The method of treatment of inflammatory diseases of maxillofacial area in patients with diabetes mellitus


(57) Abstract:

Usage: in surgical dentistry. Purpose: reduction of treatment time and increase efficiency. The inventive patient with diabetes mellitus with acute purulent-inflammatory diseases of maxillofacial area carry out comprehensive treatment, including surgical interventions and the introduction of insulin. Starting from 3-6 for after surgery daily wound loose plugging torontoi moistened with a 3.5% solution of olivina for 6-8 days. Patients with severe diabetes and spilled purulent-inflammatory processes simultaneously appoint tablet alifana 0.5 g 3 times a day for 7-10 days. Positive effect: speeds up recovery and reduces the total duration of treatment.

The method relates to medicine, namely to dental surgery.

There are various methods of treatment of inflammatory processes of the soft tissues of the neck, face and jaws. Schematic diagram of the treatment of acute odontogenic infection consists of complex events. The main components of it are:

1. Surgical intervention for the purpose of drainage votecast Detoxification treatment.

4. Desensitizing treatment.

5. Measures to restore homeostasis of the major functional systems of the body.

6. Tonic and stimulating treatment to improve immunobiological properties of the facial tissues and the whole organism (N. Gruzdev.A. Acute odontogenic infection. M. Medicine, 1978. S. 77).

One of the pressing issues of modern purulent surgery is the treatment of inflammatory diseases, developing and/or leaking in patients with diabetes mellitus. Surgical infection and diabetes mellitus, occurring at the same time, different number of features. On the one hand, any, even minor, purulent lesion causes a violation of all metabolic processes, leading to insulin deficiency, the progression of diabetes and its decompensation. On the other hand, metabolic disorders, slowing the regeneration and reparation of tissues, complicate and exacerbate the inflammatory process.

It is known that carbohydrate, protein and fat metabolism, changes in electrolyte, water balance, activation of lipid peroxidation (LPO), suppression of regenerative-reparative abilities of the body is inevitable companions sahasa changes in diabetes mellitus. Violation of the regime occurrence of the FLOOR (the increase in the intensity of the triggering effects, depletion of antioxidants, the development of the syndrome peroxidation) causes the defeat of structural-functional organization of membranes, inhibition of the functioning of mitochondria, accumulation of biologically inert polymers. In patients with diabetes, regardless of age observed a significant reduction of sulfhydryl groups, which is an active group of many biologically active substances in the body that are involved in metabolic processes governing the synthesis and accumulation of acid mucopolysaccharides, collagen formation. In diabetes there is protein deficiency, own deficit of sulfhydryl groups, which, in all probability, causes the disorder mukopolisaharidnyh complex (Pogozheva E. E. Amiraslanov Y. A. Merenkova S. A. Purulent infection and diabetes: scientific review. M. 1980. 56 C.).

Complex treatment of purulent diseases diabetes should be conducted under the following conditions:

a) surgery with wide opening foci of destruction and subject to adequate drainage;

b) antibiotic therapy, prima and desensitizing therapy;

d) correction of violations of water-salt, electrolyte, carbohydrate, protein metabolism, acid-base status, nonspecific defense (Pods Century. And. Postyshev C. K. Pods Y. C. Guide purulent surgery (AMS of the USSR. M. Medicine, 1911. C. 103-113).

The disadvantages traditionally used methods of therapy in the complex treatment of inflammatory diseases in patients with diabetes mellitus are:

1. The need for a long stay patient in the hospital.

2. The traditional method of treatment does not involve the use of drugs, which have significant antioxidant and anti-oxidant activity that does not correct tissue hypoxia festering wounds.

3. There are a significant number of contraindications for the use of physiotherapeutic procedures (e.g., electrophoresis of drugs, diadynamic therapy), the acute phase of inflammation, hypersensitivity electric current, hypertensive heart disease, malignant tumors of the maxillofacial region, erosive or ulcerative processes of the mucous membranes of the mouth, etc.

4. The possibility of allergic reactions immediate and semiclandestine substances.

The closest method of treatment of purulent-inflammatory diseases in patients with diabetes is complex, which is that under adequate anesthesia and corrective therapy aimed at maintaining and restoring disturbed by disease bodily functions, is operative intervention (opening and drainage of abscess), correction of carbohydrate metabolism with fractional use of insulin, prescription of broad-spectrum antibiotics, detoxification and immunocorrective therapy (Molchanov, K. A. content Century. And.// Dentistry. - 1981. N 1. S. 42-44; Huseynov R. R. // Dentistry. 1984. N 1. S. 48-50; Maser Ahmed // Dentistry. 1989. # 4. S. 41-44).

