Volume 03 Issue 11-2023
7
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
7-14
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
According to the data of the World Health Organization (WHO), the frequency of injuries of the maxillofacial region is
constantly increasing - their share in the total number of injuries is on average 6-8% per year. The purpose of the study
is diagnosis of damage to nerve fibers in patients with facial bone injuries and improvement of treatment efficiency.
In order to assess the frequency of nerve damage in maxillofacial injuries, in 2017-2020, archival materials and
anamnesis of patients treated in the Department of Facial Injuries and Complications of Neuroinjuries of the
Samarkand Branch of the Republican Specialized Traumatology and Orthopedic Scientific and Practical Medical Center
(RITOIATM) were studied. 197 of them (86%) were men and 32 (14%) were women.
KEYWORDS
Maxillofacial injuries, diadynamic electroneurostimulation (DD-ENS), frequency of injuries,
INTRODUCTION
According to the data of the World Health
Organization (WHO), the frequency of injuries of the
maxillofacial region is constantly increasing - their
share in the total number of injuries is on average 6-8%
per year. According to statistics, the number of
maxillofacial injuries with fractures of the facial
skeleton in large cities has increased significantly and
covers 42% of hospitalizations. In the last decade, the
rate of injury to the population has increased
dramatically. This is, first of all, a change in the social
requirements of life, in particular, the stratification of
the population's income, the further expansion of
large cities, the increase in the number of vehicles and
the speed of movement; especially in private
Research Article
IMPROVING THE TREATMENT OF NERVE DAMAGE IN JAW FRACTURES
Submission Date:
November 01, 2023,
Accepted Date:
November 05, 2023,
Published Date:
November 09, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue11-02
Erkin Beknazarovich Khatamov
Department Of Maxillofacial Surgery Samarkand State Medical University, 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
8
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
7-14
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
enterprises, it is explained by non-observance of
simple rules of equipment safety. Due to the above
conditions, the number of facial bone injuries is
increasing along with joint injuries. Worldwide, the
incidence of facial trauma ranges from 15.5% to 59%.
Most of the total share of injuries of the facial bones
falls on the lower jaw bone, its share is 65-94%. Patients
with this type of injury make up 22.4-33% of patients
admitted to a facial surgery hospital. According to a
number of authors, deformation of facial bones after
combined craniofacial trauma is observed in 19-48%,
damage of nerve fibers in 34-57%.
Karpov S.M. according to (2015), the
bioelectrical activity of the brain changes and the
process of adaptive activity of the nervous system is
disturbed when the facial skeleton is fractured
involving trigeminal nerve networks. At the same time,
in patients with fractures of the facial bones, damage
to the peripheral departments can seriously affect the
course and prognosis of the main diseases.
Rahimov Z.K. (2022) focuses on the diagnosis
of
inflammatory
complications
and
complex
pathogenetic treatment of mandibular fractures.
However, increasing the efficiency of complex
treatment of patients with trigeminal nerve bundle
injuries in fractures of the facial and jaw bones has not
been fully elucidated, and the urgency of the problem
continues to this day. All of the above-mentioned
determine the purpose of this study, and for this
reason, it is necessary to carry out these scientific
studies.
The purpose of the study: Diagnosis of damage to
nerve fibers in patients with facial bone injuries and
improvement of treatment efficiency.
Material and research methods: In order to assess the
frequency of nerve damage in maxillofacial injuries, in
2017-2020, archival materials and anamnesis of patients
treated in the Department of Facial Injuries and
Complications of Neuroinjuries of the Samarkand
Branch of the Republican Specialized Traumatology
and Orthopedic Scientific and Practical Medical Center
(RITOIATM) were studied. 197 of them (86%) were men
and 32 (14%) were women. By age, 145 (63.3%) patients
were 18-30 years old and 84 (36.7%) were 31-50 years
old.
The information of medical documents was studied,
the general condition of patients at the time of arrival
at the hospital, the presence or absence of symptoms
of damage to peripheral nerve fibers, the nature of
symptoms, the course and scope of diagnosis, the
tactics and duration of treatment, the participation of
medical specialists with other specialties in the
treatment process were evaluated.
