Manifestation of traumatic disorders is often chracterised by reorganization or ossifcation of the TMJ hematoma, while the use of conservative therapy after TMJ traumatic injuries is often ineffective. The purpose of the preswent work was to study the effectiveness of arthrocentesis in the complex treatment of post-traumatic temporomandibular disorders. 24 patients with a history of mandibular condylar fractures underwent CT, ultrasound and MRI. TMJ arthrocentesis was performed under local anesthesia. After osteosynthesis, the number of patients with stage III according to Wilkes was up to 58.33% while, after splinting- 33.33%. The control ultrasound and MRI carried out 3-6 months after arthrocentesis showed no signs of hemarthrosis in 84.61% of patients with intra-articular disorders of the second degree, and also in 72.72% of patients with internal disorders of the third degree, the position and function of the articular disc being restored. Arthrocentesis with TMJ lavage is a minimally invasive surgical manipulation that has proven useful in temporomandibular disorders of traumatic origin, in particular after fractures of the articular process of the mandible.
Introduction. The main purpose of this research was to study the effectiveness of local fbrinolytic therapy in the rehabilitation of patients with traumatic injuries of the zygomatic-orbital complex. Materials and methods. Patients in the control group (15 persons) received in the postoperative period standard antibiotic therapy, and analgesic, antiinflammatory and anti-edematous therapy. Patients in the main group (17) received into the parabulbar tissues an additional injection of „Hemase” 5000 ME once a day, for 4-5 days. The effectiveness of the treatment was compared by determining the state of microcirculation, sensory sensitivity and level of enolase in the venous blood. Results and discussion. The general conjunctival index in the control group was 18.9 ± 1.2 points on the 7th day and 16.1 ± 1.8 points on the 14th day, and 15.7 ± 1.0 (p <0.05) and 11.7 ± 1.1 points (p <0.05), respectively, in the experimental one. The threshold of electrical excitability of the infraorbital nerve in patients of the control group on the 7th day was 68.4 ± 5.2 μA, while in the main one - 48.1 ± 5.3 μA (p <0,05). On day 14, the difference in the excitability threshold was even more pronounced: in the control - 52.9 ± 4.8 μA, in the main group- 33.2 ± 3.4 μA (p <0.05), with the index on the healthy side at 27.1 ± 1.9 μA. It was also found out that, in the control group, the level of enolase on both the 7th and 14th day exceeded the values obtained during the examination of patients in the main group: 24.5 ± 1.5 ng/ml to 19 , 4 ± 1.3 ng/ ml and 15.6 ± 1.4 ng/ml to 15.1 ± 1.5 ng/ml. Conclusions. The obtained data allowed stating that application of the proposed course of postoperative rehabilitation helps restore the conduction of nerve trunks, has an anti-edematous effect on the soft tissues of the infraorbital area and improves the hemodynamics of the suborbital artery and vein.
The aim: Scientifc work aims at determining the frequency and nature of disorders in psycho-emotional and autonomic systems in patients with combined trauma of the middle face. Materials and methods: Examination included 112 patients with combined trauma of the middle face.Their psycho-emotional state was assessed using the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS). All patients were tested using questionnaires developed by Wayne A.M.. The Kerdo index was used to assess autonomic tone, while autonomic reactivity was determined using a Czermak-Gering carotid sinus test. Biochemical markers of stress - adrenocorticotropic hormone (ACTH), cortisol and anti-stress system - β-endorphins,and Garkavi L.Kh. adaptation index. Results: Patients with severe traumatic brain injury - 26.78%, and severe fractures of the facial bones - 48.21%. The consequence of traumatic events is the appearance of post-traumatic stress disorders in their mental function. Post-traumatic stress is also manifested at the hematological level in the characteristic stress reactions: the growth in the blood of stress markers - ACTH and cortisol and anti-stress factors, including β-endorphins
Conclusions: Middle facial injuries cause disorders of the psycho-emotional sphere, which are manifested in anxiety and depressive disorders. The post-traumatic period is accompanied by stress disorders, which are confrmed by hematological studies with a signifcant increase in stress markers (ACTH and cortisol) and an insignifcant increase in anti-stress factors in the blood. Insufcient stress-limiting function of the hypothalamic-pituitary system slows down the healing process and requires appropriate correction.
