Volume 03 Issue 11-2023
112
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
112-116
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
One of the features of recent years is an intensive growth of traumatism among all categories of the population. Their
causes are: technogenic catastrophes, natural disasters, road accidents, as well as military conflicts. In large cities, the
large number of road accidents and industrial injuries is a major social and economic problem. It should be noted that
among people under 40 years of age, traumatism ranks first as a cause of death. The result of epidemiologic analysis
showed that combined trauma of the facial skeleton is noted in men. The complexity of injuries was associated with
the combination of multiple fractures and the presence of rarely diagnosed craniocerebral injuries (CCI).
KEYWORDS
External skin, normal position, ablation, cranialization, obliteration, exenteration, nasalization.
INTRODUCTION
In severe combined trauma, the first minutes after the
injury are crucial for the patient's life. At this point, the
victim should be given the necessary care and start
directed pathogenetic treatment. Therefore, the
organization of the necessary care and examination of
patients with combined trauma become a priority task
on the way to solving the problem of improving the
effectiveness of care for patients with combined
injuries.
The tasks of maxillofacial surgeon in the treatment of
fractures of the upper zone of the face are:
repositioning of bone fragments in the normal
position, sealing of the frontal sinus and cells of the
Research Article
CLINICAL AND DIAGNOSTIC FEATURES OF COMBINED FACIAL INJURIES
Submission Date:
November 20, 2023,
Accepted Date:
November 25, 2023,
Published Date:
November 30, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue11-12
Shukhrat A. Boymuradov
Researcher Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 11-2023
113
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
112-116
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
lattice labyrinth from the dura mater and from the
external skin, restoration of the contours of the upper
zone of the face.
The existing options of surgical treatment of frontal
bone fractures, including ablation, cranialization,
obliteration, exenteration, nasalization, do not always
give the desired cosmetic effect.
Taking into account the combined nature of trauma,
the presence of various clinical symptoms, the nature
and severity of traumatic injuries, this circumstance
dictates further study of this issue with the
development of differentiated approaches. This
circumstance
requires
the
formation
of
interdisciplinary, coordinated approach in the tactics of
management of patients with combined trauma of
maxillofacial region. All of the above has determined
the relevance of the present study.
The aim of this study was to determine the course of
this combined facial trauma.
MATERIALS AND METHODS OF RESEARCH
We studied 251 case histories of patients with
combined injuries of the maxillofacial region. All
patients were admitted as emergencies after trauma in
the period from 2012 to 2014. Patients with combined
trauma of the maxillofacial region accounted for 28.1%
of the total number of hospitalized patients.
In the majority of cases (58.5%), combined trauma of
the maxillofacial region was the result of highway and
street accidents. The cause of injury in 18.4% was sports
injury. Criminal injuries accounted for 17.5%. Other
injuries accounted for 5.6% . The mean age of the
subjects was 37.1±2.8 years. The obtained results were
compared with the control group, which consisted of
25 healthy individuals, comparable in age and sex. The
patients had craniocerebral trauma, trauma of the
middle and lower zone of the face.
The results of the research and their discussion.
Analysis of the results of subjective and objective
clinical manifestations in patients with combined
trauma of the middle facial zone (group 1) and lower
facial zone (group 2).
Combined trauma is a trigger activator of psych
emotional breakdown. Therefore, this circumstance
led to changes in the emotional sphere of patients and
neurophysiological data of the central nervous system,
which served as a motivation for conducting this
research method. At the same time, we paid special
attention to revealing the level of adaptation of
patients after trauma, which was determined by the
degree of compensatory mechanisms in combined
CRT.
The most frequent complaints in both groups were:
severe pain at the site of injury, headache, nausea and
vomiting, dizziness, tinnitus, darkening in the eyes,
Volume 03 Issue 11-2023
114
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
112-116
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
flickering "flies" in front of the eyes, photophobia,
general
weakness,
rapid
exhaustion,
sleep
disturbance,
tearfulness,
irritability.
Somatic
complaints were presented in the form of unpleasant
sensations on the part of internal organs, fear or
anxiety, palpitations, difficulty in breathing, dry mouth.
Neurological examination of patients in the acute
period of combined CRT in different groups allowed to
reveal insufficiency of innervation of cranial nerves.
Cerebral symptomatology was represented mainly by
oculomotor disorders and insufficiency of VII and XII
pairs of cranial nerves of the central type.
