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UDK 616-002.36.364.
OPTIMAL METHODS OF TREATMENT OF PURULENT-INFLAMMATORY
PROCESSES OF MAXILLOFACIAL REGION
Farmonov Feruz Giyos ugli
https://orcid.org/0009-0002-0296-6071
Bukhara State Medical Institute named after Abu
Ali ibn Sina, Uzbekistan, Bukhara, A. Navoi str. 1.
E-
mail:
info@bsmi.uz
Annotation:
This article covers the issue of purulent-inflammatory pathologies of the
maxillofacial region, as well as the factors that cause them and possible complications. The
author analyzes effective treatment options, including the use of drugs and surgery. The
importance of prevention and oral hygiene is emphasized. The article will be interesting and
useful for dentists and medical professionals, as well as for readers interested in health problems
and self-treatment.
Keywords:
purulent-inflammatory diseases, maxillofacial region, odontogenic abscesses,
phlegmons, diagnosis, virulence of microflora, microcirculation, antimicrobial resistance, sepsis,
inflammatory processes.
Relevance.
Purulent-inflammatory diseases of the maxillofacial region (PFD of the
maxillofacial region) remain one of the most widespread and complex problems of modern
surgical dentistry and maxillofacial surgery, the main cause of intracranial complications and
septic conditions, temporary disability among the population. Despite the fact that primary
prevention of GVHD of the maxillofacial region, consisting in timely sanation of chronic
odontogenic infection foci, is the most effective, early diagnosis and treatment can reduce the
risk of the most serious complications of GVHD of the maxillofacial region [3,8].
Acute purulent-inflammatory diseases (APPD) remain one of the most widespread types of
pathology. This issue is problematic for dentistry where, despite the development of a large
number of means and methods of combating acute purulent infection, there is also an increase in
the incidence of acute purulent-inflammatory diseases of the maxillofacial region and an increase
in the number of patients with severe forms and unfavorable outcomes (Shargorodskiy A.G.,
2001; Prokhvatilov G.I. et al., 2003; Kozlov V.A., 2006, etc.). Treatment of patients with OGVZ
should be complex, including operative treatment and conservative measures. The latter are
conditionally subdivided into general and local effects. General therapy is necessary to combat
infection and intoxication, restore the balance between the div and the environment, activation
of nonspecific and specific reactivity of the div, normalization of the functions of organs and
systems. Local treatment in the acute phase of inflammation is carried out to create an outflow of
pus and exudate from the purulent focus, accelerate necrolysis, limit the zone of inflammation
and necrosis spread, reduce intra-tissue pressure, resorption of decay products, as well as to
normalize microcirculation, improve regeneration and create unfavorable conditions for
microorganisms [1].
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The relevance of this scientific study lies in the fact that acute odontogenic inflammatory
diseases of the maxillofacial region (MFR) represent an important medical problem in surgical
dentistry. The frequency of inflammatory processes in the maxillofacial region ranges from 55,
65%, and in the structure of acute purulent-inflammatory diseases of the maxillofacial region
reaches 69.5% [7].
The problem of optimization of complex treatment of patients with purulent-inflammatory
diseases (PID) of the maxillofacial region (MFR) does not lose its relevance due to the
aggravation of the course of the disease, the tendency to generalization of the process and the
steady increase in morbidity rates, the number of complications, relapses and adverse outcomes.
According to statistical data, patients with purulent-inflammatory diseases of the maxillofacial
region make up about 15-20% of patients applying to dental polyclinics and more than 70% of
patients receiving specialized medical care in departments of maxillofacial surgery. Patients
hospitalized with the diagnosis of abscess or phlegmon account for 25% to 65% of the total
number of patients [3,4, 6].
Thus, purulent-inflammatory diseases of the maxillofacial region are a serious problem that
requires correct and timely treatment. Optimal treatment includes drug therapy and surgical
intervention, as well as prophylaxis consisting of oral hygiene, regular check-ups with a dentist
and a healthy lifestyle.
Materials and methods of research.
During 2021-2024, 285 patients with purulent-
inflammatory diseases of the maxillofacial region were under our observation in the
maxillofacial surgery department of the Bukhara Regional Multidisciplinary Medical Center. On
admission to the department all patients were examined by a surgeon-dentist and maxillofacial
surgeon on duty, a detailed history of life and disease was collected. General clinical laboratory
tests required for emergency care were performed on the patients. The operation plan was made
together with anesthesiologists, if necessary, with other profile specialists in the presence of
concomitant diseases. Additional specialized investigations were performed when indicated. If
the patient's condition was severe, infusion therapy was carried out before surgery to stabilize the
functions of vital organs and systems. As a rule, surgical intervention was performed under
intravenous anesthesia and always after premedication. In the course of surgery, the location of
purulent-inflammatory process in the BFO, the size of the lesion and the degree of spread were
clarified. The recovery stage included detoxification, anti-inflammatory, desensitizing therapy,
etc. According to the indications and results of patient observation in dynamics, adjustments
were made to the treatment regimen. All medical documentation was also analyzed; statistical
methods were used to determine the average duration of treatment, the average number of bed-
days required for the treatment of various nosological forms of purulent-inflammatory diseases
of the NPO, depending on the prevalence, duration of the pathology, the number of affected
anatomical zones and other factors.
