RU2330644C1 - Method of treatment of maxillofacial inflammatory diseases - Google Patents

Abstract

FIELD: medicine; stomatology.

SUBSTANCE: invention can be used for treatment of maxillofacial inflammatory diseases. For this purpose after suppurative focus is surgically opened and drained, intratissular subcutaneous or submucous introduction of Perftoran follows. Thus Perftoran is injected from four injection points equally-interspaced by perimeter, in amount 0.3-0.5 ml and more per one point, depending on wound area. Course of treatment is 4-6 days.

EFFECT: improved efficiency of anti-inflammatory therapy due to uniform distributed Perftoran emulsion directly within inflammation centre.

5 ex

Description

The invention relates to medicine, namely to surgical dentistry, and can be used in the complex treatment of inflammatory diseases of the maxillofacial region.

There is a method of treating inflammatory diseases of the maxillofacial region, which consists in anti-inflammatory therapy by dialysis of purulent wounds with perftoran emulsion (Method for the treatment of odontogenic phlegmon of the maxillofacial region. RF Patent No. 2244518 from 01.20.2005).

This method allows you to stop inflammation in the wound, the infiltration of the surrounding soft tissues, further contributes to its granulation and epithelization.

The disadvantages of this method: lack of effectiveness, due to the impact of perftoran only on the surface layers of the wound and its dilution in wound exudate, the need for constant washing of the wound, which entails a significant increase in the consumption of an expensive drug.

There is a method closest to the claimed solution and chosen for the prototype, in which the effect on the inflammatory focus is carried out by chipping it with the type of "infiltration blockade" of 0.25-0.5% solution of novocaine with antibiotics or enzymes (Guide to surgical dentistry and maxillary -face surgery: in 2 volumes.T.1. / Under the editorship of V.M. Bezrukov, T.G. Robustova. - M .: Medicine, 2000. - P.280).

The disadvantages of this method include the following: lack of effectiveness, due to the lack of exact parameters of the place, quantity, type of drugs, the possibility of allergic reactions

Effect: increasing the effectiveness of anti-inflammatory therapy, reducing the duration of treatment and medical and social rehabilitation of patients with inflammatory diseases of the maxillofacial region, prevention of side effects.

The solution of these problems is carried out by subcutaneous or submucosal interstitial injection of perftoran emulsion along the periphery of the focus of inflammation in patients with inflammatory diseases of the maxillofacial region.

The method consists in the following: after surgical opening and drainage of the purulent lesion, further treatment of the wound is carried out by daily interstitial subcutaneous or submucosal administration of an emulsion of perftoran at the periphery of the inflammation focus (at the border of the palpable infiltrate) from four points equidistant from each other. The volume of perftoran emulsion administered depends on the area of the wound surface in the maxillofacial region:

wound area <10 cm ² - perftoran volume = 0.3 ml at one point

wound area = 10 cm ² - perftoran volume = 0.5 ml at one point

wound area> 10 cm ² - perftoran volume = 0.5 ml at one point for every 10 cm ^{2 of} wound.

Interstitial administration of perftoran emulsion is carried out once a day during dressings, in a course of 4-6 days.

Perftoran is a white-blue submicron emulsion based on organo perfluorinated compounds with a gas transport function stabilized with proxanol-268 (an adduct of polyethylene oxide and polypropylene oxide) in a salt-water medium similar in composition to blood plasma. The drug is approved for clinical use throughout the Russian Federation (License No. 64/396/97 of 04/21/97; Order of the Ministry of Health of the Russian Federation No. 50 of 06/13/96; Registration Certificate No. 96/50/10 of 02/13/96). For the treatment of inflammatory diseases of the maxillofacial region, interstitial administration of perftoran emulsion was used for the first time.

The aforementioned parameters of interstitial administration of perftoran emulsion depending on the area of the wound surface in the face and neck, giving a daily prolonged release of perfluorocarbon compounds into wound exudate, were determined experimentally in vitro and then tested in a hospital in a hospital.