Pyramidal symptoms in 67% of cases in Group 1 and 59%
in Group 2 were manifested as increased tendon
reflexes and anisoreflexia. Pathologic foot and hand
signs (Babinski's symptom, Marinescu-Radovici s.)
were detected in 13% of cases in group 1 and 25% in
group 2. We noted dysfunction of the coordinator
sphere, which was manifested mainly by instability in
Romberg's p. p. and mild disorders of statics and
coordination. Thus, in group 1 these manifestations
were noted in 72% of patients, in group 2 - in 67%.
In most cases in the acute period of CRT, autonomic
manifestations in the form of diffuse or distal
hyperhidrosis,
acrohypothermia,
labile
BP,
palpitations, generalized fever, parasthesias in the
extremities were noted. Thus, vegetative dysfunction
in group 1 patients was detected in 79.6% of cases, in
group 2 - in 83.5% of cases. The number of vegetative
dysfunction signs per one patient averaged 2.9±0.4
units in group 1, 3.9±0.5 units in group 2, control group
- 1.9±0.4 units. The average number of accompanying
symptoms of vegetative dysfunction in patients of
groups 1 and 2 was significantly (p<0.05) higher relative
to the control group. It is important to note that when
studying the state of the autonomic nervous system,
the suprasegmental disorders revealed by us were
characterized by polysystemicity and a high degree of
severity of autonomic dysfunction. Analyzing the
clinical
picture
of
trauma,
the
neurological
manifestations that we identified in 95% of group 1 and
in 91.1% of group 2 were characteristic of neurotrauma.
In the course of the study, we noted clinical
manifestations in the mental sphere with asthenia,
anxiety, and mild depression in patients. This
circumstance was the reason for a more detailed study
and analysis of these manifestations. Taking into
account
these
circumstances,
we
separately
considered the psychopathological syndrome, which
was characterized by neurotic, asthenic and neurosis-
like conditions. These manifestations were observed in
76% of patients who underwent CRT. In our opinion,
the formation of this syndrome is caused by
multifactorial nature of the processes occurring in the
nervous system during CRT, but the leading, in our
opinion, is the presence of craniocerebral trauma and
manifestation of stressful situation. It should be
Volume 03 Issue 11-2023
115
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
112-116
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
recognized that the presence of a stress factor in the
acute period of CLLT often contributes to the
smoothing of both subjective and objective
neurological symptoms, which in many respects
complicates the diagnosis of neurotrauma.
Any trauma of the maxillofacial region requires
conservative complex treatment of possible brain
disorders, where interdisciplinary participation of
various specialists is assumed. It should be recognized
that in many cases conservative therapy is quite
difficult to categorize as purely neurosurgical or
neurological care. In this regard, we proposed a
complex of conservative treatment of brain disorders,
including a number of therapeutic measures aimed, in
addition to surgical treatment, at the correction of
brain
dysfunction
and
normalization
of
psychophysiological status. Conservative treatment
included: cavinton (4 ml. IV drip on 200.0 saline
solution, No. 10); mexidol (250 mg intravenously, No.
10); vitamin therapy (neurobion 3.0, intramuscularly,
No. 10); NSAIDs: ibuprofen - 1 tablet 3 times a day,
course - 14 days.
The results of clinical effect after the completion of the
therapeutic program allowed to note a positive effect
in both groups in 85% of patients. In 15% of cases there
was an improvement of the condition in the form of
reduction
of
cerebrosthenia
symptoms
and
improvement of work capacity. The treatment
revealed that in all cases patients with combined CRT
showed improvement in the main psychophysiological
parameters: well-being, mood, increased sleep activity.
Conclusions. The analysis of maxillofacial injuries for
the period from 2020 to 2023 revealed an increasing
trend in the structure of both all maxillofacial injuries
and combined craniofacial injuries, where quantitative
indicators of combined craniofacial injuries account for
19% of all maxillofacial injuries.
The average number of associated symptoms of
autonomic dysfunction in patients with combined
craniofacial trauma was significantly (p<0.05) higher
relative to the control group. Psychopathological
changes in combined craniofacial trauma are
characterized by an increased level of personal anxiety,
asthenia and manifestations of depression of various
degrees.
Joint surgical and therapeutic treatment in the acute
period of combined craniofacial trauma leads to a
reliable (p<0.01) improvement of the patient's
recovery results in terms of quality of life.
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Volume 03 Issue 11-2023
116
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
112-116
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
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