The high growth of injuries, the absence in the country of a unified approach to the treatment of victims with pathology of the bones of the face and skull leads to a sharp increase in the number of patients with post-traumatic deformities, defects, often to their disability and death. This problem has recently acquired the greatest importance in connection with the increase in the number of victims in areas of natural disasters and road traffic accidents. Severe multiple fractures of the bones of the middle zone of the facial skeleton, accompanied by craniocerebral trauma of varying degrees, bleeding and liquorrhea, are often outwardly unnoticeable, since they are hidden by pronounced edema, hemorrhages in soft tissues, and can only be determined with a targeted specialized examination. These types of examinations and the provision of specialized medical care are possible only in multidisciplinary centers. Therefore, these types of injuries are not always diagnosed in a timely manner, especially in severely injured with the presence of pronounced injuries of other localizations.
Fractures are one of the most common components in multiple and associated injuries. Fractures of the lower jaw are observed in 76%, of the upper jaw in 24%, a fracture of the zygomatic-orbital complex in 12%. The actual problem of modern traumatology is the violation of reparative osteogenesis with injuries combined with facial trauma. The duration of the consolidation of fractures is determined by the degree of microcirculation disorders in the fracture zone, changes in cellular and coagulation hemostasis and mineral metabolism. In this connection, increasing the effectiveness of treatment of fractures of the bones of the face on the basis of early diagnosis of vascular and hemostasiological changes is of great importance for practical health care.
The problem of treatment of pyoinflammatory diseases (PID) of the face and neck is relevant for both dentists of polyclinics and maxillofacial surgeons in hospitals. About 50% of those in maxillofacial hospitals, and about 20% of those who seek help from a dentist and a surgeon of polyclinics, are patients with inflammatory diseases of the maxillofacial region (MFO), among them - 60-80% of patients with abscesses and phlegmons, the frequency of which has increased by 1.5–2.0 times over the past decade. There has been a steady growth of atypical and severely flowing progressive phlegmon, spreading simultaneously in several cellular spaces, with the development of such formidable complications as sepsis, contact mediastinitis, and thrombosis of the cavernous sinus of the dura mater. Low-symptom “erased” forms of phlegmon are found among 13.4–22% of patients, are characterized by a long course and are difficult to diagnose, which contributes to late hospitalization and untimely treatment started. Microbial etiology of HVZ CLO is due to the localization of the primary process (connection with the oral cavity, teeth).
The aim of the work is to systematize the data of special literature for the clearest definition of the directions of studying the modern approach to the diagnosis, prognosis and treatment of pyoinflammatory processes in the maxillofacial region and neck. As a result of the analysis of the data of special literature, it becomes obvious that in recent decades the idea of the etiology and pathogenesis of pyoinflammatory processes in the maxillofacial region and neck has changed, which determines the need for further search for new informative methods of diagnosis, prognosis, as well as the most effective methods of treatment and prevention of complications for this pathology.
Юз-жағ соҳаси қўшма жароҳатларида калла суяклари, бурун ва бурун ёндош бўшлиқларининг биргаликда шикастланишлари туфайли шифохоналар
жонлантириш бўлимларида йилдан йилга беморлар сони ошиб бораётганлиги амалиётда кузатилмоқда.
Юз суякларининг қўшма жароҳатлари бор беморларда бурун ва бурун ёндош бўлиқлари жароҳатларини эрта ташхислаш.
Усовершенствование тактики оказания лечебно-диагностической помощи при сочетанных травмах верхнечелюстной пазухи.
In modern conditions of society development, improving the quality of medical care is of extremely important social significance. Scientific and technological progress and the totality of modern social relations impose increasingly high professional, moral, ethical and legal requirements to specialists in the field of health care [1,2,5].
Combined injury of the maxillofacial region remains one of the topical problems of maxillofacial traumatology. Combined trauma to the maxillofacial region requires joint medical care by several specialists. Trauma of the upper and middle zones of the face is often accompanied by trauma of the eye socket, paranasal sinuses. They are difficult to diagnose, in case of untimely diagnosis and rendered assistance lead to secondary defects and deformities. Damage to the walls of the orbit, leads to scarring changes in the fiber of the eye socket, eye muscles, persistent diplopia, ocular nerve impingement, persistent eye asymmetry, decreased or loss of vision is the cause of frequent disability.
Topicality and demand of the subject of dissertation. In the world lat days chanchcd structures of trauma, increase the number of heavy combined traumas, which resulting in more heavy nature of simultaneous injuries of three , four or more anatomical regions, which creates difficulties in determining of the order of care and surgical tactics in patients with combined traumas of the facial skeleton bones (CTFSB). The syndrome of mutual burdening injuries of various anatomical regions, variety, hcavity and speed of the development of pathological process did difficulty of diagnosis of the CTFSB. Complexity of the clinical picture, features of the progress of post-traumatic shock, the development of traumatic disease cause difficulties which arise in the course of examination of patients and put tasks to the experts to find new ways of developing diagnostic algorithms and early surgical treatment of the CTFSB.
Frequency of CTFSB ranges from 34,8 to 63,3%. Fractures of orbit has been observed with an extremely high frequency (98%) in CTFSB, injury of the orbit is accompanied by damage of the eyeball and its subsidiary bodies has been observed in 66 % of eases. Consequences of eye injuries arc becoming the leading cause of disability and in 50% of eases could cause permanent loss of vision. By reason of death combined trauma take the third part after coronary heart diseases. Frequency of disfiguring defects and deformities of face occurs in 12 and 57%, disability in CTFSB reaches up to 23%. CTFSB, combined with TBI, causes up to 60% of deaths.