The kinetics of the release of perfluorocarbon compounds in wound exudate from 1 min to 36 hours (with interstitial administration of perftoran emulsion in a volume of 0.1 to 3.0 ml per injection point) was studied in patients with inflammatory diseases of the maxillofacial region (odontogenic, dermatogenic phlegmon, adenogenic etiology; boils and carbuncles, periodontitis) by recording fluorine ions and recording 19F NMR spectra on a nuclear magnetic resonance spectrometer WP80SY (Bruker) with a resonant frequency for 19F - 79.398 MHz. Samples were investigated as solutions. The internal standard was hexafluorobenzene solution. Chemical shifts in the spectrograms were given relative to trifluorotri-chloromatan.

Examples of specific performance.

Example 1

Patient M., 42 years old, with phlegmon of the buccal, infraorbital regions on the right of odontogenic etiology.

Complaints upon admission to fever up to 40.0 ° C, severe weakness, painful swelling in the right half of the face, narrowing of the palpebral fissure on the right, sleep disturbance, appetite. From the anamnesis - pain in the 16th tooth was disturbed for about a week, then the pain stopped, but there was a swelling in the infraorbital region on the right. He took aspirin and carried out thermal procedures, as a result of which the swelling became dense, sharply painful, and gradually increased in size. Hospitalized on the 12th day after the onset of the disease. Blood test on the day of admission: red blood cells 3.9 × 10 ¹² / L, hemoglobin 138 g / L, white blood cells 12.6 × 10 ⁹ / L, of which stab neutrophils 8%, segmented 55%, lymphocytes 33%, monocytes 4% ESR 55 mm / h. On the day of receipt by external access under infiltration anesthesia with a solution of lidocaine hydrochloride 1% - 25 ml, a purulent lesion was opened and drained (S wounds = 8.73 cm ² ), 16 tooth was removed. Antibacterial therapy was prescribed: benzylpenicillin sodium salt intramuscularly 1.0 × 6 times a day for 7 days; hyposensitizing therapy: diphenhydramine intramuscularly 1% - 1 ml 2 times a day for 6 days; analgin 50% - 2 ml 2 times a day for 5 days; aspirin inside 0.5 - 3 times a day for 5 days; infusion therapy (physiological solution of sodium chloride 0.9% - 400 ml, glucose solution 5% - 400 ml, Ringer's solution 400 ml, insulin 5 IU, potassium chloride solution 10% - 10 ml, ascorbic acid 5% - 5 ml, hemodes 400 ml) for 4 days. Interstitial subcutaneous perifocal administration of perftoran emulsion was carried out from four equidistant points along the perimeter, at the border of a palpable infiltrate, 0.3 ml of emulsion per point (total volume per injection - 1.2 ml), daily, 1 time per day, during ligation, the course of treatment is 6 days (the total amount of the drug administered was 7.2 ml).

Result: Sleep, appetite returned to normal on the 2nd day, body temperature - on the 3rd day. Dynamics of local changes: edema and infiltration of the edges of the wound disappeared on the 4th day, the wound completely cleared of necrosis on the 5th day, wound exudate, which at first had the character of putrefactive-purulent, changed on the 4th day to serous-hemorrhagic and completely stopped on the 6th day, in the wound islands of bright red granulations appeared and secondary sutures were laid on day 6. Blood test at the time of discharge: red blood cells 4.2 × 10 ¹² / l, hemoglobin 140 g / l, white blood cells 7.6 × 10 ⁹ / l, of which stab neutrophils 3%, segmented 62%, lymphocytes 28%, monocytes 7% ESR 25 mm / h. Further treatment was carried out in the rehabilitation room, the inpatient treatment period was 6 days.

Example 2

Patient S., 18 years old with a boil of the upper lip in the stage of abscess formation.

