A method for the treatment of uncomplicated fractures of the mandible

 

(57) Abstract:

The invention relates to medicine, namely to oral and maxillofacial surgery, and may find application in the treatment of patients with uncomplicated fractures of the mandible within the dentition. In the method carried out sequentially the percutaneous electrical nerve stimulation of the lower alveolar nerve in the area of mental openings and electromagnetic stimulation with the introduction of drugs (electromagnetic in the area of the fracture of the mandible and surrounding soft tissue with differentiated parameters depending on the nature of the fracture, the degree of nerve damage and pain intensity with individually tailored drugs. The method allows to reduce the time of treatment and rehabilitation measures for optimizing osteoreparative processes, reduce complications, inflammatory disorders, post-traumatic contractures, more quickly to stop pain, reduce the number of drugs and associated side effects. 3 C.p. f-crystals, 1 table.

The invention relates to medicine, namely to oral and maxillofacial surgery, and may find application in the fractures with the use of electrical stimulation of the damaged area to optimize osteoreparative. The most active osteogenesis was observed when the effect of direct current in the phase of mineralization of bone matrix, impulse - at all stages of the variables in the stage of formation oleoides tissue (Tkachenko S. C., rocky centuries Electrostimulation of osteoreparative.- HP: Medicine, 1989. - 208 S. ).

The disadvantages of this method are a significant number of complications infectious inflammatory disorders, in particular the bone suppuration of wounds, traumatic osteomyelitis, the use of a significant number of drugs (oral, parenteral), which leads to the development of side effects, the lack of a pronounced analgesic effect in the absence of stimulation of peripheral sensory nerves.

Closest to the claimed method is medicinal electrophoresis in the treatment of fractures of the jaws. As drug use antibiotics, calcium, iodine, lidz and others Use the technique of cross-effects. One electrode placed on the mucous membrane of the alveolar process of the mandible with vestibular side, second from the lingual side (Efanov O. I., Zagainova T. F. Physiotherapy stomatologiczne the introduction of a medicinal product, directly in the area of the gap of the fracture, which increases the risk of complications infectious inflammatory disorders (bone suppuration of wounds, traumatic osteomyelitis), no simultaneous stimulation of soft tissues from the skin in the projection of bone wounds and periosteal Department of localization, no dosage muscle stimulation, which negatively affects the local hemodynamics, especially when a lack of activity of masticatory muscles on the background bimaxillary splinting, a significant number expressed posttraumatic contractures, no differential stimulation of the peripheral section in the trigeminal system in the area of the mental foramen, in this regard, low repair of nerve trunk (long-existing pain, touch paresteticheskih violations in labio-mental area).

