фаслларига
боғлиқлигини
ўргандик.
Натижалар шуни кўрсатдики, барча
беморларда тана вазнининг камайиши,
асосан кўпрок бахорги-ёзги мавсумда
кузатилди. Бундай холат шифокорлар ва
мутахассис
диетологлар
томонидан
инобатга олиниши ва бизнинг иқлимда
тўғри
овқатланиш
тартиби
ишлаб
чиқилиши лозим.
SUMMARY
Immobilization of maxillae, along with
the same of fracture, leads to the disorder of
chewing
function,
which
limits
the
possibility of normal digestion. In patients
with the fracture of maxilla observes sharp
decreasing of appetite, slowdown of the
gastric secretion and in the result loss of
weight. We have observed div weight
changes in the treatment dynamics in patients
with the fracture of maxilla due to the
seasons. By the results estimated that in all
patients noticed negative dynamics of div
weight, especially spring-summer period.
These circumstances must be taken into
account by specialists - dietitians in the
elaboration of dietary habits, particularly in
traumas in conditions of our climate.
CONDITION OF THE PARADONTIUM IN PATIENTS WITH JAW FRACTURE
Sh.A. Boymuradov, D.T. Bobamuratova
Tashkent Medical Academy
The fracture of the facial skeleton
bones compose 3,2-5,8% of the total amount
of injures [1-3,5,9]. Main part of the facial
bones lesions is due to fracture of mandibula,
which consult to specialized clinic, from
77,0% до 90,0% of injured [5,9]. In terms of
the
growth
of
maxillofacial
injures
incidences, the problem of full-fledged and
comprehensive specialized
aid
in the
mandibula fractures remains urgent.
It is known two basic methods of the
fixation of bone splinters:conservative and
surgical. Nowadays have been elaborated and
used hybrid methods of immobilization in
mandibula fractures. At the same time there
are often use application of the first and
second
treatment
methods,
clinical
application and their combination [1,2,9].
Tooth braces are easiest and simple in
preparation, however they have essential
limitations: worsen conditions of the tooth
and oral cavity care, complicate patients
nutrition.
These
factors
of
progress
inflammation phenomena in patients with
paradontium. Tooth braces are fixed in
precervical area of the teeth with the aid of
ligature wire. Thus, both in the fixation of the
braces and during the period of their being in
the oral cavity occurs inevitableinjury of
tissue of the marginal part of paradontal
complex.
Considerable
worsening
of
hygienic condition of oral cavity and
traumatic influence of constructions either
leads to the development of the pathology in
the marginal area of parodontum or
aggravates available.
In application of the treatment of
patients with inflammatory diseases of
paradontium and injures of mandibula tooth
braces with intermandibular rubber rod
occurs progress inflammation destructive
processes in the tissues of the paradontium
[3,6-8].
Prevalence of paradontium diseases in
patients
with
complicated
injures
of
mandibula is 1,5 times higher than in patients
with uncomplicated injures of mandibula
[3,4,9].
Condition
of
the
oral
cavity
considerably influences to the process of the
healing injuries of mandibula. Chronic nidus
of infection in the oral cavity contributes to
development of inflammation complications
of mandibula injures. In patients with the
inflammation diseases of paradontium and
mandibula injures determined direct strong
correlated dependence between the severity
of the paradontium disease and frequency of
the development of purulent infectious
complications [4,9]. Obviously is the fact of
hurt in the area of lateral paradontium by
bimaxillar braces, that implies penetration of
microflora deep into soft tissues and onset of
destructive
processes,
characterized
gingivitis and periodontitis.In the literature
indicated, that after the removal of the braces
in remote terms condition of hygiene and
paradontium does not achieve indexes of
healthy people [6,7]. This situation requires
special
attention
by
the
doctor
and
elaboration of new approaches to the
treatment of patients.
Aim
To study and analyze condition of the
paradontium in the treatment dynamics of the
patients with the mandibula injures.
Materials and Methods
We
examined
51
patients
with
mandibula injures in the oral surgery and
neurosurgery department of the 2
nd
clinics of
TMA, in the period of 2013-2015 years and
made clinical investigations. The age of the
patients was from 18 to 47 years, from them
44 men, 7 women. All patients were shown
first aid and hospitalized into department
during in a day after the injure. All patients
with mandibula injure had been put braces of
Tigershted and fixed with soft rubber rod.