Based on the tasks set before the research being
carried out, 60 patients with fractures of the middle
and lower third of the face due to injury and damage to
the trigeminal nerve networks as a result of this were
Volume 03 Issue 11-2023
9
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
7-14
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
assigned to 3 groups based on the essence of complex
treatment measures, based on the method of random
selection. distributed:
Group 1 included 20 patients undergoing surgical
treatment
(reposition
of
bone
fragments,
osteosynthesis immobilization) and traditional drug
therapy.
The 2nd group was formed from 20 patients who
received the local treatment complex - surgery and as
an addition to traditional drug therapy, the drug
"Neuromidin".
Group 3 was composed of 20 patients undergoing
percutaneous diadynamic electroneurostimulation
(DD-ENS) in order to restore the sensitivity and
mobility of the peripheral branches of the trigeminal
nerve to the treatment regimen consisting of surgery
and traditional drug therapy and the addition of
"Neuromidin" .
A control group was formed from 20 somatically
healthy individuals with no injuries to the face-jaw area,
no central and peripheral nervous system pathologies
detected, in order to comparatively evaluate the
physiological indicators of the research participants in
the dynamics of the treatment and recovery process.
The results of scientific research were subjected to
statistical analysis using the generally accepted
method of variational statistics, using programs
designed for medical and biological research. The data
were entered into specially created tables for the
Microsoft Office Excel 2010 program of the Windows
XP operating system, as well as in the Stat Soft
Statistica v6.0 statistical program. The obtained data
were statistically processed using non-parametric
methods (Mann-Whitney test) and correlation analysis
(Pearson test). The results were presented as medians,
the significance of differences between mean values
was determined by Student's t-test. The principles of
evidence-based
medicine
were
used
in
the
organization and conduct of research. Student's t-test
was used (significance level 95%). Differences were
considered reasonable in cases with a significance level
of r<0.05.
Research results and discussions: 35 (58.3%) of
hospitalized patients had an isolated fracture of the
lower jaw, 15 (25%) had a fracture of the cheek bone
and upper jaw, 10 (16.7%) had a fracture of the cheek
bone and/or an isolated fracture of the cheekbone was
diagnosed. 41 (68.3%) patients had displacement
fractures, 19 (34.7%) had non-displacement fractures.
Most of the patients - 38 (63.3%) were admitted to the
hospital on the first day of injury, 11 (18.3%) - on the 2nd
day, 7 (11.7%) - on the 3rd day, 4 (6.7%)
–
brought on the
4th day.
The analysis of the rehabilitation periods of patients,
the speed of reparative processes in nerve tissue, and
the degree of restoration of motor and sensory activity
Volume 03 Issue 11-2023
10
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
7-14
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
of damaged nerves showed the following. In 22 (31.4%)
of 70 patients with sensory impairments, sensitivity in
the innervated zone of the damaged nerve was
restored in 3-3.5 months without additional drug
therapy and physiotherapy. At the same time, patients
who received injections and vitamin therapy achieved
full recovery after an average of 1.5-2 months. Of the 87
patients with symptoms of nerve fiber damage, 15
(17.2%) had persistent peripheral nerve dysfunction,
and 7 (8%) had muscle atrophy on the corresponding
side of the face, indicating poor or no efficacy of the
selected drug therapy.
In objective and X-ray examinations, it was found that
23 of 60 patients with fractures of the maxillofacial
area did not have bone displacements (0.5-0.7 cm).
Although the patients mainly complain of pain in the
area where the fracture is located, the pricus disorder
was not detected. 37 (61.7%) patients with
displacement fractures complained of loss of skin
sensation in the projection of the innervation zone of
the peripheral branches of the trigeminal nerve (Fig. 1-
2).
Out of 35 patients with mandibular fractures, 22 (62.9%)
had open, deep and transverse fractures of the pricus,
13 (37.1%) had no pricus problems. It was found that 44
(73.3%) patients suffer from painful and limited
opening of the mouth to one degree or another.
Figure 1. CT scan of fractures: on the left - image of the mandibular div taken from the right side; on the right - the
image of the upper jaw and cheekbone taken from the left side
Volume 03 Issue 11-2023
11
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
7-14
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Figure 2. Orthopantomography of the angle of the lower jaw fractured on the left side
It was found that all the patients included in the
research had varying degrees of conduction
disturbances along the nerve fibers, and this condition
was proven during electrophysiological examinations.
Axonal and demyelination changes of trigeminal motor
fibers in hypoesthetic diseases were clarified
(prolongation of initial and subsequent reflex response
components by 51.7% and 23.3%, respectively), 31 A
decrease of 7% was noted.
