Таким образом, у больных с ВРГН при сочетанном назначении
актовегина до операции наблюдается потенцирующее друг
друга фармакологическое действие, направленное на угнетение
активности системы ПОЛ и повышение энзимной системы АОС.
Можно предположить, что важном звеном в механизме
активации заживления операционного поля является экономное
и достаточно целенаправленное поступление необходимого
количества молекулярного кислорода.
Под действием актовегина снижение ПОЛ на 5-е и 9-е сутки
исследования
характеризовалось,
в
свою
очередь,
восстановлением резервов АОС и по системе "обратной связи”
подавлением ПОЛ. Фармакологическое действие актовегина
также опосредуется стимуляцией функциональной активности
системы
цитохром
Р450,
активацией
окислительно-
восстановительных
процессов,
энергообразования,
подавлением интенсивности ПОЛ, усилением пролиферативных
процессов и активацией системы АОС.
Следовательно,
результаты
клинических
наблюдений
убедительно свидетельствуют о высокой терапевтической
эффективности сочетанного применения двух лекарственных
форм актовегина до и после операции.
Выводы
1.
У детей с врождённой расщелиной губы и (или) нёба
метаболические процессы в тканях ротовой полости
значительно нарушаются.
2.
После уранопластики базисная терапия оказывает
недостаточное влияние на ПОЛ и АОС в тканях ротовой полости,
послеоперационное
течение
осложняется
нарушением
заживления раневой поверхности и расхождением швов.
3.
Включение в комплекс послеоперационной терапии
актовегина способствует значительному улучшению многих
показателей ПОЛ-АОЗ, поэтому его назначение для повышения
эффективности
послеоперационного
лечения
детей
с
врождённой расщелиной губы и (или) нёба можно считать
патогенетически обоснованным.
Список литературы
1.
Бессонов С.Н., Давыдов Б.Н. Стандартыком- плексного
лечения пациентов с деформациями средней зоны лица,
обусловленными врожденными расщелинами верхней губы и
неба II Стандартизация методов лечения в пластической и
реконструктивной хирургии: Материалы 2-й Всеукраинской
науч.-практ. конф. - Киев, 2006.-С. 8-9.
2.
Борисов Г.А., ПенкновичА.А., Мухина И.В. Мета-
болические эффекты нейротропного действия актовегина в
условиях гипоксии 1/Экспер. и клин, фармакол. -1 999.-NS2.-
C.61-63.
3.
ГерасимоваЛ.Л.
Сравнительный
анализ
эффек-
тивности различных методов комплексной терапии детей с
врожденными расщелинами верхней губы и неба: Автореф.
дис.... канд. мед. наук. - Пермь, 1991.—21 с.
4.
Дьякова С.В., Яковлев С.В., Першина М.А. Современный
подход к диспансеризации детей с врожденной патологией
челюстно-лицевой области IIВрожденная и наследственная
патология головы, лица и шеи у детей: актуальные вопросы
комплексного лечения: Материалы 2-й Всерос. науч.-практ.
конф. - М., 2006. - С. 85-89.
5.
Савенкова М.С., Гончаков Г.В., Гончакова С.Г.,
Печникова Ю.В. Выбор антибактериальной терапии в
условиях хирургического отделения у детей с врожденной
расщелиной губы и неба 1/Вестн. оториноларингол. -2010.-
№3.-С. 60-65.
6.
Чао КумДя. Профилактика раневой инфекции при
хирургическом лечении детей с врожденной расщелиной неба:
Автореф. дис.... канд. мед. наук.-М., 1991.-23с.
7. Aziz S.R., Rhee S.T., Redai I. Cleft surgery in rural
Bangladesh: reflections and experiences// J. Oral Maxillofac. Surg. -
2009. -
Vol. 67, №8. - R 1581-1588.
Gbolahan O.O., Ogunmuyiwa S.A., Osinaike B.B. Randomized
Controlled Trial comparing Dressing and No Dressing of Surgical
Wound after Cleft Lip Repair // J. Contemp. Dent. Pract. -2015,- Vol.