The aim of the invention is the reduction of terms of treatment and rehabilitation measures for optimizing osteoreparative processes, reducing the number of complications inflammatory disorders, post-traumatic contractures, faster relieving pain, reducing the amount of medication used, the medium is performed on therapeutic measures (reposition, fixation of bone fragments, the rehabilitation of bone wounds) daily consistently the percutaneous electrical nerve stimulation (tens) of the lower alveolar nerve (NAS) in the field of mental holes on the side of injury and electromagnetic stimulation in the area of the fracture of the mandible and surrounding soft tissue with individually tailored drugs (electromagnetiques (EMFs)) with differentiated parameters (stimulation intensity, exposure time, number of procedures depending on the nature of the fracture (a) incomplete - crack, b) full without displacement of bone fragments, in) full offset of fragments), the degree of damage of the NAS (a) subclinical, light, b) medium, C) moderate, severe (Korzh, M. Diagnosis and treatment of injuries of the lower alveolar nerve in the mandibular fractures and dental manipulations. Abstract. Diss.Kida. the honey. Sciences. - Minsk. - 1989. - 16 C.)) and pain intensity (a) small, b) moderate, significant). Stimulation with tens and EMF conduct short voltage pulses for all types of fractures with the following parameters: pulse amplitude of 100 V, the mode of "sweep" bipolar packs of pulses, the repetition rate of pulses per minute - in the "sweep" - 200 MS, the intensity is determined by the subjective feelings (from 1 to 10 on the scale of the instrument) when dosed to increase stimulation, depending on the nature of the fracture, the degree of destruction of the NAS and intensity of pain. Incomplete fractures of the mandible, the defeat of the national Academy of subclinical and mild, slight pain syndrome intensity tens expressed, the exposure time 3 min, the intensity of electromagnetic stimulation electromagneticradiation the introduction of medicinal substances (EMFs) expressed, the exposure time is 5 min, the number of procedures 3-5, once a day, every day. At complete fracture without displacement, the defeat of the NAS moderate, moderate pain syndrome - intensity tens reasonable, the exposure time is 5 min, the intensity of electromagnetic stimulation electromagneticradiation the introduction of medicinal substances (EMFs) moderate, the exposure time of 8 min, the number of procedures 6-9, once a day, every day. When complete fractures with displacement, the defeat of the NAS moderate and severe degree, expressed painful syndrome - intensity tens minor, the exposure time is 10 min, the intensity of electromagnetic stimulation electromagneticradiation vodev day, on a daily basis. When conducting electromagnetic stimulation electromagneticradiation the introduction of medicinal substances (EMFs) in the fracture area from the mucosa (with vestibular side) put the coil inductance, the conclusions of which are placed, respectively, at 0.5 cm on either side of the fracture. Electrode for tens fitted directly above the coil inductance (through the layer of soft tissue). The voltage on the findings of the inductor has an amplitude, the value of which depends on the intensity of stimulation from 1 to 5 C. in Addition, pre: in the fracture area (in the complete fracture without displacement and offset) podlesice and subperiosteal enter, for example, a 30% solution of lincomycin hydrochloride (2 ml), the inductor (for all types of fractures) wrapped sterile cloth moistened with, for example, a 1% solution of lincomycin hydrochloride, another cloth moistened, for example, a 1% solution of lincomycin hydrochloride (for all types of fractures) placed under the electrode tens from the skin. CHENS and EMF spend every day, once a day. The exposure parameters for different types of fractures of the mandible, the defeat of the NAS, the intensity of pain with the Le traditionally performed primary surgical treatment (if indicated removal of the tooth from the gap of the fracture, remove nonviable tissue, suturing the mucosa, sanitation cracks fracture), reposition of bone fragments and immobilization their conservative orthopedic treatment (for example, overlay duclottni tires) (described in detail in the literature (Alexandrov N. M. injuries to the maxillofacial region. - M.: Medicine, 1986. - 225 C. ), (Arzhantsev P. H., Ivashchenko, M., Lurie T. M. Treatment of injuries of the face. - M.: Medicine, 1975.), spend consequently tens of NAS in the area of mental openings and electromagnetic stimulation with electromagneticradiation the introduction of medicinal substances (EMFs) with differentiated parameters, the introduction of the drug into the region of the gap of the fracture and the surrounding soft tissues. CHENS and EMFs on the side of the fracture is performed with the following parameters: pulse amplitude of 100 V, the mode of "sweep" bipolar packs of pulses, the repetition rate of pulses per minute - 80, the repetition period of the pulses, changing the inside of the pack in the "sweep" - 50 MS, the duration of the pulse packet mode "sweep" - 200 MS, the intensity of stimulation and the number of procedures depending on the nature of the fracture, the degree of destruction of the national Academy of pain intensity (shown in table). The technique of electromagnetic stimulation of the ons between the mucosa of the cheeks and of the alveolar ridge in the projection slit fracture scrap, put the coil inductance, wrapped in a cloth, moistened, for example, a 1% solution of lincomycin. Pre podlesice, subperiosteal on transitional stock in the projection slit fracture injected 2 ml of 30% aqueous solution of lincomycin (full fractures with offset without offset). Then from the skin directly above the coil inductance (and therefore cracks fracture) impose electrode for tens with a cotton swab dipped, for example, a 1% solution of lincomycin. An inductor having two wire output (0.5 cm), is located so that the ends of the findings are on both sides of the slit fracture. Stimulation every day, once a day. When incomplete (subperiosteally fractures, cracks subclinical, mild lesions of the national Academy of Sciences, minor pain syndrome) - stimulation is performed in the mode of intense vibration, the number of procedures 3-5. The exposure time 3 min (intensive enss) + 5 min (intense EMF). At complete fracture without displacement (average degree of the damage of the NAS - moderate pain syndrome) - stimulation is carried out in the regime of moderate vibration, the number of procedures 6-9. The exposure time 5 min (moderate chance) + 8 min (emergeny pain syndrome) - stimulation is carried out in the minor mode of vibration, the number of procedures 10-14. The exposure time 10 min (minor enss) + 10 min (minor EMFs). The stimulation intensity is adjusted differentiation depending on the individual sensitivity of the victim to these physical factors, severity of pain, the degree of post-traumatic edema and infiltration of the soft tissues in the zone of fracture, the nature of the fracture, the degree of destruction of the NAS, the severity of post-traumatic contracture. The rationale for this is the following, the more intense pain, the weaker the intensity of the stimulation. The latter is adjustable from 1 to 10. In addition, the more damaged bone (fracture, complete fracture without displacement, shifting fragments), the more dangerous microensure bone fragments when stimulated by muscle contraction. On this basis, the stimulation intensity changes accordingly. The dependence of the intensity of vibration from the nature of the fracture, the degree of damage of the NAS and severity of pain are presented in the table. You should make a digression: when CHENS in the projection of the mental hole subjectively felt vibration in the field of osteomalacia with electromagnetism drugs (EMFs) are perceived vibration of varying intensity in the layout area of the inductance (lateral division of the body of the mandible).

