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.
Pathological scars are not only an integral medical and aesthetic problem nowadays, but also serious functional and aesthetic consequences of traumatic and surgical wounds. The purpose of our study is to determine the effectiveness of silicone-based materials in wound healing and the prevention of scar tissue formation. The study was conducted at the Department of Maxillofacial Surgery, the Lviv Regional Clinical Hospital. Twenty patients (10 men and 10 women) with traumatic soft tissue injuries in the maxillofacial area participated in the study were divided into two groups of 10 patients each. The first experimental group received a silicone-based patch after suturing the wound, while the patients of the second clinical (control) group were operated on according to standard techniques without additional methods of scar prevention. The nature of the scars was assessed according to the modern scale for evaluating scarred tissues developed and implemented at the Poltava State Medical University. The analysis was carried out using seven indicators for different periods of the observation (on the 120th and 240th day of the clinical study). On the 240th day of the clinical study, the patients of the first group showed moderate hyperemia in 30% of cases, close to intact skin in 70%, moderate pigmentation in 20%, and isopigmentation in 80%. The scar raised above the skin surface in 20.0% (2 patients) of cases for 1-2 mm, while in the rest, 8 people, the scar raised less than 1 mm. Uniform raising of the scar was observed in 30.0% of cases (3 patients), while the surface was close to intact skin in 70.0% of cases (7 people). 20.0% of cases (2 patients) had a moderately compacted scar, while in 80.0% of cases (8 patients), the scares were assessed as mildly elastic, and only 1 patient complained of mild discomfort (itching). Other participants had no complaints. Non of patients in the first group complained of pain. On the 240th day of the clinical study, the second control group exhibited the following indicators: moderate hyperemia in 70.0% of cases (7 patients) and normal vascularization in 30.0% of cases (3 individuals). Hypopigmentation was observed in 60.0% (6 cases) and isopigmentation in 40.0% of cases (4 patients). The height of the scar above the skin surface was 1-2 mm in 60.0% of cases (6 patients) and less than 1 mm in the remaining 40.0% of cases (4 patients). A uniform increase in scar size was noted in 70.0% of cases (7 cases), while the surface was similar to that of intact skin in 30.0% of cases (3 individuals). Moderately thickened scars were observed in 50.0% of cases (5 patients) and pronounced induration of soft tissues in the other 50.0% of cases (5patients). Regarding subjective sensations, 70.0% (7 patients) had no complaints, 30.0% of cases (3 patients) experienced slight discomfort, and 10.0% (1 patient) reported mild pain, while the remaining 90.0% (9 individuals) had no complaints. Comparing the results of the clinical study on the 240th, the first study group's performance was better and 77.0% lower compared to the second control group. This allows us to suggest that the use of silicone gel after the wound closure, compared to the standard method, promotes the wound healing process and reduces the risk of pathological scarring.
The purpose of the work was to study the effectiveness of arthrocentesis in the complex treatment of post-traumatic temporomandibular disorders. Materials and methods. The clinical part of the study included 24 patients, who had a history of fractures of the mandibular articular process. Patients underwent radiological examination – orthopantomography, computer tomography, ultrasound and magnetic resonance. Patients with titanium mini-plates after osteosynthesis were subjected to ultrasound, and since the reposition and fixation of fragments was performed using intermaxillary fixation they were subjected to magnetic resonance imaging. Pain assessment was performed according to visual analogue scale. Temporomandibular joint arthrocentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia. Results and discussion. All patients complained of the temporomandibular joint pain, which was rated from 1 to 6 points. All patients noted pain on palpation of the temporomandibular joint. Limited mouth opening ranging from 30 to 38 mm was found in 11 patients. Lower jaw deviation was observed in 18 patients. All patients had articulatory noises – clicking, and 11 had blocked movement of the joint head. Orthopantomograms or computer tomography revealed satisfactory restoration of the anatomical shape of the mandible after fractures and complete consolidation of the fracture. Ultrasound and magnetic resonance revealed signs of unabsorbed hematoma as consequences of hemarthrosis; in 18 patients – deformity of the capsule, in 17 – a slight thickening of the posterior edge of the articular disc, in 18 patients – disc adhesion, in 13 people – forward disc displacement with reduction, in 11 patients – disc protrusion without reduction. According to clinical and radiological signs after traumatic temporomandibular disorders, patients were divided into two groups according to Wilkes classification: 13 patients with stage II (early-middle) and 11 – with stage III (middle). We also found that after surgical treatment – osteosynthesis, the number of patients with stage III according to Wilkes makes up 58.33% (7 people), while those after splinting – 33.33% (4 people). The control ultrasound and MRI carried out 3-6 months after arthrocentesis showed no signs of hemarthrosis in 11 (84.61%) patients with intra-articular disorders of the second degree, and in 8 (72.72%) patients with internal disorders of the third degree, the position and function of the articular disc were restored. Conclusion. Arthrocentesis with temporomandibular joint 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. Arthrocentesis is recommended to be used after ineffective conservative treatment, as well as to prevent post-traumatic intra-articular disorders in the early post-treatment fractures (intermaxillary fixation or osteosynthesis) with the attenuation of acute post-traumatic events, which is our goal of further work
Мета роботи – вивчення застосування доплерівської флоуметрії як діагностичного методу для оцінки комбінованого методу профілактики утворення патологічних рубців шкіри обличчя. Матеріали і методи. Роботу виконано на базі відділення ЩЛХ Львівської ОКЛ. Обстежено 25 пацієнтів, які в подальшому були розподілені на 2 групи. До групи порівняння (n=10) включено хворих, в яких рани загоювалися первинним натягом та не проводили жодних профілактичних процедур. До основної групи (n=15) входили пацієнти, в яких рани гоїлися первинним натягом та застосовували комбінацію сеансів ЕУХТ та аплікацій силіконового гелю “Стратадерм”. Результати досліджень та їх обговорення. При контрольній доплерографії післяопераційних рубців у пацієнтів групи порівняння візуалізуються поодинокі локуси кровопостачання довкола рубця, ознак набряку чи запальної інфільтрації не виявлено. При контрольній доплерівській флоуметрії післяопераційних рубців у пацієнтів основної групи, виявлено виражені локуси кровопостачання різної інтенсивності з наявністю живильних судинних структур по всій площі обстежуваної ділянки.
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