Table 1
Characteristics of admitted patients with mandibula injures
Forms of injure
Treatment
Number of patients
One sided
Orthopedic
16
Orthopedic and surgical
13
Bilateral
Orthopedic
8
Orthopedic and surgical
14
Total
51
Depending
on
the
condition
of
paradontiumthe patients were divided into 4
groups: 1
st
group 14 patients with intact
paradontium, 2
nd
group 13 people with the
mandibula injury and manifestations of
gingivitis. 3
rd
group 13 patients with the mild
degree of paradontium, 4
th
group 11 patients
with paradontium of medium degree of
severity. In the dynamics of the treatment
course in all patients we paid attention to
complaints of patients, signs and condition of
paradontium, determined depth of paradontal
recess, index of RMA. Has been developed
individual parodontal card of the patient,
where
were
included
passport
data,
anamnesis information, data of objective
examination.
The
depth
of
paradontal
recess
determined with graduate bulbous end probe
from the four surfaces of each tooth
(glossal,vestibular, medial and distal), which
carefully introduced into the recess and took
into
accountthe
highest
indexes.
The
presence of subgingival “stone” as well as
have been determined by probing roughness
in the movement of the probe along anatomic
configuration root of tooth.
To estimate the severity of gingivitis
(in the following – registration of the process
dynamics) used papillar-marginal-alveolar
indexes PMA (Schour I., Massler M., 1948),
in modification С. Parma (1960).
Have estimated gum conditions in each
tooth after the staining it with the solution of
Shiller-Pisarev. Here inflammation of the
gum area acquired brown staining account of
the existence of glycogen in the presence of
inflammation.
Estimation of PMA index carried out
by following codes and criteria:
•
0 – absence of inflammation;
•
1 – inflammation of only gingival
papilla (Р);
•
2 –inflammation of marginal gum
(М);
•
3 —inflammation of alveolar gum
(А).
Index PMAcounted by formula:
IndexPMA = the sum of points х 100%
3 x number of teeth
In the norm PMA index is 0. More than
number index, higher the intensity of
gingivitis. Indexes up to 30% conformed
mild degree, 30-60% - middle, higher 60% -
severe degree of inflammation. PMA index
take to reversible indexes, corresponding,
dynamics of its changes is reliable criteria of
the treatment results. Parodontal index (PI)
by Russel (1956) determined by 8 point scale
according to severity of inflammation,
counted by following formula:
PI = total of points
Number of teeth
Results and discussion
In the dynamics of the patients
treatment with mandibula injure is observed
negative changes by the parodontium after
the braces of Tigershted. In patients with
severity more characterized are complaints to
gum bleeding, odor nuisance from the mouth,
sense of itch, burning, feeling of dyscomfort.
In the examination of treatment
dynamics observed considerable hyperemia
of gum area, pastosa, increasing of gum
papilla capacity, light bleeding in probing
and disorder of wholeness tooth gum
connection determined mineralized tooth
sediments. Depth of paradontal recess
increased in all patients in the treatment
dynamics of maxilla injures. Analysis of
depth of parodontal recess determined
maximall number means in frontal area in
vestibular and distal surfaces of the incisors
and canines, and in lateral areas of maxilla in
the area of distal buccal surfaces of molars
and premolars. In patients of the 1sa and 2
nd
groups appeared pathologic recess with depth
3,5-4 mm, in the patients of the 3
rd
and 4
th
groups depth of the recess deepened into 2-
2,5 mm reached average 4,4±0,5 mm in the
patients with the light degree of paradontium,
6,6±0,4 mm in the patients of the 4
th
group.
Table 2
Main clinical index in the dynamics of the patients with jaw injury
Before
the
brace
10
th
day
20
th
day
30
th
day
PMA,%
1
st
groupn-14
0
15,1+1,0
ac
18,9±1,56
21,4±2,1
2
nd
group n-
13
11,6+0,2*
27,45+0,3
36,4±2,3
a
39,4±1,4
b
3
rd
groupn-13
22,4±1,4
36,6±1,2
41,3±1,7
50,7±2,0
b
4
th
groupn-11
43,7±2,9
61,4±1,6
69,7±1,3
a
73,3±1,8
PI, POINTS
1
st
group n-14 0,28+0,01
a
1,6±0,04
2,2±0,03
2,4±0,05
2
nd
groupn-13 0,93+0,03
a
2,93+0,03
a
3,75±0,08
3,99±0,1
b
3
rd
group n-13 2,15±0,06
4,00±0,09
4,99±0,06
5,76±0,04
4
th
group n-11 3,9±0,06
5,1±0,06
5,83±0,08
b
6,78±0,05
Note.
a
–
statistically
reliably
with
value
(p<0,05);
b
–
statistically
reliably
with
value
(p<0,01);
c – statistically reliably with value (p<0,001).