Thus, a distinctive feature compared with the prototype include the following:

Electroneurostimulation national Academy of Sciences in the area of mental openings with various options depending on the degree of destruction of the NAS and severity of pain.

Electromagnetically soft tissues in the zone of fracture and reactive changes (post-traumatic soft tissue swelling, hematoma without signs of inflammation, reactive changes of oral mucosa, periosteum)

Electromagnetiques with the introduction of the drug into the soft tissue from the skin and from the mucosa of the oral cavity, with the last pick in the submucosal and subperiosteal space in the area of the gap of the fracture with the individually tailored drugs.

Differentiated approach to the choice of parameters (stimulation intensity, exposure time, number of procedures) CHENS lower alveolar nerve, depending on the degree of nerve damage, pain intensity, extent and nature of damage of the bone tissue.

Differentiated approach to the choice of parameters (intensity of stimulation, the time in the Roma the extent and nature of damage of the bone tissue.

The rationale for the use of the two treatment factors, namely tens of NAS and electromagnetic stimulation of the damaged area with electrophoretic introduction of individually selected medicinal substances (EMFs) and differentiated parameters, sequence manipulation.

Known direct correlation of pain intensity in the lower third of the face and the severity touch paresteticheskih violations in labio-mental field of the degree of damage of the lower alveolar nerve. (Korzh, M. Diagnosis and treatment of injuries of the lower alveolar nerve in the mandibular fractures and dental manipulations. Abstract. Diss. Kida. the honey. Sciences. - Minsk.-1989. -16 C., Shargorodsky A., Lesion of the trigeminal nerve in fractures of the facial bones. - M.: Medicine, 1975, - 152 C.) When the stimulation intensity is inversely proportional to the degree of nerve trunk (Yasnohorodska Century, Electrotherapy. - M.: Medicine, 1987, 240 C.), stimulation of the latter causes the improvement intraoccular blood supply. Known dependence of the degree of damage of the NAS and the magnitude of displacement of bone fragments (bruise, sprain, infringement of the popular nerve in fractures of the lower jaw and dental manipulations. Abstract. Diss. Kida. the honey. Sciences. - Minsk. - 1989. - 16 S.). Hence, the intensity of stimulation with tens and EMF, the time depends on the above factors.