Complaints at admission to fever up to 37.4 C, pain and swelling in the upper lip, weakness, poor sleep. Blood test: red blood cells 3.4 × 10 ¹² / l, hemoglobin 121 g / l, white blood cells 8.0 × 10 ⁹ / l, of which stab neutrophils 5%, segmented 62%, lymphocytes 30%, monocytes 3%, ESR 45 mm / h

On the day of admission under infiltration anesthesia with a solution of lidocaine hydrochloride 1% - 8 ml, a purulent lesion was opened and drained, S wounds = 2.08 cm ² .

Antibacterial therapy was prescribed: benzylpenicillin sodium salt intramuscularly 1.0 × 6 times a day in a course of 5 days. Interstitial subcutaneous perifocal administration of perftoran emulsion was carried out from four equally spaced points along the perimeter, at the border of the palpable infiltrate, 0.3 ml of emulsion per point (total amount per injection - 1.2 ml), daily, 1 time per day during dressings, the course of treatment is 4 days (the total amount of the drug administered was 4.8 ml).

Result: after the first procedure, hyperemia around the wound disappeared, the pain stopped, the body temperature returned to normal, locally: the infiltrate decreased by 1/2 of its value. On the 3rd day, exudation stopped, granulation appeared in the wound, epithelization appeared on the edges, which ended with complete healing of the wound by 5 days, which allowed the patient to be discharged from the hospital with recovery. Blood test at the time of discharge: red blood cells 3.5 × 10 ¹² / l, hemoglobin 125 g / l, white blood cells 5.6 × 10 ⁹ / l, of which stab neutrophils 1%, segmented 62%, lymphocytes 31%, monocytes 6% ESR 12 mm / h.

Example 3

Patient L., 43 years old, came to the clinic with complaints of bleeding and soreness of the gums when brushing, gum recession and increased sensitivity of the neck of the teeth, tooth mobility in the front of the upper jaw, bad breath, and nasal discharge from periodontal pockets.

From the anamnesis of the disease: bleeding and soreness of the gums worries for 9 years, hypersensitivity for about 4 years, tooth mobility is observed for 3 years. Earlier, the dentist was consulted periodically with the aim of rehabilitating the oral cavity and conducting professional hygiene, the treatment was carried out by a periodontist about 1.5-2 years ago, teeth were splinted in the front of the lower jaw, after which mobility decreased. Heredity for periodontal disease is burdened by the mother.

Objective examination: the face is symmetrical, regional lymph nodes are not palpable, the complexion is pale pink. Interdental, marginal, alveolar gums are stagnantly hyperemic, edematous, loosened, bleeding during sounding. Oral hygiene is satisfactory. Dental deposits on the vestibular surface of the molars of the upper jaw and the lingual surface of the incisors of the lower jaw. The Green-Vermilion index is 1.5, the bleeding index is 2.3; RMA - 73%. The depth of periodontal pockets in the area of 16, 17, 11, 21, 27, 26, 33 teeth - 10-11 mm; 12, 37-8 mm; 15, 14, 13, 22, 23, 24, 25, 34, 35 teeth up to 6-7 mm; 31, 32, 38, 41, 42, 43, 44, 45, 47 teeth - up to 4-5 mm. Mobility of the IV degree is determined in the area of 16, 17, 11, 21, 27, 26 teeth; mobility of the III degree - 12,24,25,34 teeth; II degree - 37.35; 1 degree - 14, 15, 13, 23, 33 teeth. Gingival recession in the area of 43-33 teeth up to 3 mm; 12-22 teeth up to 4 mm. Orthognathic bite, multiple supracontacts. PI 4.3, Fuchs index 0.45. An X-ray examination on an orthopantomogram reveals extensive foci of destruction of the alveolar bone with the destruction of the interalveolar ridges at an angle of 2/3 or more of the root length, the fuzziness and unevenness of the contours of the destroyed bone tissue, which indicated the activity of the process.

Diagnosis: severe chronic generalized periodontitis. Stage of exacerbation.

The patient received the following treatment:

1. Teaching oral hygiene, monitoring oral hygiene;

2. Professional oral hygiene

3. The treatment and prophylactic complex, including: the perifocal administration of perftoran emulsion under the gingival mucosa was carried out from four equally spaced points along the perimeter, 0.3 ml of the emulsion per point (total amount per injection - 1.2 ml), daily, 1 time per day during dressings, the course of treatment is 6 days (the total amount of the drug administered was 7.2 ml).

