RU2227017C2 - Method for treatment of chronic relapsing lip fissures and combinations of chronic relapsing lip fissures with exfoliating or atopic cheilitis - Google Patents

Abstract

FIELD: medicine, therapeutic stomatology. SUBSTANCE: treatment method involves using proteolytic enzyme, application of ointment of the complex composition on fissure and all red border of lips, carrying out lidocaine blockade with preliminary premedication with apo-diazepam in the dose 5 mg by sublingual route, using ointment "Lorinden C", carrying out the section by helium-neon laser on damaged lip sites, prescribing anti-histaminic preparations, antiallergic diet and correction of psychoemotional state. Treatment is carried out on the background of every day application of oral gels for lips protection and intaking polyvitamins. Homeopathic ointment "Traumel" is prescribed for children instead ointment "Lorinden C". Method exhibits high effectiveness and after carried out treatment relapses of diseases are absent and neurodystrophic and inflammatory processes around lips and perioral skin are eliminated. EFFECT: improved and enhanced effectiveness of treatment. 1 tbl, 3 ex

Description

The invention relates to medicine, namely to therapeutic dentistry.

There is a method of treating chronic recurrent lip cracks (HRTG) and combinations of HRTG with exfoliative (EC) or atopic cheilitis (AH), which consists in the fact that when treating HRTG, a cloth moistened with 0 min. A 1% solution of the proteolytic enzyme, then the proteolytic enzyme is washed off with a swab moistened with a warm 1% hydrogen peroxide solution, washed from crusts, after which an ointment of a complex composition having the following composition is applied to the crack and red border of the lips for 20 minutes, g: Sol. Retinoli acetatis oleosae 1.0; Sol. Tocopheroli oleosae 1.0; Thiamini bromidi 0.2; Insulini acropidi 3.0; Ung. Celestodermi 30.0; Ung. Solcoseryli 20.0; and mixed ex tempore, the procedure is repeated at intervals of 2-3 days 3 times, during the 3rd visit of the patient to the doctor an additional one-time blockade is carried out with a 1% warm solution of lidocaine in a dose of 1 ml exactly under the crack, in addition, this ointment is applied to at home for 7-10 days 3 times a day after meals. In the treatment of HRTG in combination with EC, the proteolytic enzyme is applied to the crack for 5 minutes, and to the entire red border - for 20 minutes, lidocaine blockade is carried out first under the crack, and after 3 days in the lateral sections of the lips, an additional three times a day is prescribed for 7- 10 days applying the Lorinden S ointment to the red border of the lips before applying the ointment of a complex composition, and they also prescribe tranquilizers for a month (Skin and sexually transmitted diseases. A. Mashkillayson, S. A. Kutin, E. I. Abramova, etc. Edited by Prof. Mashkillayson A.L. - M.: Medicine, 1 986, p.129). In the treatment of HRTG in combination with AH, lidocaine blockade is made into commissures with an interval of 3 days 2 times, Lorinden C ointment is applied to commissures and perioral skin three times daily for 7-10 days before applying the ointment of complex composition, as well as within a month prescribe antihistamines inside and an anti-allergic diet. All treatment is carried out against the background of everyday use of hygienic lipstick as a protective agent for the lips (E. Rybalkina, The Importance of Neurovascular Disorders in the Development of Chronic, Recurring Lip Cracks, Substantiation. Author. Diss. ... Ph.D. Moscow State Medical stomat.un.-t. - 2002, 24 pp.). This method is chosen by us for the prototype.

The disadvantage of this method is its low efficiency, which is expressed in the fact that several months after treatment relapse occurs.

The objective of the invention is to increase the effectiveness of treatment by eliminating neurodystrophic and inflammatory processes in the lips and perioral skin.

This is achieved due to the fact that, starting from the second visit to the doctor and daily for 8-10 days, 20 minutes after applying the ointment of a complex composition having the following composition, g: Sol. Retinoli acetatis oleosae 1.0; Sol. Tocopheroli oleosae 1.0; Thiamini bromidi 0.2; Insulini acropidi 1.0; Ung. Heparim 20.0; Ung. Celestodermi 15.0; Ung. Solcoseryli 20.0; and removing its excess, a luminescence with a helium-neon laser is performed for each affected area of the lips for 2 min in a continuous mode with a power of 10 W with an obligatory air gap of 0.5 cm and using a mirror nozzle; before lidoacaine blockade, premedication with apodiazepam in a dose of 5 mg sublingually; lidocaine blockade is done through the mucous membrane of the lips, lubricating the injection site with a 10% lidocaine solution; ointment "Lorinden C" is applied to the red border of the lips and in case of chronic recurrent cracks for 7-10 days 3 times a day after eating before applying the ointment of a complex composition, with a combination of chronic recurring lip cracks with atopic cheilitis, the proteolytic enzyme is also applied for 20 minutes on perioral skin; for pediatric patients, Lorinden S ointment is replaced with Traumeel ointment, multivitamins and the use of oral gels as a means for everyday lip protection are prescribed for one month.