We examined 285 patients with purulent-inflammatory diseases of the maxillofacial region. As a
result, a control group of 150 patients was formed. Depending on the type of local therapy the
patients were divided into 3 groups by random sampling method
Localization of purulent-
inflammatory disease of the
maxillofacial area
Groups
1
2
3
conventional
therapy
conventional therapy
+
Propolis 30mg
conventional
therapy +
Propolis
30mg
+laser
photodynamic
therapy
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One anatomical
space (n=67)
17
25
25
Two anatomical spaces
(n=52)
20
15
17
Three or more anatomical
spaces (n=31)
13
10
8
Total
50
50
50
Group 1 consisted of 20 patients in whom local treatment after opening of the purulent focus,
exudate evacuation and drainage installation was limited to regular washing with antiseptic
solutions - furacillin in the ratio of 1:5000 and 5% chlorophylipt solution during daily dressings,
and also laser photodynamic therapy (LPT) was performed.
The 2nd group consisted of 20 people who were included in the local treatment complex after
traditional wound treatment with dressings with “Propolis 30 mg” ointment;
The 3rd group consisted of 20 patients who were included in the complex local therapy after
washing the purulent wound with antiseptic solutions (conventional therapy) during daily
dressings with water-soluble polyethylene glycol (PEG) based ointment “Propolis 30 mg” in the
form of a dressing with the application of local laser photodynamic therapy (LPT).
RESULTS AND DISCUSSION
Patients in all groups of the study were first of all treated surgically: extraction of the causative
tooth, opening and drainage of the purulent focus.
Taking into account the prevalence of the inflammatory process and the nature of the course of
the disease, all patients were prescribed complex treatment: in the acute period of the disease -
therapy with broad-spectrum antibacterial drugs, and then selective prescription of antibiotics
taking into account the composition and sensitivity of microflora, detoxification therapy,
including colloid and crystalline solutions (glucose solution 5%, saline solutions - 0.9% sodium
chloride, hemodez, rheopolyglukin, metrogil-100), desensitizing therapy (dimedrol, suprastin),
vitamin therapy and symptomatic treatment depending on the disease clinic.
In local treatment in patients after opening of abscess or phlegmon, during daily dressings, drains
were changed, the wound surface was irrigated with antiseptic solutions (3% hydrogen peroxide,
furacilin 1:5000, chlorophyllint 5%), early secondary sutures were applied.
Then the patients of the 2nd and 3rd groups (after LFDT procedure) were applied bandages with
ointment on water-soluble polyethylene glycol (PEG) base “Propolis 30 mg”. “Propolis 30 mg”
is a combined preparation, has antimicrobial, anti-inflammatory, local anesthetic, regenerating
effect. Hydrophilic and hyperosmolar base of the ointment is a mixture of polyethylene oxides
(polyethylene glycols) with molecular weights of 400 and 1500 (PEG-400 and PEG-1500),
which provides dehydrating (moisture-absorbing) and osmotic action on tissues, which is 20
times stronger than 10% sodium chloride solution and lasts up to 18-20 hours. Hyperemia and
edema of soft tissues in the area of inflammation significantly decreased. In the control group (25
patients), treated by traditional methods, 88,3 % of patients had relief of these symptoms on
average 2,3±1,05 days later than in the main group, and 11,7 % of patients required 2,9±1,3 days
more time for relief of these clinical signs.
CONCLUSIONS.
Purulent inflammatory diseases of the maxillofacial region can be caused by various reasons
such as bacterial infection, trauma, and others. Optimal treatment includes drug therapy and
surgical methods, as well as a preventive approach such as proper oral hygiene and a healthy
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lifestyle. It is important to seek medical attention at the beginning of the disease to avoid
possible complications and preserve the health of the maxillofacial region. Inclusion of dressings
with “Propolis 30 mg” ointment and LFDT sessions in the traditional treatment regimen for
purulent-inflammatory diseases of the maxillofacial region restores microbiological,
immunological and biochemical parameters to normal values, which is positively reflected in
clinical observations - signs of inflammation are eliminated on the 3-4 day of treatment, and the
healing time of purulent wounds is significantly reduced (up to 38% on average), preventing the
formation of purulent scars and the development of complications.
In order to objectivize pathological therapy, a complex scheme of joint application of LFDT and
polyethylene glycol-based ointment “Propolis 30 mg” was developed and implemented, allowing
to reduce the period of hospitalization of patients to an average of 35%.
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