In the next 5 days of treatment, the patient did not complain. Body temperature and blood pressure are normal. When examining the oral cavity, mild edema and hyperemia of the mucous membrane of the marginal gum from the vestibular side in the area of the operation were observed.

Bleeding, pain during antiseptic treatment was not observed.

3 months after the complex treatment, the patient had no complaints. The gum is pale pink, dense; the depth of periodontal pockets decreased in the region of 14, 15, 24, 25, 34, 35 teeth by 4-4.5 mm, 12 by 5 mm, 13.22-3 mm and amounted to 2-2.5 mm. Temporary splinting was maintained in the area of all teeth. Hygienic Green-Vermilion index 0.63, PMA 15.9%, bleeding index 0.33, PI 3.92, Fuchs index. 0.56. Compared with the initial orthopantomogram 5 months after treatment, compaction of the contours of the resorbed alveolar septa and an increase in their height by 2.5 mm in the area of 24.25 teeth by 1.5-2 mm in the area of 15, 14, 13, 12, 34 were revealed. 35 teeth, up to 1.5 mm - in the area of 22.23; restoration of bone tissue in the area of extracted teeth. There are no signs of process activity.

Example 4

Patient S., 52 years old with a festering wound of the zygomatic and buccal areas on the left.

Complaints upon admission to elevated body temperature up to 40.0 ° C, severe weakness, pain in the wound radiating to the temporal region on the left and orbit on the left, suppuration from the wound, sharply painful swelling of tissues around the wound. From the anamnesis - an injury 9 days ago (slipped, fell and hit a curb in the yard of his house), did not seek medical help, streptocide fell into a wound at home. 3 days ago, sharp pains appeared in the wound, the body temperature increased, a painful swelling of the tissues around the wound appeared and began to grow. Hospitalized on the 10th day after the injury. A blood test on the day of admission: red blood cells 4.9 × 10 ¹² / L, hemoglobin 158 g / L, white blood cells 18.6 × 10 ⁹ / L, of which stab neutrophils 15%, segmented 42%, lymphocytes 33%, monocytes 4% , ESR 60 mm / h. On the day of admission under infiltration anesthesia with a solution of lidocaine hydrochloride 1% - 40 ml, the primary surgical treatment of a purulent wound (S wound = 14.82 cm ² ) was performed. Antibacterial therapy was prescribed: cefazolin intramuscularly 1.0 × 3 times a day for 7 days; hyposensitizing therapy: diphenhydramine intramuscularly 1% - 1 ml 2 times a day for 5 days; analgin 50% - 2 ml 2 times a day for 3 days; aspirin inside 0.5 - 3 times a day for 5 days. Interstitial subcutaneous perifocal administration of perftoran emulsion was carried out from four equally spaced points along the perimeter, at the border of the palpable infiltrate, 0.75 ml of emulsion per point (total volume per injection - 3.0 ml), daily, 1 time per day, during ligation, the course of treatment is 5 days (the total amount of the drug administered was 15.0 ml).

Result: Body temperature returned to normal on day 2, pain in the wound disappeared on the first day of inpatient treatment. Dynamics of local changes: edema and infiltration of the wound edges disappeared on the 4th day, the wound completely cleared of necrosis on the 5th day, wound exudate, which at first was purulent, changed to serous on the 4th day and completely stopped on the 5th day, islets appeared brightly in the wound -red granulation and on the 5th day secondary sutures are applied. Blood test at the time of discharge: red blood cells 5.2 × 10 ¹² / L, hemoglobin 156 g / L, white blood cells 6.6 × 10 ⁹ / L, of which 4% are stab neutrophils, 62% are segmented, 28% are lymphocytes, 6% are monocytes ESR 35 mm / h. Further treatment was carried out in the rehabilitation room, the inpatient treatment period was 5 days.

