RU2232025C2 - Method for treatment of chronic traumatic osteomyelitis complicated with suppurative-inflammatory process in paramaxillary soft tissues - Google Patents

Abstract

FIELD: medicine, maxillofacial surgery.

SUBSTANCE: method involves complex medicinal therapy in combination with additional prescription of the preparation "Vinibis" by course for 5 days in the dose 0.65 g, 4 times per a day. Method provides reducing time treatment.

EFFECT: improved treatment method.

4 tbl, 2 ex

Description

The invention relates to the field of medicine, namely maxillofacial surgery.

In recent years, there has been an increase in the number of facial bones injuries, among which the leading place (65-95%) is occupied by fractures of the lower jaw. Moreover, despite the success in their treatment, the frequency of development of purulent-inflammatory complications in this type of pathology from 1983 to 1995 increased from 11 to 41%. Moreover, it is known that their occurrence is largely determined by a decrease in the immunological reactivity of the organism and non-specific factors of its protection. Traumatic osteomyelitis is the most common complication in open fractures of the lower jaw. Its occurrence is promoted by inadequate and untimely therapy of purulent process in the maxillary soft tissues [3].

It is known that bee products (honey, propolis, wax, royal jelly, bee venom, etc.) have a bactericidal effect on streptococci, white and Staphylococcus aureus, including antibiotic-resistant ones, as well as on Pseudomonas aeruginosa, intestinal, protea and typhoid bacilli possess antifungal and antiviral properties, have a pronounced anesthetic effect on the mucous membrane and skin, accelerate the regeneration of wound surfaces [2]. However, in well-known sources of information, despite the pronounced immunobiological effect of beekeeping products, we did not find their use in the complicated course of fractures of the lower jaw. Although there are reports of a positive clinical effect of topical application of these products in other inflammatory diseases of the maxillofacial region.

It is known that atomic absorption methods make it possible to determine practically all the elements of the Periodic System and are distinguished by high selectivity and sensitivity (up to 10 ^-14 g). Moreover, the exchange of calcium and silicon is closely related. Silicon promotes collagen biosynthesis and bone formation. It has been established that in bone fractures, the amount of silicon in the fracture region increases by almost 50 times [1].

At the same time, it is known that there is a drug based on bee products in tablet form. The main active ingredient of this dosage form is bee bread - a vital product of bees that contains the active components of plant and animal (bee) origin; does not give negative side effects, expressed in individual intolerance to bee products. The advantage of this drug is that it is presented in tablet form, which makes it possible to use it dosed in contrast to the known analogues, and internal use significantly increases its immunobiological effect [2].

The composition of 4 g of the drug “Vinibis” contains the following components:

Vitamins

Vitamin A 200 I.E.

Vitamin B1 33 mcg

Vitamin B2 71 mcg

Vitamin B3 76 mcg

Vitamin B6 22 mcg

Vitamin B12 5 mcg

Folic acid 24 mcg

Vitamin C 70 mcg

Vitamin D 64 mcg

Vitamin PP 15 mcg

Vitamin (H) 2.4 mcg

Vitamin E 3.6 mg

Vitamin P 2.4 mg

Trace elements, mg:

Phosphorus 24

Potassium 44

Calcium 45

Sodium 1.6

Magnesium 14

Copper 0.06

Iron 10

Manganese 5.6

Sulfur 40

Chlorine 3.2

Silicon 5

16 more trace elements

Amino acids, mg

Arginine 200

Isoleucine 204

Leucine 252

Lysine 260

Methionine 84

Phenylalanine 164

Threonine 128

Valin 232

Histidine 112

Tryptophan 56

Another 9 amino acids and more than 40 enzymes.

Thus, given the known composition of the drug, we used a daily dose of 2.6 g, which corresponded to 4 tablets of 0.65 g each 4 times a day for 5 days.

Materials and research methods.