Known significant percentage of complications infectious inflammatory disorders with mandibular fractures, particularly of the skeletal structures in the area of the slit of a fracture (bone suppuration of wounds, traumatic osteomyelitis, soft tissue in the fracture area (suppuration traumatic hematomas) (Kabakov B. D. , Malyshev Century A. Fractures of the jaws. - M.: Medicine, 1988. -286 C.), (Lukyanenko Century. And. Osteomyelitis of the jaws. - L.: Medicine, -1986. - 184 C.), ((Arzhantsev P. 3., Ivashchenko, M., Lurie T. M. Treatment of injuries of the face. - M.: Medicine, 1975.). Know the use of lincomycin hydrochloride as an osteo-antibiotic (Mashkovsky M. D. Medicines. So 2, M. : Medicine, 1986, - 576 S.), including the method of introducing the latter into the fracture (Alexandrov N. M. injuries to the maxillofacial region. - M.: Medicine, 1986. - 225 c.). Know the use of a 1% solution of lincomycin hydrochloride for medicinal electrophoresis (Yasnohorodska Century, a Handbook of physiotherapy. M.: Medicine, 1992. - 438 C.). It is known that medicinal electrophoresis input substances the volumes. So 1. - M.: Medicine, 1985, at 560 C. (Galvanization and electrophoresis of drugs. C. S. ulaschyk, S. 322-331). In the proposed method, carried out the introduction of medicinal substances (for example, lincomycin) simultaneously in the fracture gap (injection podlesice and subperiosteal and electrophoretic method) and soft tissue and the soft tissue of the medicinal substance is introduced from the side of the skin - swab drug substance is located under the electrode (extraoral), and the mucosa of the oral cavity, the coil is wrapped with a cloth with the medicinal substance (intraoral).

Know the development of posttraumatic contactor, which are caused as a blunt trauma of the masticatory muscles, and prolonged immobilization of the jaws duclottni tires (up to 3-3,5 weeks) (Kabakov B. D., Malyshev Century A. Fractures of the jaws. - M.: Medicine, 1988. - 286 C.), which is clinically manifested by difficulty in mouth opening after removing the tire. It is known that Gilo and weakness of the masticatory muscles affects extraosseous hemodynamics, delaying osteoreparative processes (C. M. Kulagin and other Electrostimulation therapy of functional disorders of the masticatory muscles. // VIII In the th muscles optimizes local hemodynamics, eliminates the phenomenon of post-traumatic contracture.

It is known that excessive stimulation of the muscles fractures can lead to microensure bone fragments that provokes the development of traumatic osteomyelitis (Yasnohorodska Century, a Handbook of physiotherapy. M.: Medicine, 1992.- 438 C.). Based on this rational differentiated the stimulation intensity and the exposure time depending on the nature of the fracture (incomplete, complete without offset with offset). The greater the degree of disturbance of the bone tissue, the more gentle settings.

Example 1. Incomplete fracture of the lateral division of the body of the mandible with lesions of the lower alveolar nerve mild.

Patient A., 36 years old, history N 1203, was admitted to the Department of oral and maxillofacial surgery 15.10.98, with a diagnosis of Fracture of the lateral division of the body of the mandible on the right. The profession of the driver. Trauma household 15.10.98,

Complaints at admission: a little soreness in the lower jaw to the right, a slight pain when opening the mouth, increased pain when eating.

The objective of the study: minor asymmetry of the face due to swelling of soft tissues in the lower OTDELA, malocclusion is not observed, breaks mucous in the mouth no teeth not moving.

X-ray examination: review radiographs (FAS, the profile of the lower jaw to the right) there is a violation of the integrity of bone tissue in the lateral part of the lower jaw on the type of "crack", the displacement of the fragments is missing.

Neurological examination (EMG blink reflex, electrosensory, instrumental determination of the threshold of pain sensitivity and discriminatory in labio-mental area (Korzh, M. Diagnosis and treatment of injuries of the lower alveolar nerve in the mandibular fractures and dental manipulations. Diss. Kida. the honey. Sciences. Smolensk, 1989, 179 C. ) diagnosed with mild lesions of the lower alveolar nerve.

15.10.98, Under local anesthesia imposed duclottni tires with sazanami hinges and rubber traction, 16.10.98, the patient was prescribed a course electroneuromyographic and electromagnetically. Electrical nerve stimulation was performed in the area of mental hole on the right with the following parameters: pulse amplitude of 100 V, the mode of "sweep" bipolar packs of pulses, the repetition rate of pulses per minute - 80, the repetition period of the pulse is subjective sensations of severe vibration. Then on the face put a tampon soaked in 1% solution of lincomycin in the mouth put the inductor in the projection slit fracture in a napkin soaked in 1% solution of lincomycin, has established an electrode for tens directly above the coil inductance and made electromagnetic. The exposure parameters similar to the CHENS. Feelings expressed vibration. The exposure time 3 min tens + 5 min EMFs.

Treatment 5 treatments a day. At discharge 20.10.98, was clinically observed complete regression of post-traumatic swelling, relief of pain after 2 treatments. Mouth opening in full, painless. Neurological symptoms were absent.