Pathological changes localized in the red border of the lips, commissures, and skin of the perioral region are often manifestations of diseases of the digestive system, hematopoietic system and immunity, endocrine glands, as well as anxiety-depressive states and vitamin deficiencies.

In the pathogenesis of HRTG with various background pathologies, an important role is played by changes in blood microcirculation, discoordination of regulatory mechanisms.

The role of neurodystrophic changes in the development of pathological processes in the lip area was confirmed by us in the clinic (Doppler flowmetry) and in the experiment (dystrophic changes in blood vessels and destruction of nerve fibers: elimination of neurodystrophy - lidocaine blockade - (relieves vascular spasm, relieves pain, improves nervous trophism; lidocaine It has a pronounced vasodilating effect at the injection site, blocks vasoconstrictor nerve impulses that enter the sympathetic fibers belonging to group "C", the anesthetic penetrates quickly into the nerve fibers of group “C” and has a therapeutic effect); increased crack epithelialization by applying the proposed ointment of complex composition; improved crack healing with a long history of 10-15-20 years - by exposure to a helium-neon laser; elimination of itching, chronic inflammation - with Lorinden C ointment, and in children with Traumeel ointment; restoration of the elasticity of the red border of the lips - by taking vitamins A and E, as drugs that improve the condition of epithelial tissues; elimination of dry lips - by using oral gels; correction of the psychoemotional sphere by conducting pharmacotherapy depending on the background pathology and thus eliminating bad habits.

The use of a helium-neon laser, starting from the 2nd visit to the doctor, especially for protracted forms of the disease (10-20 years), is due to the lack of drug treatment with profound changes in the stroma, the presence of scars and hyperkeratosis and provides a deep anti-inflammatory and wound healing effect. To avoid injury to the affected area, an air gap between it and the electrode of the apparatus is required, and the use of a mirror nozzle provides deep penetration of the infrared rays into the tissue.

The optimal regime and technical characteristics of laser treatment were proposed by the Department of Physiotherapy, Moscow State Medical and Dental University.

When HRTG is combined with atopic cheilitis, along with the red border of the lips, perioral skin is also affected, which necessitates the application of a proteolytic enzyme to this area. Application time (20 min) is the most optimal for softening flakes and crusts in this zone.

Carrying out with lidocaine blockade of premedication with apodiazepam sublingually at a dose of 5 mg relieves psycho-emotional stress, which often leads, as practice shows, to fainting; an injection of lidocaine through the mucous membrane of the lip prevents the formation of a hematoma and prolonged bleeding from the injection site, since the lip area is characterized by abundant blood supply; applying a 10% lidocaine solution to the injection site is due to the fact that the red border of the lips and the perioral region represent a powerful reflexogenic zone and any intervention on it can lead to pale skin, dizziness and fainting; administration of lidocaine is painless, since the pH of the anesthetic (6.5) is close to the pH of the tissues.