Six patients with chronic traumatic osteomyelitis complicated by purulent-inflammatory process in the maxillary soft tissues aged 26 to 48 years were examined, of which 3 patients underwent traditional complex treatment (group 1) and 3 patients who underwent traditional complex treatment treatment included the drug “Vinibis”, one tablet of 0.65 g 4 times a day for 5 days. We studied mixed unstimulated saliva (oral fluid) in 6 healthy people without dental diseases aged 20 to 27 years (control group).

Methodology for the study of mixed unstimulated saliva (oral fluid).

The patient pre-rinses his mouth with bidistilled water in an amount of 50 ml for 5 minutes. Oral fluid is collected in a dry clean polyethylene tube in an amount of 2.0 ml. The oral fluid is taken with a micropipette with a volume of 10-20 μl and introduced into the cuvette of the atomic absorption spectrometer. The atomic absorption signal of the corresponding element is recorded. Registration conditions: AAS 30 spectrometer with an EA-3 atomizer manufactured by Cad-Zeiss-Yena (Germany) is pre-calibrated using calcium and silicon solutions with a known concentration. By this result it is issued immediately in units of concentration. The total analysis time (from the moment a patient takes a sample to the result of the analysis) is 2 minutes.

The biological sample was taken from the control group 2-3 hours after breakfast (10-11 hours in the morning). Before collecting saliva, the subjects thoroughly rinsed their mouth with bidistilled water (50 ml), spit 2-3 times into the sink, and then saliva was collected in clean polyethylene tubes for 10-15 minutes by spitting. Saliva was collected in a well-lit room, while the subjects were sitting, breathing through their nose, not talking or smoking.

The data obtained were processed by the method of variation statistics. The calculations were performed using a personal computer such as IBM PC / XT. When processing digital data, the calculation of the arithmetic mean, the average error of the arithmetic mean, determination of the reliability of the difference between the average values (by student criterion t).

The results are presented in table 1 and table 2.

The Ca / Si coefficient in the oral fluid of patients with chronic traumatic osteomyelitis, complicated by purulent-inflammatory process in the maxillary soft tissues, the complex treatment of which did not include the drug “Vinibis”, - 1 group, and those whose complex treatment included this drug - 2 -th group (table 1 and table 2).

As can be seen from table 2, despite the fact that the average value in the 1st and 2nd groups was higher than in the control group, in the absence of a significant difference in the values between them (p> 0.05) at the time of discharge, the coefficient Ca / Si in the 1st group increased both in comparison with the control group (p <0.01) and in comparison with the 2nd group (p <0.05), in which the value of this coefficient decreased and reached the values of the control group (p> 0.05). Moreover, the average bed day in the 1st group was 28, in the 2nd - 17.

Therefore, the use of the drug “Vinibis” in the complex treatment of chronic traumatic osteomyelitis, complicated by a purulent-inflammatory process in the maxillary soft tissues, is accompanied by a faster recovery of patients, which allows us to recommend its use in this pathology.

Consider two specific examples, one from each group. Both patients had the same diagnosis and identical complex treatment, which differed only in that one of the patients was included in the treatment with the drug “Vinibis”, one tablet of 0.65 g 4 times a day for 5 days.

1. Patient Shulgin VV, 48 years old, was hospitalized in the Department of Maxillofacial Surgery BSMP with a diagnosis of chronic traumatic osteomyelitis of the lower jaw in the chin, complicated by phlegmon of the submental area. I received an injury 3 weeks ago, I did not apply for medical help. The general condition at admission is satisfactory, body temperature 36.9 ° C. Tigerstedt double jaw splint with hook loops, intermaxillary rubber traction was applied to the patient, the bite was restored. Under local anesthesia, an autopsy was performed on phlegmon, and pus was obtained. 1 lower tooth on the right, 2 and 3 lower teeth on the right adjacent to the fracture line were removed to the patient; curettage of the holes removed 1, 2, 3 of the lower teeth on the right, granulation removed, 1 sequestration with a diameter of 0.4 × 0.2 cm. The holes are sutured. Under conditions of general anesthesia, a sequestrectomy operation was performed, 1 lower tooth on the left was removed for the purpose of rehabilitation. At discharge, stitches were removed. A course of antibacterial therapy (ampicillin, medoglycine), anti-inflammatory (analgin), desensitizing (diphenhydramine), immunostimulating (methyluracil), general strengthening (B vitamins), physiotherapy - electrophoresis with calcium chloride solution No. 10 was carried out.