There is a method of local application of ointments "Iruksol" and balm of shestakovskaja in the treatment of purulent-inflammatory diseases of soft tissues in patients with diabetes mellitus. These samples were used to accelerate the cleansing of the wounds of necrotic tissue and stimulate regeneration. However, despite the improved results of treatment, the average length (36 days) and total (50-57 days) treatment remained quite large, was observed deaths (Goryunov A. I. Kuleshov E. C.// Sov. IU is but the disadvantages traditionally used methods of treatment of purulent-inflammatory diseases of maxillofacial area in patients with diabetes mellitus are:

1) low efficiency, manifested slow purification of the festering wounds of necrotic tissue, sluggish development of granulation as a result of metabolic disorders, disorders of microcirculation and hypoxia;

2) complexity;

3) duration of treatment time;

4) a significant rate of complications and high mortality (7-22%).

The aim of the invention is the reduction of treatment time and increase efficiency.

The essence of the invention lies in the fact that the patient with diabetes mellitus with acute purulent-inflammatory diseases of maxillofacial area (periostitis of jaw, jaw osteomyelitis, abscess, cellulitis) carry out comprehensive treatment, including opening and drainage of abscess, antibacterial and detoxification therapy, administration of insulin (correction of the level of blood glucose by insulin). Along with this after surgery (3-6 days) should be performed within 3-5 days local therapy of 3.5% aqueous solution of olifen and/or oral administration of the last 0.5 g 3 times deeley structure, has a direct effect on the respiratory chain of mitochondria. The presence in the polymeric structure of the drug thiosulfate group determines expressed antiradical and antioxidative action. This contributes to the improvement of respiratory processes in tissues, normalization of the disturbed metabolism in the body, which results in the acceleration of wound healing, bringing it to natural conditions. The choice of dosage and course of treatment based on the instructions for use of olivene (decision of the Pharmacological Committee of Ministry of health USSR N 01 from 18.03.88 year).

The method is as follows: 3-6 days after surgery (opening and drainage of abscess) carry out the treatment of the wound with antiseptic solutions (0.05% chlorhexidine digluconate, 1:5000 furatsilina), subsequent irrigation her saline solution, and then washing the 3.5% solution of olifen. Over the next 6-8 days the wound on day loose plugging torontoi moistened with the same solution. Local application of a 3.5% solution of olivina continues until the rich granulation and epithelialization of the wound, overlapping secondary sutures. Patients with spilled inflammation and asthma oznachaet inside 0.5 g three times a day 30 minutes before a meal. In case of severe diabetes and limited inflammatory process olifen internally in the same doses for 7-10 days.

P R I m e R 1. Patient B s A. N. 29 years old, hospitalized 3.09.92, in the dental Department of the Smolensk oblast clinical hospital with a diagnosis of cellulitis of the submandibular, podzavalovo, kralovice-jaw and okolopochechnogo spaces to the right: diabetes mellitus (type I, moderate). Complaints received at a General weakness, fever, pain, swelling in the submandibular and parotid-masticatory areas to the right, painful swallowing. Sick 6 days, when there was pain in the tooth. Medical help is not sought. The General condition for admission severe: the patient is pale, dinamico, body temperature was 38.1oC, blood pressure 110/80 mm RT.article pulse 92 in 1 min, satisfactory qualities, respiratory rate 20 per minute Local: asymmetry of the face due to infiltration and pronounced swelling of the soft tissues of the chin, parotid-masticatory, submandibular areas on the right. Infiltrate without clear boundaries, sharply painful to palpation. AB submandibular region to the right is determined by the fluctuation. Mouth opening was painful to 0.5, see koroni infiltrated and hyperemic. Blood test on admission: ESR 52 mm per hour, Ayr. 3,59 1012/l, C.p. 0,94, hemoglobin 110 g/l, leukocytes 11,2 109/l, LII 4,1, PSM 0,41% blood Sugar - 15:5 mmol/l urine: protein 1,65% beats. weight 1043, leukocytes large quantities of erythrocytes to 15-18 in the field of view, a single hyaline and granular cylinders. Identified increase the intensity of SEX: the concentration of MDA reached 12.4 mmol/l, EWP to 5.5%

