what its scales at the moment is how serious. On a x-ray film it is possible to consider, the gum is how deeply affected whether there is no pus in other areas, and whether damage of a periosteum began. Only when determining of all specified moments it is possible to appoint competent treatment and to achieve effective result.
If fistula on a gingiva developed owing to periodontitis, for elimination of a problem it is necessary to treat, first of all, the illness reason. Initially the doctor cleans channels of tooth from carious deposits, pus, after that the pulp cavity is cleaned and processed by an antiseptic agent. After that the doctor fills a tooth. After the termination of this stage of treatment acute display of an illness manages to be muffled partially. Further the stage of disposal of microorganisms follows for what to the patient appoint special drugs in the form of ointments and pastes.
Today many modern methods of treatment of fistula are used: ultrasonic method, laser influence, cauterization by current. Medicamentous therapy is also without fail carried out. At the same time antiinflammatory drugs are appointed, antibiotics are often used.
If fistula on a gingiva has a severe form, then in this case to the patient the surgery is appointed. Even if the person does not feel pain, pus comes out through the fistular course, then after a while pus nevertheless gets into a periosteum. At damage of a periosteum operation needs to be done as soon as possible. Therefore the course of a disease without pain is considered the most dangerous. At a similar course of a disease doctors try to keep tooth to the patient, and also to avoid afterwards the expressed defects of a gingiva. Also surgical method of treatment of fistula is used if granulation expands too strongly.
Therefore, it is very important to ask for the help in time, at competent approach to treatment closing of fistula happens for a week.
That rehabilitation after a disease took place quicker, use of some national methods is recommended. For example, it is recommended to rinse an oral cavity salt solution, broths of a sage, a camomile, an eucalyptus.
Rectum fistula – the disease called by also chronic paraproctitis at which there is an inflammation in a proctal crypt, a pararectal fat, intersphincteric space. At the same time the fistular course as which internal opening the struck crypt acts forms. At fistula there is an infection from a gut gleam. In the purulent course the wall is formed of connecting fabric. As a rule, the outside opening of fistula is dug out on a crotch. Diameter of fistula in most cases makes no more than one millimeter. Rectum fistula often arises as the phenomenon postoperative, posttraumatic.
In most cases fistula of a rectum is shown at the person after earlier postponed acute paraproctitis.
As a rule, the person addresses the specialist with complaints to existence of a wound (which is a fistular opening) near an anus. Usually from this wound pus, an ichor therefore the person tests strong inconvenience is constantly emitted. Often allocations happen very strong therefore owing to their continuous emergence skin near a fistular opening itches and is irritated.
If fistula full and, respectively, is well drained, then pain of the person does not disturb. It is shown at incomplete internal fistula of a rectum. As a rule, pain arises during defecation, and after it begins to abate gradually. Most often the disease has a wavy current. Sometimes at fistula inflammatory process in a pararectal fat escalates. The inflammation is shown as a result of obstruction of the fistular course by granulyatsionny fabric or is purulent - necrotic masses. Owing to such phenomena there is abscess which is opened later, and after its emptying the condition of the patient improves. But the wound nevertheless remains – it has diameter no more than one centimeter. Through this outside opening of fistula and further there is a pus.
During remission the patient does not feel pain and if he carefully follows all rules of hygiene, then fistula can not give it an inconvenience at this time. However during aggravations the state sharply worsens. Except pain and inconveniences in the field of education of fistula of the patient suffers from astenisation, a headache, sleep disorders. Problems with mentality and a potentiality at men can be observed.
In the presence at the person of the fistula of a rectum complicated by presence of infiltrates and purulent cavities, aggravations happen rather often. Respectively, the general condition of the person can strongly worsen. Besides there are heavy changes of local character: the crotch, the proctal channel can be deformed, muscles which squeeze an anus change. A result of all these phenomena — insufficiency of a proctal sphincter. Also as complication of a disease there can be a pectenosis of which emergence of hems in a wall of the proctal channel is characteristic. If fistula not to treat for many years, then the illness can take malignant shape.
Diagnosis of fistula of a rectum
As a rule, diagnosis of fistula of a rectum is carried out after the patient addresses the specialist with the corresponding complaints. The doctor initially performs external examination at which the outside opening is found (on condition of existence at the patient of full fistula). After that the palpation of a crotch and perianal area is carried out. Also the doctor conducts manual research of a rectum and the proctal channel. The specialist studies the anamnesis of the patient in detail.
After that the attending physician appoints carrying out other researches: at fistula of a rectum test with dye, sounding of fistula is applied. Also each patient with fistula has to pass surely a rektoromanoskopiya for the purpose of definition of a condition of a mucous rectum, and also detection of other diseases.
Sometimes as an auxiliary diagnostic method X-ray inspection is used. It is important to differentiate fistula from cysts of a pararectal fat, actinomycosis, other types of fistulas also.
Treatment of fistula of a rectum
The diagnosis "rectum fistula" is a state at which the direct indication to carrying out a surgery takes place. An important point in treatment of fistula of a rectum is time of carrying out such operation. Determining the term of carrying out operation, it is important to consider the clinical course of an illness. So, if the exacerbation of an illness takes place, and abscess was created, at first it is necessary to carry out opening of an abscess and to liquidate purulent process.
However carrying out operation should not be postponed for a long time, periodically the aggravation will repeat. As a result, perhaps emergence of scarring and subsequent deformation of a crotch and proctal channel.
If on the course of fistula infiltrates take place, then the doctor appoints a course of antiinflammatory treatment of fistula. In the course of therapy to the patient reception of antibiotics, a physical therapy course is appointed. After elimination of infiltrates to the patient the surgery is appointed. However operation is performed only when fistula is open.
There are several different types of operations which are appointed to patients at rectum fistula. So, carrying out a syringotomy in a gleam of a rectum, a syringectomy in a rectum gleam with the subsequent opening and carrying out drainage of zatek, a similar syringectomy and sewing up of a sphincter, etc. is possible.
To choose an optimum method of operation, the doctor is guided by some moments. First of all, that matters, the fistular course relatively to an outside sphincter of an anus is localized where exactly. It is important to consider and, cicatricial process is how developed and also whether purulent infiltrates and cavities in a pararectal fat take place.
It is important that operation was performed by the experienced specialist coloproctologist in a specialized hospital. If there is a sharp aggravation of a chronic paraproctitis, then urgent operation can be executed in an all-surgical hospital. However the highly specialized doctor in connection with big risk of emergence of complication has to carry out the subsequent treatment.
Most often after operation patients as complication have a recurrence of fistula, and also insufficiency of a proctal sphincter can be shown. Recurrence of a disease arises in connection with the wrong choice of a method of operation, its wrong carrying out, and also because of emergence of errors in postoperative recovery of the patient.
As a rule, at rectum fistula the forecast is favorable if only this is not about fistulas of which recurrence, a long inflammation, cicatricial changes in a sphincter, a gut, a pararectal fat is characteristic. Therefore for full treatment it is important to carry out a surgery in time.
Prevention of fistula
To provide prevention of fistula of a gingiva, it is important to fix all problems with teeth in time and to do it only by means of professional specialists. There is the general rule that each person has to pass survey at the stomatologist twice a year. Also with a certain frequency (once in several years) it is necessary to do diagnostic pictures of teeth which were exposed to treatment earlier, on purpose as soon as possible to prevent probable complications.
Besides, for prevention of formation of fistulas it is important to support the due level of immunity.