16, №7. - P. 554-558.
http://dx.doi.org/10.26739/2091-5845-2019-2-25
UDK: 616.833.156.6-001 +616.091.9-092.4
STUDY OF ULTRASTRUCTURAL CHANGES IN
THE NERVE FIBERS ON AN EXPERIMENTAL
MODEL OF ACUTE TRAUMA OF INFERIOR
ALVEOLAR NERVE
Kaliberdenko V.B., Poleshchuk O.Yu., Khamidova
Sitora Alisher qizi, Khallaev Kamran Kerim ogli,
Shanmugaraj K.
Vernadsky Crimean Federal University, Simferopol, Russia
Аннотация
Предложен способ формирования моделей травмати-
ческого неврита на экспериментальной модели острой травмы
нижнего альвеолярного нерва. Авторы проанализировали
ультраструктурные изменения в нервном волокне на третий,
десятый и тридцатый день. На третий день после травмы мы
наблюдали нарушение внутрисистемной гемомикроциркуляции,
вызванное повышенной проницаемостью сосудов. К 10-му дню
эксперимента в периневральной ткани и самом нервном волокне
преобладали дегенеративные и воспалительные процессы. На
30-
е сутки после повреждения сосудистонервного пучка нижнего
альвеолярного нерва дегенеративные и воспалительные
явления в нервном волокне сменились дегенеративными и
склеротическими процессами.
Annotation
We propose a method of forming models of traumatic neuritis in
an experimental model of acute trauma of the inferior alveolar nerve.
We analyzed the ultrastructural changes in the nerve fiber on the
third, tenth, and thirtieth day. On the third day after the injury, we
observed a violation of the
30
Стоматология • №2(75)2019
3
J
j
I/
3
1
.
■ eastern
hemomicrocirculation caused by increased vascular
jevmeability.
By the 10th day of the experiment, in the
:e- neural
tissue and the nerve fiber itself, degenerative and -
■ammatory
processes dominated. On the 30th day after the
*>-7
of
the
neurovascular bundle of the inferior alveolar
-e-.e.
degenerative and
inflammatory phenomena in the
-=-.e
fiber
gave place to
degenerative and sclerotic
:neoesses.
Key
words:
Ultrastructural changes in the nerve fiber,
Ecenmental
model, Traumatic neuritis, Inferior alveolar
"'acmatic
neuritis (TN) of the inferior alveolar, nerve in the
:
.“scent dental practice is one of the most frequent complica- №
arising
from non-compliance with the technique
:;-?_ction
anesthesia, endodontic treatment of molars and
«rrfcular
premolars,
dental implants, removal of third lower ■ ■ (especially regarding
retention and dystopia).
:
'otlems
of damage and regeneration of the nervous
sue and
pathological changes in the nerve fiber during re.srrent
were
discussed in many scientific publications
sarachev
DA, Chumakov
E.I., 1999; Timofeev A., Vesova
2906:
Popelyansky J.Yu., 2005;
Edranov S.S., 2008). At
re
same time,
most of the works describes
the morphological
re -
ces that
occur with the complete crossing of
the nerve.
S j
гifica
ntly less research were devoted to injuries accom-
:&■
ec oy short-term mild damage to the inferior alveolar ner- e
= r
cugh
such damage is the most characteristic of outpati- : oomtments
with
a dentist. We have developed a method
-
—.ng
models of TN, the
most characteristic of dental
э:е"оп.
It
was found that the most
pronounced inflammatory
: h» dystrophic morphological changes in
the nerve and ’=‘e-ral
tissues develop in animals that have
undergone
I .• ~om short-term compression of the neurovascular :
e -ewever, it still needs to be discovered, what kind of crural
changes are caused by such trauma and how
c ‘ lakes for these
changes. Data on this will allow
я
- ::
"g
methods of pathogenetically
directed therapeutic
:■ :’~e prevention and treatment of traumatic
neuritis.
И-
•
Й
«I
M
1
Й
e
■
e
ю
м
le
D
a-
le
1
И
Aroose of the study
The aim
of our research was to study about the
л as-.rural
changes in inferior alveolar nerve fibers in the
—г :e->cds after
damage on an experimental model's injury
short-term compression
of the neurovascular
:ic
ne
al
iy.