Research of evoked trigeminal somatosensory (ETS)
potentials during hyperesthetic changes showed the
presence of structural peripheral damage, which was
expressed in the prolongation of the latency period of
the initial and subsequent ETS components, and their
amplitude reduction.
In 11.7% of patients with hypoesthetic disorders, the
initial components were lost, and the subsequent
oscillations were characterized by low amplitude.
Trigeminal nerve damage was noted in 56.7% of
patients with fractured cranial nerves and during
electrophysiological
examination
sensory
and
paresthetic disorders were not detected by objective
methods, in others, ENMG results of healthy and
damaged sides and indicators of trigeminal ETS did not
differ. Electrophysiological examinations conducted in
patients with hypoesthetic changes made it possible to
identify signs of axonal and demyelination damage of
the motor fibers of the trigeminal nerve. In the ETS
curve, it was observed that the latency period was
lengthened, the amplitude of the initial components
was reduced, the primary threshold for sensing electric
Volume 03 Issue 11-2023
12
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
7-14
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
stimulation was expanded, in 18.3% of cases it was
found that the first components were missing, which
indicates a serious structural defect.
Thus, in 100% of all patients with fractures of the face-
jaw area examined in clinical conditions and by
instrumental methods, it was found that nerve fibers
were damaged. Trigeminal nerve involvement was
found in 53.3% of cases with severe fracture, sensory
and paresthetic disorders detected in clinical
conditions. With the help of electrophysiological
methods, in the absence of sensory-paresthetic
changes, the interest of the trigeminal nerve was
noted in 26.7% of cases. To sum up, the overall rate of
trigeminal nerve damage in the fractures of the UJS
was 78.3%.
By determining the zones of hypesthesia and
hyperesthesia in the patients of the studied groups, by
evaluating the condition and tone of the chewing
muscles, disorders of one or another sensory and
motor function of the peripheral branches of the
trigeminal nerve were noted. All patients who were
brought to the hospital as a result of fractures of the
bones of the facial skeleton underwent electro-
odontodiagnosis on the same day. But during the
examination, the teeth in the fracture hole were not
covered and they were removed according to the
instructions. During EOD, no obvious disturbance of
the sensitivity of the maxillary teeth was detected, the
indicators were noted to be within the normal range,
which is explained by the specific characteristics of the
innervation of the maxillary teeth row (back, middle
and anterior upper alveolar branches).
CONCLUSIONS
The low effectiveness of treatment measures aimed at
restoring the activity of damaged nerves in patients, as
well as the quality and efficiency of the specialized
assistance provided by our algorithm in diagnosis,
treatment and rehabilitation have been increased.
Early and late complications of orthopedic and surgical
operations in facial bone fractures, depending on the
level and severity of damage to the fibers of the
trigeminal nerve, were studied. disturbances of one or
another sensory and motor functions were noted, in
particular, a severe level of nerve damage was noted in
13 (21.7%) cases where the bone fragments were
displaced more than 1.0 cm. 29 (48.3%) cases with
displacement of 0.5-1.0 centimeters were recognized
as moderate, and cases with displacement up to 0.5
centimeters were recognized as mild displacement.
REFERENCES
1.
Абдуллаев
Ш.Ю.
Остепластические
материалы
для
ущерба
дефектов
и
деформаций челюстно
-
лицевой области. /
Ш.Ю.
Абдуллаев,
Н.В.
Храмова
//
Стоматология. 2018.
-
Т. 59–60, № 1
-2. -
С. 98
-
101.
Volume 03 Issue 11-2023
13
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
7-14
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
2.
Абдуллаев А. и др. ПОРОГ ВОЗБУДИМОСТИ
ПРИ НЕВРИТЕ ВЕТВЕЙ ЛИЦЕВОГО НЕРВА
//Центральноазиатский журнал образования
и инноваций. –
2023.
–
Т. 2. –
№. 6 Part 4. –
С.
27-32.
3.
Абрамов Н.В., Шарахова Е.Ф. Динамика
основных
показателей
травматизма
населения
Кемеровской
области
//
Сибирское мед. обозрение. 2019.
-
№2.
-
С.
41-
44.
4.
Байриков И.М., Логинов О.А., Савельев А.Л. и
др. Сравнительный математический анализ
применения
накостных
пластин
для
остеосинтеза отломков нижней челюсти
//Вестник Вестник Российской Военно
-
Медицинской Академии. Приложение, 2019.