A method of treating HRTG is as follows: a napkin moistened with a 0.1% solution of proteolytic enzyme is placed on the crack and on the entire red border of the lips for 5 minutes, then it is washed off with a swab moistened with a warm 1% hydrogen peroxide solution, washed from crusts, and then For 20 minutes, an ointment having the following composition is applied to a crack and a red lip rim, g: Sol. Retinoli acetads oleosae 1.0; Sol. Tocopheroli oleosae 1.0; Thiamini brornidi 0.2; Insulini acropidi 1.0; Ung. Heparini 20.0; Ung. Celestodermi 15.0; Ung. Solcoseryli 20.0; and mixed ex tempore, the procedures are repeated with an interval of 2-3 days 3 times, in addition, this ointment is applied at home for 7-10 days 3 times a day; during the 3rd visit to the doctor, 20 minutes after applying the ointment of the proposed composition, premedication with apodiazepam at a dose of 5 mg is done sublingually, a single blockade is carried out with a 1% warm solution of lidocaine in a dose of 1 ml exactly under the crack on the side of the mucous membrane of the lip, after having lubricated injection site with 10% lidocaine solution. It is advisable to use an insulin syringe. Starting from the 2nd visit to the doctor every day 20 minutes after applying and removing excess ointments of complex composition, a helium-neon laser glows for 2 minutes on a crack in a continuous mode with a power of 10 W with an obligatory air gap of 0.5 cm and using a mirror nozzles with a course of 8-10 days; ointment “Lorinden C” is applied to the red border of the lips after eating 3 times a day for 7-10 days before applying the ointment of complex composition; prescribed daily use of oral gel to protect the lips and multivitamins for one month. The treatment of HRTG in combination with EC is carried out as for HRTG, but the proteolytic enzyme is applied to the crack for 5 minutes, and to the entire red border - for 20 minutes, during the third visit to the doctor, the lidocaine blockade is carried out only under the crack, and to the side sections of the lip - after 3 days. The treatment of HRTG in combination with AX is carried out as with HRTG, but the lidocaine blockade is made into commissures, if the patient feels fear and tension during the lidocaine blockade, it is possible to block for the first time in one commissure, and with an interval of 3 days in the second , and the ointment “Lorinden S” is applied to the commissures and perioral skin, within a month prescribed intake of antihistamines inside and an anti-allergic diet.

Instead of Lorinden C ointment, children are prescribed Traumeel homeopathic ointment.

The optimality of the number of procedures and the duration of treatment courses are confirmed by studies conducted in the treatment of 39 patients.

The effectiveness of the treatment according to the proposed method in comparison with the prototype method is shown in the table.

Clinical example No. 1.

Patient K., 19 years old, and / b No. 8902. Complaints of pain, tightness, dry lips, difficulty eating, smiles. Diagnosis: chronic recurrent lip crack in combination with exfoliative cheilitis.

On an outpatient basis, the patient was applied with a 0.1% trypsin solution to the lip crack for 5 minutes, and to the entire red border for 20 minutes, then it was washed off with a swab moistened with a warm 1% hydrogen peroxide solution, washed from crusts, and then onto the crack and a red lip rim for 20 min was applied ointment of the specified composition and mixed ex tempore, the procedure was repeated at intervals of 2-3 days 3 times. During the third visit to the doctor, an additional insulin syringe was used to block 1 ml of warm lidocaine solution in a dose of 1 ml exactly under the crack through the mucous membrane of the lip, after lubricating the injection site with 10% lidocaine solution, and after 3 days lidocaine blockade was made in the side sections of the lip. Lidocaine blockade was carried out with preliminary sedation of apodiazepam at a dose of 5 mg sublingually. On the second visit to the doctor, 20 minutes after applying the ointment of a complex composition and removing its excess, a helium-neon laser glowed on the crack and the affected areas of the red border for 2 minutes in a continuous mode with a power of 10 W with an obligatory air gap of 0.5 cm and using a mirror nozzle in the course of 10 procedures daily. At home, the patient took multivitamins for one month, eglonil at a dose of 5 mg 2 times a day to correct the psycho-emotional sphere, as well as to protect the lips when outdoors and when dry, the Pansoral oral gel; 3 times a day after meals for 10 days, the patient first applied Lorinden S ointment to the red border of the lips, and after soaking it, an ointment of a complex composition, after which the patient was indoors for 20-30 minutes.

The cure came on the 14th day. On examination: the red border of the lips is elastic, with no signs of pathology. After a year, the red border of the lips is unchanged.

Clinical example No. 2.

Patient L., 15 years old, and / b No. 2091. Complaints about difficulty opening the mouth, soreness in the corners of the mouth, tightness, dry lips. Diagnosis: chronic recurrent lip crack in combination with atopic cheilitis.