Aerials and methods
■ : anoratory
rats of the Wistar line, under intramuscular
e~es
a the
mucosa and periosteum were dissected in
?-
• : :a: on of the
mouth and the preparation of the ■ -. ■:. ascular bundle of the
inferior alveolar nerve was carried
r ~e~
a hemostatic clamp was
applied to the later for 30 Ti::-:s. After
the procedures were
performed, the
: ce^osteal flap was put in place and fixed with
interrupted sutures.
In the postoperative period of 2 days the ani-
-
ё = -s-ce ved inside a suspension of nime sulide 2 ml, 2 times
:
E
.
-
-
:ermsof1st,3rd, 10th and 30th days, they were taken
: j
re
experiment. In order to obtain a review of micro: : preparations, as
well as for studying the state of -rnec-eve
tissue elements, we used
conventional histolo-
: ■ -ethods of staining with Hematoxylin-Eosin
and Van Ses:- The
material for electron microscopy was prepared
?:;x " ng to the standard technique: fixed on cold in 2.5%
glutaraldehyde solution on phosphate buffer with a pH of 7.4,
followed by fixation by Millohing one percent solution of OsO4. After
dehydration in acetone, the nerve pieces were poured into epon and
placed in a thermostat at + 60° C for 48 hours to polymerize the
resin. UMTP-7 ultramicrotome was used to obtain semi-thin
sections, on the basis of which targeted sharpening of the pyramids
was carried out. Ultrathin sections were stained with uranyl acetate
and lead citrate by Reynolds, viewed and photographed in a
transmission electron microscope PEM-100.
Results and discussion
The developed methodology of the experiment stimulates
situations that arise during the short-term penetration of the dental
implant into the mandibular canal, removal of the lower molars
(including retained and dystopic third molars) directly adjacent to the
inferior alveolar nerve.
When observing the animals of this series in the 1st day after
surgery there was swelling and hyperemia of soft tissues around the
operating wound that spread to neighboring areas. Animals were
lethargic, poorly consumed food. By the 3rd day tissue edema
slightly decreased, hyperemia persisted and slight infiltration
appeared around the edges of the wound. Palpation of tissue in the
wound area caused a violent motor reaction of animals. By the 10th
and 30th day on the mucous membrane of vestibule of the mouth
was determined dense whitish scar, slightly towering over
surrounding tissues. Palpation of tissues in the scar area in animals
caused a moderate motor response.
After 24 hours of surgery, microscopic examination showed
signs of edema and serofibrinous soaking at the edges of the wound,
tissue structures, foci of necrobiosis and hemorrhages with
disorganization of glandular structures, signs of vacuole and
granular dystrophy with hyperchromia and karyopicnosis of nuclei.
In electron microscopic examination areas of pronounced
microcirculatory disorders revealed morpho-functional signs of
transcapillary metabolism with disorganized intracellular organelles
of endotheliocytes, basement membrane, pericytes. There were
patches of endothelial cell cytolemma detachment from the basal
membranes, in their cytoplasm - micropinocytotic vesicles,
numerous finger like outgrowths in capillary lumen. Pericyte cores -
marginal standing chromatin, cariolemma invagination were also
determined. The nerve consists of separate fibers and was
surrounded by endoneurium. Myelin sheath has lost their clarity to
external contours.
By the 3rd day of development of the preparations were
revealed inflammatory and reactive changes and circulatory
disorders directly in the nerve and surrounding tissues. In the distal
segment from the site of injury, the plethora of blood vessels were
noted in nerve sheaths. The vessels were paralyzed and filled with
blood, they were marked with phenomena of stasis and
hemagglutination. The main changes that were detected by electron
microscopic examination shows predominantly the myelin sheath of
the nerve were affected and in significant to a lesser extent, the
substance of the nerve trunks. First of all, it should be noted that the
myelin nerve fibers in ultrathin sections in the overwhelming majority
have a rounded or (depending on the cut) oval shape. In general,
the nerve retains its structure and consists of individual nerve fibers
surrounded by a fibrous connective tissue endoneurium and a
connective tissue perineural envelope.