The causes of unsufficient results is non-availability of a diagnostic algorithm, which includes the most informative research methods, determining the order of interaction and priority of work of doctors of various specialties in CTFSB.
In some eases, requires specified an indications, character, scope, sequence and timing of surgical interventions, depending of the objective assessment of heaviness of injuries to various anatomical regions, prognosis criteria, the nature and heaviness of life-threatening consequences of combined trauma. The research work earned out within the framework of the achievement of the set by the Decree of the President of Republic of Uzbekistan “About measures on the further deepening reform the health care system” November 28, 2011, № PD-1652, maintenance of high-quality medical aid to the population under modem requirements and standards.In this regard the need for the development of algorithms of diagnosis and early methods of surgical treatment of patients with CTFSB constitute one of the important criteria demand the theme of dissertation.
Purpose of research is improvement of the diagnostic tactics and therapeutic interventions in patients with acute combined injuries of the facial bones according to the severity and location of the injury.
Scientific novelty of disscrtational research consists in the following: revealed the structure and features provide consistent care to patients with combined injuries in Republic of Uzbekistan;
The sequence of diagnostic and therapeutic measures, depending on the patient's general condition with CTFSB first determined by using created CT program "ADIL
developed innovative methods for early reduction and fixation of bone fragments in CTFSB;
identified endogenous factors, affecting on the wound process, disclosed the mechanisms of post-traumatic complications in CTFSB;
proved, that at 2 - 3rd days after the injury occurs the depression of cell and humoral immunity in the blood. Increases the level of proinflammatory cytokines, reduced the level of anti-inflammatory cytokine (in 2,8 at patients with heavy commonl condition. Increased levels of pro - and reducing anti - inflammatory cytokines is a poor prognostic factor in the development of inflammatory complications (bone wound suppuration, osteomyelitis of the jaw bones, soft tissue abscess);
patients with CTFSB at 2 - 3rd days after the injury occurs the depression of the content of protein and micronutrients (calcium, potassium and phosphorus) in the blood, which is a prognostic factor of the development of complications;
a scheme was developed for integrated medical correction of endogenous factors affecting on the development of posttraumatic complications;
1. CTFSB in 100% of cases combined with TBI, in 27.7 % with injuries of skeleton and internal injuries. In the diagnosis and treatment of patients with CTFSB should participate resuscitator, maxillofacial surgeon, neurosurgeon, ophthalmologist, and otolaryngologist. Primary debridement of wounds, reduction and fixation of bone fragments in patients in compensated state should be done within 3 hours after injury, while at subcompensated state - during the first day, and at the decompensated state - within 3 days.
2. With the CT program "ADIL" can determine the overall condition of patients in a short time. The most informative diagnostic criteria arc the general condition of patients, level of consciousness, hemodynamic stability, shock index and temperature gradient. The severity of the general condition of patients is directly dependent on the localization of the fracture of the facial bones. Multiple fractures of the upper and middle areas of the face arc the most serious injury in patients.
3. Patients with CTFSB in compensated and subcompensated state emergency surgical aid and diagnostic procedures should be performed in full volume (maxillofacial surgery, traumatology, neurosurgery, surgery, ophthalmology and otorhinolaryngologist), including the reduction and fixation of bone fragments in the first day. To patients with CTFSB in state decompensated should be performed at least diagnostic procedures, limiting the amount of emergency surgery. Reduction and fixation of bone fragments should be done after the restoration of function of vital organs and systems.
4. The method of choice for the treatment of depressed large bone fragments of facial bones is a titanium distractor, the use of which gives a good clinical and functional outcome.
5. When depressed fracture of the zygomatic arch application of the developed device will allow us to produce reduction and fixation of bone fragments in the early stages (within one day) with a good cosmetic result.
6. At patients with CTFSB in posttraumatic period (7- 14th day.) there arc a deep depression of CD3, CD4 cell composition, humoral factors and secretory immune system, increased necrosis factor CD95, increasing the levels of proin-flammatory (IL-6 ) and a decrease - anti- inflammatory (IL -10) cytokines. On 9-10th day reduced total protein, calcium, potassium and phosphorus in the blood .
7. Reduction of cellular and humoral immunity, increased proinflammatory cytokine and tumor necrosis factor, reducing the anti-inflammatory cytokine , the protein concentration in the blood, calcium, potassium and phosphorus arc predictors of complications.
8. Application of complex drug therapy within the 1-3 days after the injury with the inclusion of immune ( immunomoduline, ribomunil ), enzyme ( Voben-zym ) drugs osteoplastic materials allows to correct the violation of homeostasis, also used to prevent complications.
The article presents the results of an experiment to study the effect of surfactant concentration and type on foam formation in clay suspensions. As a result of the study, it was found that the addition of surfactants to the system leads to an increase in the volume of foam, and the most significant effect is observed when using surfactants of the type OP-10. With an increase in the concentration of surfactants to a specific value (0.3%), a sharp increase in the height of the foam is observed; however, a further increase in the concentration does not have a significant effect on the
amount of the formed foam. The study also showed that the height of the foam in the system with surfactant type OP-10 is higher than in the system with surfactant type GKJ-11, which indicates greater foam adsorption at the liquid-air interface. The study of the surface tension of surfactant solutions showed that the surfactant type OP-10 has more significant properties of the surfactant than the surfactant type GKJ-11. These results may be useful to improve the foaming in slurry drilling fluids using various types and concentrations of surfactants.