Example 5

Patient Z., 36 years old, with phlegmon of the submental and submandibular regions on the right of odontogenic etiology.

Complaints upon admission to fever up to 39.5 ° C, weakness, painful swelling in the submandibular region, sleep disturbance, appetite. From the anamnesis - pain in the +7 tooth was disturbed for about a week, did not seek medical help, soon a swelling appeared in the submandibular region on the right. She took rinzasip, there was no improvement, the swelling became dense, sharply painful, gradually increased in size. Hospitalized on the 10th day after the onset of the disease. Blood test on the day of admission: red blood cells 2.9 × 10 ¹² / l, hemoglobin 128 g / l, white blood cells 14.6 × 10 ⁹ / l, of which stab neutrophils 12%, segmented 51%, lymphocytes 33%, monocytes 4% , ESR 65 mm / h. On the day of receipt of external access under endotracheal anesthesia, a purulent lesion was opened and drained (S wounds = 9.93 cm ² ), 47 tooth was removed. Antibacterial therapy was prescribed: benzylpenicillin potassium salt intramuscularly 1.0 × 6 times a day for 7 days; hyposensitizing therapy: diphenhydramine intramuscularly 1% - 1 ml 2 times a day for 6 days; analgin 50% - 2 ml 2 times a day for 5 days; aspirin inside 0.5 - 3 times a day for 5 days; infusion therapy (physiological solution of sodium chloride 0.9% - 400 ml, glucose solution 5% - 400 ml, Ringer's solution 400 ml, insulin 5 IU, potassium chloride solution 10% - 10 ml, ascorbic acid 5% - 5 ml, hemodes 400 ml) for 4 days. Interstitial subcutaneous perifocal administration of perftoran emulsion was carried out from four equidistant points along the perimeter, at the border of the palpable infiltrate, 0.5 ml of emulsion per point (total volume per administration - 2.0 ml), daily, 1 time per day during ligation, the course of treatment is 6 days (the total amount of the drug administered was 12.0 ml).

Result: Sleep, appetite returned to normal on the 3rd day, body temperature - on the 3rd day. Dynamics of local changes: edema and infiltration of the edges of the wound disappeared on the 4th day, the wound completely cleared of necrosis on the 6th day, wound exudate, which at first had the character of putrefactive-purulent, replaced on the 2nd day on purulent, on the 4th day on serous-hemorrhagic and completely stopped on the 6th day, islands of bright red granulations appeared in the wound and on the 6th day secondary sutures were applied. Blood test at the time of discharge: red blood cells 3.7 × 10 ¹² / l, hemoglobin 140 g / l, white blood cells 8.6 × 10 ⁹ / l, of which stab neutrophils 3%, segmented 62%, lymphocytes 28%, monocytes 7% ESR 35 mm / h. Further treatment was carried out in the rehabilitation room, the inpatient treatment period was 6 days.

The positive effect of using the proposed method in comparison with the known one is as follows: the effectiveness of anti-inflammatory therapy is increased by bringing the perftoran emulsion directly to the site of inflammation, the terms of medical and social rehabilitation of patients are reduced. A significant advantage is a significant reduction in the volume of an expensive emulsion of perftoran, as a result of which, a reduction in the drug load on the patient’s body, and the prevention of side effects (the development of allergic reactions).

Claims (1)

A method of treating inflammatory diseases of the maxillofacial region, including interstitial administration of drugs along the periphery of the purulent-inflammatory lesion, characterized in that after surgical opening and drainage of the purulent lesion, a 4-6-day course of daily interstitial subcutaneous or submucosal administration of perfluorane emulsion from four points of injection is carried out equidistant along the perimeter from each other, in a volume depending on the area of the wound surface in the maxillofacial region: when the area of the wound is less than 10 cm ² at one point 0.3 ml of perftoran is injected, with a wound area of 10 cm ² , 0.5 ml of perftoran is injected at one point, with a wound area of more than 10 cm ^{2, the} volume of perftoran at one point is calculated from a ratio of 0.5 ml for every 10 cm ^{2 of} wound