On the part of endoneurium, the phenomena of edema,
Стоматология • №2(75)2019
31
STOMATOLOGIYA
expressed with some separation of individual nerve fibers,
accompanied by focal loosening of connective tissue fibrils with
theirfragmentation and loss ofclarityofthe outer contours of the myelin
sheath were noted. In most fields of the view, myelin sheath of the
nerve appears to be sharply osmiophilic, homogeneous, and high
electron-optical density and has more or less clear outlines. At high
magnifications, it can be determined that, structurally, it consists of
ordered, tightly packed, parallel to the fibrillar structures between
which only some places define insignificant gleams and
enlightenments, the appearance of which, apparently, is the result of
a violation of their spatial organization in the process of technical
processing of the material. The myelin sheath of the nerve is
surrounded by perineural cells that have an elongated nucleus with
a clearly contoured nuclear membrane and evenly distributed
euchromatin along the karyoplasm.
In the zone of perivascular edema (in the area of direct
clamping) along with dystrophic changes in endothelial cells in the
form of homogenization of cytoplasm, hyperchromic nuclei,
irregularly shaped with deep constrictions, changes in pericytes were
noted. The cytoplasm of the later is homogenized, the nuclei are
enlightened, there were signs of destruction of the karyolemma, an
uneven distribution of chromatin.
By the 10th day, in the tissues surrounding the inferior alveolar
nerve, phenomena of significantly decreased edema and circulatory
disorders were noted, although in this period there were areas with
signs of edema, stasis and diapedesis was seen. Mature fibrous
connective tissue appears in surrounding tissues with a
predominance of mature forms of cellular elements like fibroblasts.
In electron microscopic study of drugs of this period it turned out that
rounded nerve fibers are found almost everywhere, in the myelin
sheath of which focal enlightenments are clearly visible. The latter
have a rounded or irregular shape and are located in the thickness
of the myelin sheath, closer to its inner or, on the contrary, outer
edge. At the same time, in the area of such enlightenments, the outer
boundaries of the myelin sheath lost the clarity of its contours, and
the sheath itself becomes highly osmiophilic, homogeneous. Inside
the detected enlightenments, it is possible to determine the
fragmented, loosened fibrillar material, which allows to make a
conclusion not only about the focal edema of the myelin sheath, but
also about the violation of its integral structure. In some cases,
enlightenment, located in close proximity to the inner border of myelin
sheath, accompanied by a zone of edema, penetrating into the nerve
trunk in the form of a lacuna were found.
From the side of the main substance of the nerve trunk, as a
rule, there were only mild edema in the form of loosening and some
loosening of the fibrous structures without any pronounced focal
changes. It was also noted the active formation of collagen fibers in
paraneural tissues. Thus, collagen fibers with characteristic
transverse striation are collected in compact bundles. Among the
collagen
fibers
visible
fibroblast,
morphological
features
corresponding to collagenoblast type II were determined. Its
cytoplasm is almost entirely occupied by expanded cytoplasmic
reticulum cisterns filled with loose flaky substance. The core is
hyperchromic and had abnormal forms. As for circulatory disorders,
expressed in the previous term, on the 10th day, the phenomena of
increased permeability remained in vascular wall with perivascular
edema, dilation and fullness of small caliber vessels were observed,
there were also violations of transcapillarytransport with the
formation of a large numberof
micropino-cytosis vesicles.
By the 30th day after injury around the nerve were determined a
tight scar. The structure is coarse, orthochromatic, collagen fibers,
between which there were single fibroblasts and fibroclasts. At
departments, apparently close or exposed immediate clamping
injury, met foci of incompleteness of fibrillogenesis, loose
polymorphocellular infiltrates, plethora postcapillary vessels and
perivascular edema were seen. Foci of young granulation tissue
were noted, surrounded by an area of inflammatory infiltration and
productive reaction with intense fibrillogenesis; these foci extended
the zone of scar-transformative changes in the tissues surrounding
the nerve. In electron microscopic examination of this period, the
cytoplasm of cells having different electron density, various size and
shape of the vacuole, and the loosening of the cytoplasmic
membrane occurred, which was accompanied, first of all, by the
swelling of the mitochondria with the clearing of their matrix,
reduction, disorganization and fragmentation of the crises. The focal
ripples of densely packed myelin fibrils attracted attention, shell with
the advent of enlightenment of various sizes and cone-shaped
protrusions directed towards the center appeared, representing the
detachment of one or several myelin fibrils by edematous fluid.