Papillar-marginal-alveolar index before
the brace was not high in the 2
nd
and 3
rd
groups of patients, and in the 1
st
group of the
patients were not noted inflammation. Under
the influence carried out measures PMA
index increased in all the patients during the
treatment. Increase of PMA was 21,4±2,1 in
the patients with intact parodontium at the
end of the treatment, in the patients of the 2
nd
group
increased
3,4
times
and
was
39,4±1,4%. PMA index before the brace with
the light degree of severity was 22,4±1,4%,
after a month noted negative dynamics and
increase of index was 50,7±2,0%, in the
patients of the 4
th
group was worsened
destructive and inflammation processes,
PMA index increased up 1,7 times at the end
of the month.
Visually
determined
inflammation
processes manifestations in the gum area of
the saliva membranae, gums became clear
light color, no closely adjoined to the dental
cervix.
Parodontal index in all the groups in
the dynamics of the treatment reliably
(p<0,05) increased from 0,28+0,01 points up
to 2,4±0,05 points in patients of the 1
st
group,
from 0,93+0,03 points to 3,99±0,1 points in
the patients of the 2
nd
group at the end of the
treatment that demonstratesworsening of the
condition of parodontium tissues and oral
hygiene. In patients with jaw fracture with
parodontium light and middle degree
increased PI was 2,67and 1,75 times with
comparison of parodontal index which
received month before.
Conclusions
In the dynamics of the treatment of all
patients with jaw fracture noticed negative
dynamics of study indexes, however notable
changes were registered in the patients with
parodontium.
Received
data
grounds
necessity
of
carrying
preventive
and
treatment measures in the patients with jaw
fracture with brace constructions in the oral
cavity during their fixation.
LITERATURE
1.
Boymuradov
Sh.A.
Краниофациал жарохат олган беморларни
консерватив даволашнинг узига хос
хусусиятлари // Биология ва тиббиёт
муаммолари. – 2014. – №1. – С. 31-37.
2.
Cobum D.G., Kennedy D.W.,
Hodder
S.C.
Complications
with
intermaxillary
fixation
screws
in
the
management of fractured mandibles // Brit. J.
Oral. Maxillofac. Surg.
–
2002.
–
Vol. 40,
№3.
–
P. 241-245
3.
Gavrilenko
М.S.
Complex
influence to the tissue of parodontium in the
treatment of the patients with mandibula
fracture. – Perm, 1999. – 16 p
.
4.
Lamphier J., Ziccardi V.,
Ruvo A. Complications of Mandibular
Fractures in an Urban Teaching Center // J.
Oral. Maxillofac. Surg.
–
2003.
–
Vol. 61.
–
P. 745-749.
5.
Maloney P.L., Welch T.B.,
Doku
H.C.
Early
immobilization
ofmandibular fractures // J. Oral. Maxillofac.
Surg. – 1991. – Vol. 49, №7. – P. 698-702.
6.
Medvedev Yu.A., Kutsenko
R.V. Condition of areal parodontium in
mandibula fractures of mandibula in tooth
raw // Russian stomatological journal. –
2012. – №3. – P. 36-39.
7.
Redinova T.L., Kolesnikov
S.N., Influence of the braces to the condition
of soft tissues of the teeth and parodontium
in the patients with jaw fracture //
Stomatology. – 1998. – №1. – P. 42-44.
8.
Robinson P.G. Manual versus
powered tooth brushing for oral health. //
Cochrane Database. Syst. Rev. – 2005. –
Issue 2.
9.
Tegza N.V. Medical economic
basis of the usage of the dry nutritional
mixtures in the nutrition of military man with
the injures and diseases of mandibulofacial
area in medical institutions of MD RF. –
Moscow, 2008. – 28 p.
РЕЗЮМЕ
Изучено состояние пародонта у 51
больного с переломом нижней челюсти в
динамике
лечения
перелома,
находившихся в отделении ЧЛХ и
нейрохирургии 2-й клиники ТМА. Всем
больным
с
переломом
челюсти
накладывали
шины
Тигерштеда.
В
течение месяца обращали внимание на
клинические
признаки
и
состояние
пародонта,
определяли
глубину
пардонтального кармана, индекс РМА и
пародонтальный индекс до наложения
шин. В динамике лечения у всех больных
с переломом челюсти наблюдалась
отрицательная
динамика
изучаемых
индексов. П под влиянием проволочных
шин и лигатуры ухудшается гигиена
полости рта, возникает неизбежная травма
маргинальной
части,
прогрессируют
воспалительно-деструктивные процессы в
тканях пародонта.
