The aim: Scientific 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 confirmed by hematological studies with a significant increase in stress markers (ACTH and cortisol) and an insignificant increase in anti-stress factors in the blood. Insufficient stress-limiting function of the hypothalamic-pituitary system slows down the healing process and requires appropriate correction.
The aim: The aim of our research is to study the features of toxic osteomyelitis in drug addicts, their diagnosis and comprehensive treatment, aimed at strengthening motivation for the suspension of the use of psychoactive substances and the elimination of the pathological process in the lower jaw . Materials and methods: The features of toxic osteomyelitis, complicated by abuse, have been studied on 46 patients in the department of oral and maxillofacial surgery of Lviv regional clinical hospital during 2013-2019. Psychoactive substances, used by the patients, varied from homemade drugs “Screw” taken by 32 men (69.5%), synthetic drug amphetamine consumed by 10 men (21,7%) to Subutex used by 4 patients (8,7%) for their pleasure. All the patients underwent comprehensive examination, which included clinical, laboratory, radiological, pathohistological studies. Almost all patients – 41 ( 89.1% ) underwent sequestrectomy. Results: Clinical picture progressed quite rapidly in the form of diffuse destructive-necrotic osteomyelitis of the mandible, which was characterized by a severe, atypical course of the pathological process with permanent inclusion of other additional areas of the lesion of the mandible. The X-ray at this stage showed an increase in destructive processes in the bone. Conclusions: Appropriate surgical tactics and pathogenetic therapy are of great importance for toxic osteomyelitis in drug addicts. Due to the treatment, despite the total destruction of the mandible, it was possible to stop the destructive bone processes and to preserve life for such patients.
The aim: To study the consequences of temporomandibular joint injury and efficacy of arthrocentesis for treatment of post-traumatic internal temporoman¬dibular disorders. Materials and methods: 24 patients who experienced trauma history in the head without jaw fractures underwent CT, ultrasound and/or MRI. TMJ ar¬throcentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia by means of blockade of the peripheral branch of the auricular-temporal nerve on the background of intravenous sedation. Results: The ages of the patients varied between 18 and 44 years, and mean was 32,58 years. The causes of trauma were diverse, as traffic accident – 3 (12,5%), assault 12 (50%), hit by materials 3 (12, 5%), and fall-down 6 (25%). According to clinical and radiological signs after traumatic temporomandibular disorders, patients were divided into two groups according to Wilkes classification (1989): 13 patients with stage II (early-middle) and 11 - with stage III (middle).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 in 72.72% of patients with internal disorders of the third degree, the position and function of the articular disc was restored. Conclusions: Arthrocentesis with TMJ lavage is a minimally invasive surgical manipulation that has proven itself in temporomandibular disorders of traumatic origin, in particular after fractures of the articular process of the mandible.
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