-
№1.
-
С. 65
-66.
5.
Бузрукзода Ж. Д. и др. УСТРАНЕНИЕ
ПЕРФОРАЦИИ ДНА ВЕРХНЕЧЕЛЮСТНОГО
СИНУСА
С
ПРИМЕНЕНИЕМ
ОСТЕОПЛАСТИЧЕСКОГО
МАТЕРИАЛА
//Интернаука. –
2021.
–
№. 7
-1.
–
С. 25
-27.
6.
Ерокина
Н.Л.
Ранняя
диагностика
осложненного течения перело¬мов нижней
челюсти и обоснование иммунокоррекции:
Автореф. дис. ... канд. мед. наук.
-
Волгоград,
2018. 16 с.
7.
Жартыбаев
Р.Н.
Профилактика
посттравматических
осложнений
при
переломах нижней челюсти: / Дис. ...
-
Алма
-
Ата, 2008. 158 с.
8.
Железный П.А. Результаты костной пластики
нижней челюсти у де¬тей и подростков //
Восстановительная
хирургия
челюстно
-
лицевой области.
-
М., 2015.
-
С. 107
-109.
9.
Иорданашвили
А.К.
Заболевания,
повреждения и опухоли челюстно
-
лицевой
области: руководство по клинической
стоматологии / А.К. Иорданишвили
-
Санкт
-
Петербург, СпецЛит, 2007. 494 с.
10.
Иорданишвили А.К., Слугина А.Г., Балин Д.В.
и
др.
Возрастные
особенности
репаративного остеогенеза челюстей //
Курский
научно
-
практический
вестник
«Человек и его здоровье». 2014. № 3.
-
С. 15
-
21.
11.
Калиновский Д.К., Матрос
-
Таранец И.Н.,
Алексеев С.Б. Совершенствование оказания
медицинской помощи на этапах лечения и
реабилитации пострадавших с травмами
челюстно
-
лицевой
области
/
Д.
К.
Калиновский, // Врач скорой помощи.
- 2009.
-
№ 5.
-
С. 18
-24.
12.
Alimdjanovich R. J., Abdullaev A. S. PASTKI
ALVEOLYAR
NERV
YALLIG’LANISHINI
DAVOLASHDA NUKLEO CMF FORTE NING
O’RNI //Евразийский журнал медицинских и
естественных наук. –
2022.
–
Т. 2. –
№. 5. –
С.
82-92.
Volume 03 Issue 11-2023
14
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
11
P
AGES
:
7-14
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
13.
Alimdzhanovich R. J., Sarkhadovich A. A.
Prospects for the treatment of neuritis in
fracture of the lower jaw //ACADEMICIA: An
International
Multidisciplinary
Research
Journal.
–
2022.
–
Т. 12. –
№. 4. –
С. 712
-717.
14.
Abdullaev A., Turopov F., Narzikulov D.
POSTTRAUMATIC NEURITIS OF THE INFERIOR
AL
VEOLAR NERVE //Бюллетень студентов
нового Узбекистана. –
2023.
–
Т. 1. –
№. 6 Part
2.
–
С. 67
-70.
15.
Fayzullaev U. R., Sarkhadovich A. A. A METHOD
FOR INCREASING THE EFFECTIVENESS OF
CHON-DROPROTECTIVE
THERAPY
IN
PATIENTS WITH TMJ ARTHRITIS-ARTHROSIS
ACCOMPANYING
CERVICAL
OSTEOCHONDROSIS
//Asian
journal
of
pharmaceutical and biological research.
–
2022.
–
Т. 11. –
№. 2.
16.
Sarkhadovich A. A., Saidalimovich K. A.,
Alimdjanovich R. J. ПОРОГ ВОЗБУДИМОСТИ
ПРИ
НЕВРИТЕ
НИЖНЕАЛЬВЕОЛЯРНОГО
НЕРВА //JOURNAL OF BIOM
EDICINE AND
PRACTICE.
–
2022.
–
Т. 7. –
№. 4.
17.
Turanboyev B., Abdupattayev A., Abdullaev A.
INFLYATSIYANING QIMMATLI QOG'OZLAR
DAROMADIGA TA'SIRI //Yosh Tadqiqotchi
Jurnali.
–
2023.
–
Т. 2. –
№. 2. –
С. 88
-100.