РЕЗЮМЕСИ
Юз-жағ
жаррохлиги
ва
нейрохирургия бўлимида даволанган 51
нафар
пастки
жағ
суяги
синган
беморларда даволаш жараёнида пародонт
холати кузатилди. Барча беморларга
иммобилизация мақсадида Тигерштед
шинаси қўйилди ва 1 ой давомида
кузатилди. Шина қўйишдан аввал, 10-, 20-
, 30-кунлари кўрик вақтида пародонтдаги
ўзгаришлар,
пародонтал
чўнтаклар
чуқурлиги, РМА ва пародонтал индекслар
аниқланди. Бундай беморларда кузатувлар
натижасида
барча
кўрсаткичларнинг
манфий томонга ўзгариши кузатилиб,
барча клиник белгилар кучайди. Шундай
қилиб, пастки жағ суяги синишида
шиналар қўлланилиши оғиз бўшлиғи
гигиенасини
ёмонлаштиради,
милк
қирғоқларини жарохатлайди, пародонт
тўқимасида яллиғланиш ва деструктив
жараёнларни кучайтиради.
SUMMARY
We studied and analyzed condition of
the paradontium in the treatment dynamics of
the patients with the mandibular fractures.
Was examined 51 patients with
mandibularfractures, the age of the patients
was from 18 to 47 years. All patients with
mandibula injure had been put braces of
Tigershted and fixed with soft rubber rod.
During
month
we
paid
attention
to
complaints of patients, signs and condition of
paradontium, determined depth of paradontal
recess, index of PMA and periodontal index
before splinting, 10
th
, 20
th
, 30
th
days of
treatment. In the dynamics of the treatment
of all patients with jaw fracture noticed
negative dynamics of study indexes. In
conclusion, under influence of constructions
worsening of hygienic condition of oral
cavity and traumatic either leads to the
development of the pathology in the marginal
area and inflammatory-destructive process of
parodontum.
Стоматология детского возраста
КЛИНИКА ВТОРИЧНЫХ И ОСТАТОЧНЫХ ДЕФОРМАЦИЙ ЛИЦА ПОСЛЕ
ПЕРВИЧНОЙ ХЕЙЛОПЛАСТИКИ ПРИ ВРОЖДЕННЫХ РАСЩЕЛИНАХ
ВЕРХНЕЙ ГУБЫ И НЕБА
Д.М. Дусмухамедов, Р.А. Амануллаев, М.З. Дусмухамедов
Ташкентский государственный стоматологический институт
Врожденная расщелина губы и неба
(ВРГН) занимает первое место среди
аномалий развития челюстно-лицевой
области
и
второе
в
структуре
антенатальной патологии (Исмаилова
В.И., 2000; Мамедов Ад.А., 2001;
Амануллаев Р.А., 2002; Мурзабаева С.Ш.,
2003; Очнева Г.И., 2005; Сутулов В.В.,
2006; Шокиров Ш.Т., 2012; Coleman J.,
Gaukroger M.J., Smith L.F., Sundberg K.,
2009). Рождение ребёнка с расщелиной
верхней губы и неба становится сильным
психическим стрессом для родителей и
оказывает отрицательное влияние на
дальнейшую
психоэмоциональную
атмосферу в семье [1,3-5].
Лечение
детей
с
ВРГН
предусматривает
многоэтапные
оперативные вмешательства, постоянное
диспансерное наблюдение и лечение у
хирургов,
ортодонтов,
логопедов,
педиатров,
оториноларингологов
и
других специалистов (Субханов С.С.,
2010; Salyer K.E., 2006; Steinbacher D.M.,
2011). Методы хирургического лечения
всегда находятся в центре внимания
челюстно-лицевых хирургов, постоянно
улучшаются результаты лечения больных
[2,6,7].
Несмотря на большие достижения в
хирургии,
результаты
оперативных
вмешательств
зачастую
не
вполне
удовлетворяют как пациентов, так и
врачей.
Многообразие
клинических
проявлений
деформаций
лица
и
факторов,
влияющих
на
их
возникновение, продолжительность и
трудности
лечения,
неустойчивость
результатов
диктуют
необходимость
дальнейшего
изучения
патогенеза
вторичных
деформаций
и
совершенствования
способов
их
хирургического лечения [2,3,5-7].
Цель исследования
Анализ отдаленных результатов
первичной хейлопластики ВРГН и оценка
характера
и
частоты
остаточных
дефектов и вторичных деформаций.
Материал и методы
Независимо от сроков проведения
операций и самих методик после
первичной хейло- и уранопластики, как
правило,
возникают
различные
вторичные и остаточные деформации. В
клинике
детской
челюстно-лицевой
хирургии
Ташкентского
государственного
стоматологического
института в 2010-2015 гг. произведена