Example 2. Complete fracture of the lateral division of the body of the mandible without displacement fragments with lesions of the lower alveolar nerve moderate.

Patient B., 32 years old, history N 1254, was admitted to the Department of oral and maxillofacial surgery 20.10.98 was diagnosed with a fracture of the lateral division of the body of the mandible on the left. The profession of a chef. Trauma household 20.10.98,

Complaints at admission: moderate tenderness in the left lower jaw, moderate pain and limitation porodica left.

The objective of the study: srednevyrazhennoy asymmetry of the face due to swelling of soft tissues in the lower sections of the buccal region, skin color is not changed, palpation painful mouth opening is limited to 4.5 cm, painful, malocclusion is not observed, the gap mucosa in the oral cavity in the area of the first molar teeth fixed, the first molar in the gap of the fracture, the symptom load positive in the lower jaw to the left, the mobility of the bone fragments.

X-ray examination: review radiographs (FAS, the profile of the lower jaw on the left) there is a violation of the integrity of bone tissue in the lateral part of the lower jaw, the displacement of the fragments is missing, the first molar in the gap of the fracture.

Neurological examination (EMG blink reflex, electrosensory, instrumental determination of the threshold of pain sensitivity and discriminatory in labio-mental region) diagnosed with moderate lesions of the lower alveolar nerve.

20.10.98, Under local anesthesia performed the removal of the tooth from the gap of the fracture, antiseptic treatment of bone wounds, suturing the mucosa of the oral cavity imposed duclottni tires with sazanami loops, resiga holes on the right with the following parameters: pulse amplitude 100 V, the mode of "sweep" bipolar packs of pulses, the repetition rate of pulses per minute - 80, the repetition period of the pulses, changing the inside of the pack in the "sweep" - 50 MS, the duration of the pulse packet mode "sweep" - 200ms. Subjective sensations of moderate vibration. Then in the projection slit fracture podlesice and subperiosteal was introduced 2 ml of 30% aqueous solution of lincomycin. On the face put a tampon soaked in 1% solution of lincomycin in the mouth put the inductor in the projection slit fracture in a napkin soaked in 1% solution of lincomycin, has established an electrode for tens directly above the coil inductance and made EMFs. The exposure parameters similar to the CHENS. Sensations of moderate vibration. The exposure time 5 min/tens + 8 min EMFs.

Treatment 9 procedures daily. At discharge, 29.10.98 clinically noted an almost complete regression of post-traumatic swelling, relief of pain after 4 treatments. Mouth opening in full, kababalaghan. Neurological symptoms: mild hypoesthesia in labio-mental area left. Subjectively, the patient noted a significant decrease in the intensity and spread of "numbness" in the field of social recovery of NAS.

Example 3. Complete fracture of the lateral division of the body of the mandible with displacement of fragments with lesions of the lower alveolar nerve moderate degree.

Patient C., 38-year old history N 1119, was admitted to the Department of oral and maxillofacial surgery 10.10.98 was diagnosed with a fracture of the lateral division of the body of the mandible on the left. Unemployed. Trauma household 10.10.98,

Complaints at admission: severe pain in the left lower jaw, severe pain and marked limitation in mouth opening, the inability of the meal, the significant sense of "numbness" in the lower lip and chin to the left, the inability to close the teeth.

The objective of the study: the marked asymmetry of the face due to swelling of soft tissues in the lower sections of the buccal region, skin color slightly hyperemic, palpation painful mouth opening is limited to 3.5 cm, sharply painful, significant malocclusion, rupture of the mucous membrane in the oral cavity in the region of the second molar teeth, the teeth are not movable, second molar in the gap of the fracture, the symptom load strongly positive in the lower jaw to the left, the mobility of the bone fragments.

X-ray examination: obsorne part of the lower jaw, a significant shift of fragments vertically, second molar in the gap of the fracture.