On an outpatient basis, the patient made an application with a 0.1% trypsin solution on the lip crack, the entire red border and perioral skin, then washed it off with a swab moistened with a warm 1% hydrogen peroxide solution, washed off the crusts, and then on the crack and red border of the lips by 20 min ointment of the specified composition and mixed ex tempore were applied, the procedure was repeated at intervals of 2-3 days 3 times. Starting from the 3rd visit to the doctor, 3 times with an interval of 3 days, an insulin syringe was used to additionally block 1% warm lidocaine solution in a dose of 1 ml into the commissures through the mucous membrane of the lip, after lubricating the injection site with 10% lidocaine solution. Lidocaine blockade was carried out with preliminary sedation of apodiazepam at a dose of 5 mg sublingually. Starting from the 2nd visit to the doctor, 10 daily sessions of luminescence with a helium-neon laser were prescribed for the area of commissures, which was carried out after applying an ointment of a complex composition and removing its excess. The luminescence was performed for 2 min for each commissure in a continuous mode with a power of 10 W with an obligatory air gap of 0.5 cm and using a mirror nozzle. At home, the patient took multivitamins, antihistamines for one month, followed an anti-allergic diet, and when using outdoors and feeling dry lips, she used Pansoral oral gel. 3 times a day after meals for 10 days, the patient applied ointment “Lorinden C” to commissures and perioral skin, and after it was absorbed, the ointment was of a complex composition, after which it did not leave the room for 20-30 minutes. The cure came on the 18th day. When viewed through a year of commissure and a red border without pathologies.

Clinical example No. 3.

Patient D., 9 years old, and / b No. 2863. Complaints of a painful crack in the lower lip that impedes conversation, a smile, wide opening of the mouth. Diagnosis: chronic recurrent lip crack.

The patient was given an application on the crack and the entire red border of the lips with 0.1% trypsin solution for 5 minutes, then it was washed off with a swab moistened with a warm 1% solution of hydrogen peroxide, washed from crusts, and then ointment was applied to the crack and red border of the lips for 20 minutes the specified composition and mixed ex tempore, the procedure was repeated with an interval of 2-3 days 3 times. During the 3rd visit to the doctor, an additional insulin syringe was used to block 1% warm lidocaine solution in a dose of 1 ml exactly under the crack on the side of the mucous membrane of the lip, after lubricating the injection site with 10% lidocaine solution. Lidocaine blockade was carried out with preliminary sedation of apodiazepam at a dose of 5 mg sublingually. Starting from the second visit, the doctor conducted 8 daily sessions with a helium-neon laser to the crack area for 2 min in a continuous mode with a power of 10 W with an obligatory air gap of 0.5 cm and using a mirror nozzle. The glow was carried out 20 minutes after applying a special ointment of complex composition, and removing its excess. At home, the patient took multivitamins for one month, used Pansoral oral gel while outdoors, lubricated the lower lip with Traumeel ointment 3 times a day after meals for 7 days, and after absorbing it, ointment of a complex composition, after which within 20-30 minutes did not leave the room.

Crack healing occurred on the 10th day. When viewed after a year, the red border of the lips without pathologies.

Claims (3)

1. A method of treating chronic recurring lip cracks and combinations of chronic recurring lip cracks with exofoliative or atopic cheilitis, including applying a proteolytic enzyme to a crack and red lip rim, washing it off with hydrogen peroxide, removing crusts and applying ointment to a crack and red lip rim, conducting lidocaine blockades in the affected areas, the use of hygiene products for daily protection of the lips, the appointment of antihistamines and the correction of the psychoemotional state, distinguishing The fact is that after removing the crusts, an ointment containing Sol is applied every day for 8-10 days after 20 minutes. Retinoli acetatis oleosae, Sol. Tocopheroli oleosae, Thiamine bromidi, Insuline acropidi, Ung. Heparini, Ung. Celstodermi, Ung. Solcoseryli in the following components, g: Sol. Retinoli acetatis 1.0 Soi. Tocopheroli oleosae 1.0 Thiamini bromidi 0.2 Insulini acropidi 1.0 Ung. Heparini 20.0 Ung. Celestodermi 15.0 Ung. Solcoseryli 20.0 and they glow with a helium-neon laser for the affected area of the lips for 2 min in a continuous mode with a power of 10 W with an obligatory air gap of 0.5 cm and using a mirror nozzle, and before lidocaine blockade, apodiazepam is premiumized in a dose of 5 mg sublingually, with lidocaine blockade is carried out through the mucous membrane, lubricating the injection site with a 10% lidocaine solution, and with a combination of chronic recurring lip cracks with atopic cheilitis, apply to the affected areas of the lips and perioral skin proteolytic enzyme and ointment “Lorinden C” or “Traumeel”. 2. The method according to claim 1, characterized in that they additionally carry out the correction of the psychoemotional state using antidepressant drugs. 3. The method according to claim 1, characterized in that oral hygiene is used as hygiene products.