Sometimes in one field of view it was possible to detect several such
protrusions from the side of the myelin sheath. Axial cylinder turned
off from myelin shell. In some cases, the inner membrane lost its
integrity, and then inside the lacunae, fibrous and partially
fragmented osmiophilic fibrillar structures were found.
In many areas, the edematous fluid is due to the rupture of
pinned osmiophilic membranes penetrated inside the axial cylinder
that was accompanied by loosening of neurofilaments, violation of
their integrity and the appearance of electro-optically transparent
areas of irregular forms with blurred borders. This period is
characterized by an almost complete normalization of circulatory
disorders in the surrounding tissues. Only in some areas (apparently,
directly subjected to compression by clamping) in post-capillary
vessels, plethora, stasis continue to occur, signs of edema and
disorganization of collagen fibers occur. Plasma cells with signs of
high functional activity were found among cellular elements, as
evidenced by the intracellular organelles, in particular, developed
rough endoplasmic reticulum.
So a short 30 second impact of the compression of
neurovascular bundle, including the lower alveolar nervein animals,
in the absence of therapeutic benefits, leads to significant
ultrastructural changes in the nerve and perineural tissues:
pronounced degenerative-inflammatory processes, manifesting itself
as a violation of the normal structure of functionally significant
structural elements, alternating by 30 days with degenerative and
sclerotic phenomena.
Findings
On the 3rd' day after injury in the tissues of the inferior alveolar
nerve, there is a violation of intra-stem blood microcirculation due to
increased vascular permeability walls, its plasma impregnation and
perivascular edema, causing circulatory hypoxia. At the same time,
reactive changes were observed in nerve fibers appear to be partially
reversible, representing a reaction to acute circulatory hypoxia and a
direct mechanical alteration.
By the 10th day of the experiment, in the perineural tissues and
the nerve fiber itself a degenerative-inflammatory process, that
manifest themselves as a violation of the normal
32
Стоматология • №2(75)2019
ere
se,
ere
ntly
of
jlar
jlar
ere
and
foci
the
•pic
•ing
the
ane
ling
on.
seal
on,
and
iter
aral i
of
the
elin
and
ited
eof
xial
fila-
।
of
with
lost
the
ctly
lary
and
with
ular
, in
1 of
vein
a to
ural
aes,
a of
,30
=r_~ure
of
the majority of functionally significant structural
?e~ents.
Бу the
30th day after tissue dissection and compression
re
neurovascular
bundle of the inferior alveolar nerve,
:e<"e'ative-
inflammatory
phenomena in the nerve fiber are
“c^oed by
degenerative and sclerotic processes, and in the
■ -• _~d ng tissues
by the development of gross cicatricial
-a- :es with
foci of incomplete
fibril logenesis.
References
■ Snyder
D.J., Bartoshuk L.M. Oral Sensory Nerve
Causes
and Consequences H Rev. Endocrinol,
гс Zs.-Vol.17,№2.-
P.149-158.
2
Ceballos
D., Cuadras J., Verdu E.j Navarro X.
tr
■ Tietric
and
ultrastructural changes with ageing in
-:. se
fSpheral nerve//J. Anat.
-1999. - Vol. 195 (Pt 4). - P.
5c3-576.
Park J.,
Van Trinh N., Sears-Kraxberger I. et al.
. - -
_
'restructure changes in trigeminocervical complex
2. : '
ze
nal
nerve injury //J. Comp. Neurol. -2016,- Vol.
-P. 309-322.
-
Chen
y.-J.,
Huang F, Zhang M., Shang H.-Y.
zzcal
Stress
Alters Ultrastructure and Energy
Ifci&cc ; m
of
Masticatory Muscle in
Rats // J. Biomed.
Е- гГ-'У
-2010.-Vol.2010.
: 3-yub
V.M.,
Brewer J., Wu X. et al. Neurostereology
: ; : -
г
unbiased
quantification
of
neuronal
injury
and
.e'■eration//FrontAgingNeurosci.-2015.-Vol.196.
z Johnston C.D., Owens RD. Reinnervation of
к
. -.c'-z mt
molars
//J. Anat.
— 1991. — Vol. 176.-P. 169-
~ Z~ uwal
A.,
Narayan R.K., Chaung V/. et al.