Given the severity of the condition, the patient was transferred to intensive care unit, where he was the correction of glycemia and implemented preoperative preparation. After reducing the concentration of sugar in the blood (up to 6.7 mmol/l) and preoperative detoxification therapy under General anesthesia was opened phlegmon. Subsequently the patient was conducted desintoxicacion, antibacterial and dehydration therapy, correction of blood glucose, the treatment of purulent wounds. After transfer of the patient in the dental office (on day 7) in the complex treatment was included olifen (oral 0.5 g three times a day for 10 days). When the dressings after necrotomy, wash the wound with antiseptic solutions (furatsilina, chlorhexidine), wash the wound with antiseptic solutions (furatsilina, olifen. In the loosely wound for 6 days was introduced turunda impregnated by the same drug. Already on the second day after the combined application of olivina the patient noted improvement in General condition: it has become more active, stopped gnetaceae from the wound for 3 days appeared abundant pink granulation expressed marginal epithelization. This resulted in a 6 day apply a secondary stitches on the wound. After the hospital 24 hospital bed day, the patient is in satisfactory condition 21.09.92 was discharged to outpatient treatment. Before discharge normalized indicators of homeostasis: the number of er-tov increased to 4.43 1012/l, hemoglobin up to 130 g/l, WBC decreased to 8.0 109/l, erythrocyte sedimentation rate reached 26 mm per hour, LEAH dropped to 1.3. Normalized and indicators GENDER.

P R I m m e R 2. Patient sh-VA H. I. 70 years, hospitalized 17.02.92, dental Department, SOCB with a diagnosis of odontogenic osteomyelitis of the mandible to the right (acute phase), diabetes mellitus (type II, moderate). Complaints received at a General weakness, painful swelling of the right cheek, limited mouth opening, pain when swallowing, numbness of the skin of the chin and lower lip on the right. Sick about two weeks. Zabolevania due to the swelling and moderate infiltration colocolostomy soft tissues on the right, thickening of the body of the mandible. Palpation painful. Symptom Vincent positive. Leather colocolostomy region in color is not changed, freely going into the crease. The mouth opening is limited to 1.5 cm From the mouth: the crown of the tooth is destroyed half, percussion him slightly painful. Transitional fold right edematous and infiltrated, mabuhay. There is swelling of the mucous membrane retromolar region and krylovidnymi folds to the right. Treatment: under General anesthesia produced by the removal of the tooth, made the incision of the mucous membrane on the transition fold, the resulting pus, the wound drained. Appointed: kanamycin 0.5 three times a day/muscle, 10% solution of calcium chloride to 1 tablespoon three times a day. Held: rinse the mouth with antiseptic solutions, daily irrigation of the wound solutions furatsilina, chlorhexidine digluconate, and was ointment compresses on the area of the body of the mandible on the right. Consultants endocrinologist and internist recommended insulin injections under the scheme, cardiac glycosides. From the second day after surgery the patient is assigned olifen inside 0.5 g three times a day for 7 days. On the 3rd day after the beginning of reception of olivina noted the infiltration of soft tissues. Normalized body temperature, has improved the condition of the patient. To the day of discharge 26.02.92, (10 day) the wound was completely salpetersaure. In the treatment of olivenol experienced a more significant reduction of endogenous intoxication (LII decreased from 3.4 to 2.1% and the concentration of medium molecular peptides NSR decreased from 0.31 to 0.26%). Observed normalization of GENDER: the content of malondialdehyde (MDA) decreased from 7.9 to 7.0 mmol/l and peroxide resistance of erythrocytes (EWP) from 3.5% to 3%

The specified method of treatment of purulent-inflammatory diseases of maxillofacial area applied in 5 patients with diabetes mellitus. In all cases, the results are good immediate and long (up to 10 months) treatment results. All patients reported improvement in General condition and health. There was a significant decrease intoxication, defined both clinically and through laboratory studies. Normalized indicators of lipid peroxidation. After two or three times the treatment of wounds with a solution of olivina decreased pain in the lesion edema and infiltration of the soft tissues, gnetaceae; accelerated cleansing the wound of necrotic tissue. 3-4 day appeared abundant granulation and regional patients with diabetes provides the following benefits:

1. An example of a highly effective pathogenetic treatment of these diseases in patients with diabetes, as olifen in conditions of tissue hypoxia increases the efficiency of tissue respiration.

2. The use of olivina after the first procedure accelerates the phase hydration (reducing it from 6 to 3 days) and its transition phase dehydration of wounds, reduces inflammation, cleansing the wound of necrotic tissue, accelerates wound healing (granulation, epithelization), which is most clearly expressed after local treatment of the wound with a solution of olifen and taking the last inside.

3. Reduces the overall duration of treatment.

4. Decreases in 4-5 days time overlay secondary sutures.

5. The method is simple and can be implemented in practice dentists, clinics, medical organizations.

The method of treatment of inflammatory diseases of maxillofacial area in patients with diabetes through surgery and drug therapy, wherein the patient is additionally within 6 to 8 days injected into the wound on turunda a 3.5% aqueous solution of olivina, patients with severe diabetes and 0.5 g 3 times daily for 7 to 10 days.


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