Among the bone fractures of the midface, blow-out fractures amount to 11-28% and occupy the third place after zygomatic and zygomatic arch fractures and fractures of nasal bones. According to our observations izolated orbital bottom fractures occurred in 8.9% of cases. With the blow-out fracture, the presence of clinical signs of neuritis of the infraorbital nerve is an important pathognomonic symptom indicating the localization of bone fracture at the orbital floor. The main factors that determine the rate and quality of unprompted recovery of affected functions and, accordingly, the scope and target of the therapeutic interventions in cases of peripheral traumatic neuropathies include: the degree of nerve guide lesion, the level of destruction, tissue ischemia, the kind of the disturbing factor. When the nerve is constricted, the degree of conductivity failure depends primarily on the duration and intensity of constriction injury. Research objective was to improve diagnostics of traumatic lesions of infraorbital and zygomatic nerves in patients with blowout fractures. Clinical, radiological, neurofunctional and biochemical methods of research were applied in 19 patients, aged 20 to 65 years, with blow-out fractures. The degree of destruction of infraorbital and zygomatic nerves was assessed by classification of H. Seddon (1943), which allows determining the degree of lesion of the nerve trunk according to the changes in conductivity in each of its segments. The degree of lesion of the branches of the maxillary nerve was determined according to the data of electrophysiological tests according to Nechaieva N.K. et al. (2014). Electrodiagnostics of sensitivity of skin branches of maxillary nerve was carried out in their exit sites on the surface of face using low-frequency electrotherapy device "Radius-01 FT" (Belarus) in the mode of electrical stimulation. Electroodontometry of teeth on the corresponding side of the upper jaw was carried out using a portable electroodontometer "Pulptester" (Taiwan). In the peripheral venous blood of patients, there was determined the concentration of neuron-specific enolase (NSE), which is a neuron-specific isoform of enolase found in neurons. It was analyzed by an immunochemical method with the use of electrochemiluminescent detection, using a Cobas 6000 analyzer and test system by Roche Diagnostics (Switzerland). Statistical processing of the results of research was carried out with the help of a computer program for statistical computation "Statistica 8".We found a mild degree (neuropraxia) of damage to the orbital nerve in 12 patients. The content of neuron-specific enolase in the blood did not exceed the upper limit of normal - 15.9 ± 1.4 ng / ml (p> 0.05). Sensitivity disorders of the teeth and soft tissues in the area of innervation of the suborbital and zygomatic nerves in all patients in this group were temporary. The sensitivity of the damaged nerves completely recovered after 3 - 4 weeks. The presence of axonotmesis of the suborbital and zygomatic nerves in seven patients caused severe sensory disturbances in the soft tissues of the suborbital and zygomatic areas, loss of sensitivity in the upper jaw teeth on the side of the injury. These pathological changes were identified to be caused by their compression of the orbital floor by bone fragments, which were displaced into the maxillary sinus. In their blood, such patients had an increased concentration of neuron-specific enolase, which exceeded the upper limit of normal - 20.6 ± 1.7 ng / ml (p <0.01). In this category of patients, sensitivity, as a rule, completely recovered in 1,5 - 2 months after operations on reconstruction of the orbital bottom and after a course of drug therapy.The use of electrophysiological tests and study in the blood of the nervous tissue damage marker- neuron-specific enolase allow us to identify the degree of damage to the suborbital and zygomatic nerves in patients with isolated fractures of the fundus
Scars are a pathological consequence of the functons of recovery and reconstructon afer tssue damage, which affect the patent's appearance, physical functons and cause deformites that have an impact on psychological burden, especially when the scar is located in the maxillofacial area. It is customary to include hypertrophic, atrophic and keloid scars in the pathological group. The purpose of the study: to highlight and analyze data on modern preventon methods and their impact on the formaton of a pathological scar. PRP (injectons of platelet-rich plasma) is one of the modern methods of preventng pathological scars This is a new and modern method of preventon and treatment, which is constantly expanding, and shows great prospects in medicine. Emer J describes in his studies that PRP combined with hardware treatment reduces transepidermal water loss and reduces inflammatory hyperpigmentaton. Wu W and the authors using hypoallergenic microporous tape in their clinical studies proved that it is able to reduce tension in tssues. Limmer EE and the authors used a painless alternatve to cortcosteroid injectons in their studies, namely cortcosteroid tape. A correctly chosen method of preventon and treatment improves a beter aesthetc result, shortens the tme of wound healing, and also reduces the percentage of recurrences in the postoperatve period, which is a desirable result not only for doctors, but also for the loss.