X'~*ectrve
Effects of Trigeminal Nerve Stimulation in
> e
~
~mzmaticBrain Injury//Sci. Rep. -2017. - Vol. 7.-P.
http://dx.doi.org/10.26739/2091-5845-2019-2-27
УДК: 616.94-08:616.716.8/617.52-002.36
: Ь -ЕНКА
ВЛИЯНИЯ КОМПЛЕКСНОЙ
ТЕРАПИИ
H АФИНАМ И КУ ЭНДОГЕННОЙ
ИНТОКСИКАЦИИ ПРИ
е 1ЕГМОН
АХ
ЧЕЛЮСТНО-ЛИЦЕВОЙ
<*ЕЛАСТИ
arior
ood
alls,
sing
jere
ible,
id a
■ura
l
itory
nal
“а_ ■ ё-
-
кхий
государственный
институт
i.-мотеция
зэавнительный
анализ эффективности комп-
--S
лечения
флегмон челюстно-лицевой области.
Иг хшал и
методы:
под наблюдением были 66 больных с
: -
гми
челюстно-
лицевой области, разделенные на
2 группы в зависимости от схемы лечения. Результаты: у
больных 1-й группы под влиянием традиционной комплексной
терапии показатели сорбционной способности эритроцитов и
уровень
среднемолекулярных
пептидов
снижались
недостаточно быстро. У пациентов 2-й группы гипохлорит
натрия оказывал на гнойную рану благоприятное влияние, о чем
свидетельствовала заметная нормализация лаборатор-ных
показателей, отражающих степень эндогенной интоксикации.
Выводы: раствор гипохлорита натрия может использоваться
для лечения пациентов с острыми гнойно-воспалительными
заболеваниями челюстно-лицевой области.
Ключевые слова:
флегмоны челюстно-лицевой области,
эндогенная
интоксикация,
сорбционная
способность
эритроцитов, среднемолекулярные пептиды.
Annotation
Based on the study of indicators of endogenous intoxication in
66 patients with phlegmon of the maxillofacial region, an increase in
the level of endotoxemia was revealed. In the first subgroup of
patients, after traditional complex therapy, there was an insufficiently
effective decrease in parameters of erythrocyte sorption capacity
(ESC) and medium molecular peptides (MMP). The results of the
study in the 2nd subgroup of patients showed a favorable effect of
sodium hypochlorite solution on purulent wounds, which was
manifested by a noticeable normalization of laboratory indicators
reflecting the degree of endogenous intoxication to purulent wound.
Лечение острых гнойно-воспалительных заболеваний
челюстно-лицевой области остается одной из наиболее
актуальных проблем хирургической стоматологии [2,7]. Поиску
эффективных мероприятий при этой патологии посвящены
многочисленные исследования отечественных и зарубежных
авторов [1,4-6]. В последние годы лечение больных с острыми
гнойно-воспали-тельными заболеваниями челюстно-лицевой
области привлекает все большее внимание специалистов
челюстно-лицевой хирургии в связи с увеличением частоты и
тяжести течения этих заболеваний [3,8,9].
Цель исследования:
сравнительный анализ эффек-
тивности комплексного лечения флегмон челюстнолицевой
области.
Материал и методы
Исследование проведено у 66 больных с флегмонами
челюстно-лицевой области, которые в зависимости от
проводимой терапии были разделены на две группы. В1 - ю
группу вошли 33 больных, у 30 из которых острый гнойно-
воспалительный процесс занимал одну, у 3 - две анатомо-
топографические области. Эти больные получали только
традиционную комплексную терапию. Во 2-ю группу были
включены 33 больных с флегмонами челюстно-лицевой
области, у 28 из которых патологический процесс занимал одну,
у 5 - две анатомо-топографические области. В этой группе
проводилась комплексная терапия в сочетании с орошением
раны раствором гипохлорита натрия, который получали с
использованием аппарата Эсперо-1. Сорбционную способность
эритроцитов (ССЭ) определяли по методу Тогайбаева -
Кургузкина (1987). Количество среднемолекулярных пептидов
(СМП) определяли по методу Габриэляна и соавт. (1981).
Стоматология * №2(75)2019
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