Neurological examination (EMG blink reflex, electrosensory, instrumental define the threshold of pain sensitivity and discriminatory in labio-mental region) diagnosed with moderate damage degree of the NAS. 10.10.98, Under local anesthesia performed the removal of the tooth from the gap of the fracture, antiseptic treatment of bone wounds, suturing the mucosa of the oral cavity imposed duclottni tires with sazanami hinges and rubber traction, bite fixed. The control x-ray standing fragments satisfactory, 11.10.98, the patient was prescribed a course CHENS and EMFs. CHENS were conducted in the area of mental hole on the right with the following parameters: pulse amplitude of 100 V, the mode of "sweep" bipolar packs of pulses, the repetition rate of pulses per minute - 80, the repetition period of the pulses, changing the inside of the pack in the "sweep" - 50 MS, the duration of the pulse packet mode "sweep" - 200ms. Subjectively feeling a slight vibration. Then in the projection slit fracture podlesice and subperiosteal was introduced 2 ml of 30% aqueous solution of lincomycin. On the face put a tampon soaked in 1% Raney 1% solution of lincomycin, set the electrode for ENS directly above the coil inductance and made electromagnetic. The exposure parameters similar Enns. Feeling a slight vibration. The exposure time 10 min ENS + 10 min EMFs.

The treatment course of 12 treatments daily. At discharge, 22.10.98 clinically significant regression of post-traumatic swelling, inflammation was not observed, the relief of pain after 6 treatments. Mouth opening in full, kababalaghan. Neurological symptoms: srednevyrazhennoy hypesthesia in labio-mental area left. Subjectively, the patient noted a significant decrease in the intensity and spread of "numbness" in the lower lip and the skin of the chin. Electrophysiological and sensometrics methods indicate the functional restoration of the national Academy of Sciences.

The use of the proposed method due to the above therapeutic effects provides the following benefits (positive effects).

The shortening of hospital treatment due to more rapid relief of post-traumatic symptoms (edema, infiltration of tissues, bruising and prevent complications vos is s and paresteticheskih violations more rapid relief of pain, lack of necessary medical antalgic correction.

The reduction in the number of drugs anti-inflammatory spectrum (used for oral, parenteral) and the associated side effects.

Reducing the number of complications infectious inflammatory disorders (bone suppuration of wounds, traumatic osteomyelitis, festering hematomas).

Reducing the number of victims with posttraumatic contracture of the muscles (more full and pain-free mouth opening after removing duclottni tires).

Reduction of terms of treatment and rehabilitation activities at the expense of the listed therapeutic effects, and the lack of need for long-term outpatient follow-up care. Provides good tolerance of physical therapy, taking into account individual sensitivity to electromagnetic effects.

Allows you to use a wide range of drugs (known for use in medicinal electrophoresis), which allows targeted to influence the processes of hemodynamics and osteoreparative.

1. The method of treatment of drug electrophoresis zone of fracture, characterized in that on the first day after the reduction and immobilization of bone fragments consistently spend percutaneous electrical stimulation of the lower alveolar nerve in the area of mental openings and electromagnetic stimulation in the area of the fracture and the surrounding soft tissues with electrophoretic introduction of individually selected medicinal substances, while the stimulation is carried out with individually selected parameters, depending on the nature of the fracture, the degree of damage of the lower alveolar nerve and pain intensity.

2. The method according to p. 1, characterized in that in case of incomplete fractures (cracks), the damage to the lower alveolar nerve subclinical and mild degrees, slight pain syndrome performed consistently expressed the percutaneous electrical nerve stimulation and expressed electromagnetic stimulation with electrophoretic drug administration, while stimulation spend every day, once a day for 3 and 5 min, respectively, the number of procedures 3 - 5.

3. The method according to p. 1, characterized in that, with the fractures with displacement of bone fragments, moderate lesions of the lower alveolar nerve, moderate pain syndrome is a transmission with electrophoretic drug administration, accordingly, the electromagnetic stimulation in the area of crack fracture subperiosteal and podlesice introduce a solution of the antibiotic, the time of stimulation, 5 and 8 min, respectively, the number of procedures 6 - 9.

4. The method according to p. 1, characterized in that, with the fractures with displacement of bone fragments, the damage to the lower alveolar nerve moderate and severe degrees, expressed painful syndrome performed consistently insignificant the percutaneous electrical nerve stimulation and low electromagnetic stimulation with electrophoretic drug administration, because the electromagnetic stimulation in the area of crack fracture subperiosteal and podlesice introduce a solution of the antibiotic, the time each stimulation for 10 min, the number of procedures 10 - 14.

 

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