On a panoramic x-ray in nasolope projection, a veiled fracture line in the chin is defined, passing between 2 and 3 lower teeth on the right. The area of bone resorption at the edges of bone fragments, 2 dense shadows of irregular shape (sequestra) are determined. On the control x-ray in the nasolope projection, the presence of sequesters in the chin is not determined.

Upon admission, basophils - 2%, plasma cells - 0.5% are determined in a general blood test, no other pathological changes are determined in a biochemical analysis, a general urinalysis. At discharge in the general analysis of blood, the general analysis of urine, pathological changes are not determined.

The dynamics of changes in the concentration of calcium (Ca) and silicon (Si) upon admission and discharge, as well as the Ca / Si coefficient are presented in table 3.

The patient was discharged in satisfactory condition with improvement for outpatient treatment (it is recommended to continue physiotherapy, removal of intermaxillary fixation in the clinical consolidation of bone fragments). Bed days - 36.

2. Patient Balandin VA, 44 years old, was hospitalized again in the Department of Maxillofacial Surgery of the BSMP with a diagnosis of chronic traumatic osteomyelitis of the lower jaw in the angular section on the left, complicated by phlegmon of the left upper chewing space. I got injured about 27 days ago. He was previously hospitalized for an open traumatic fracture in the region of the angle of the lower jaw on the left. The patient underwent appropriate complex treatment, removing the 8 lower tooth on the left from the fracture line at discharge. He was outpatient in a dental clinic at the place of residence. About 3 days ago, the patient developed a painful infiltrate in the parotid-chewing area on the left, purulent discharge from the fistula in the area of the fracture line in the projection of the removed 8 lower tooth on the left. General condition upon receipt of moderate severity, body temperature 37.0 ° C. Under conditions of general anesthesia, the phlegmon was opened, pus was obtained, and the wound was drained. Under conditions of general anesthesia, a sequestrectomy operation was performed, 2 sequestra were removed. At discharge, the Tigerstedt double-jaw tire with hook loops was removed, and the joints were removed. A course of antibacterial therapy (oxamp, medoglycine), anti-inflammatory (analgin), desensitizing (diphenhydramine), detoxification (infusion therapy using a hemodesis solution), UHF physiotherapy was carried out, and for 5 days the patient received the drug Vinibis according to one tablet 0.65 g 4 times a day.

On a panoramic x-ray in nasolope and left lateral projection, a veiled fracture line is determined in the region of the angle of the lower jaw on the left. The area of bone resorption at the edges of bone fragments, 2 dense shadows of irregular shape (sequestra) are determined.

In the general blood test at admission, a slight increase in ESR up to 10 mm / h is determined. In the biochemical analysis of blood and in the general analysis of urine, pathological changes are not determined.

The dynamics of changes in the concentration of calcium (Ca) and silicon (Si) upon receipt and discharge, as well as the Ca / Si coefficient are presented in table 4.

The patient was discharged with recovery. Bed days spent - 20.

Sources of information.

1. Borisenkova R.V. Silicon // BME. - 3rd ed. - M., 1979. T. 11. - S. 520-523.

2. Troyansky I.V., Mozharenko V.P., Furmanov L.I. The use of beekeeping products in dentistry // Dentistry. - 1983. - T. 62. - No. 4. - S. 80-82.

3. Surgical dentistry: Textbook / Ed. T.G. Robustova. - M .: Medicine, 1990, - 576 p .; silt. - (Textbook. Lit. For student. Medical. Universities).

Claims (1)

A method for the treatment of chronic traumatic osteomyelitis complicated by a purulent-inflammatory process in the maxillary soft tissues, comprising complex drug therapy, characterized in that “Vinibis” is additionally prescribed as a medicine with a 5-day course of 0.65 g 4 times a day.