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.
The problem of installation of dental implants in atrophied distal mandibular aspects is extremely relevant. From the point of view of classical twostage implantation, the height deficiency of the alveolar process, due to the topographic proximity of the inferior alveolar nerve, requires the use of so called short or ultra-short implants or vertical augmentation of bone tissue using autologous, allogeneic, xenogeneic materials. Moreover, the installation of classical cylindrical or bullet-shaped implants is possible only in the presence of sufficient width of the alveolar process laterally or medially to the mandibular canal. The invention of single-piece cone-shaped implants of different lengths and diameters has allowed to realize the idea of their installation “bypassing” the inferior alveolar nerve, minimizing or avoiding the need for additional surgery to increase bone volume.
This work demonstrates our own approach to the rehabilitation of patients with dentition defects in the distal mandible by precise analysis of computed tomography scans of patients and the installation of implants “bypassing” the inferior alveolar
Introduction. Pathology of the temporomandibular joint (TMJ) is one of the urgent problems of modern maxillofacial surgery. In the early stages following cartilage damage, the loss of proteoglycans and collagen mesh disorder leads to functional disorders and diffculties in daily life. The aim of the present work was to diagnose the damage to cartilage and bone components of TMJ in traumatic fractures of the mandibular condylar process (MCP), and to study the correlation of magnetic resonance imaging (MRI) results and biochemical parameters in dynamics. Materials and methods. 22 males with traumatic condylar fractures were considered for the study. All patients underwent MRI upon admission, for 30 and 180 days after the treatment. To study the degree of bone and cartilage damage of TMJ, the levels of pyridinoline (PID) and deoxypyridolin (DPID) were determined by fluorescent immunoassay in the urine samples of patients, both before the treatment and after 21, 30 and 180 days. Results and discussion. Upon admission after MRI, only 22.73±9.14% of the subjects showed damaged joint surfaces while, on the 30th day - 31.82 ± 10.16% and on the 180 day - 40.91±10.73%. Biochemical studies performed in the frst days after injury showed an increased PID in all patients and increased levels of DPID in 20 patients, with average values of 150.82±10.73 and 37.00±2.22 nmol/mmol creatinine, respectively. Conclusions. MRI offers good analysis of all structures in joints, being able to detect damage to the articular cartilage only when present, and less suitable for detecting cartilage disorders as a disease stage, which precedes the lesion. Instead, tissue markers of PID and DPID bone destruction can be used to diagnose lesions of cartilage structures in very early stages and make predictions on the disease and its treatment.