Method for treating odontogenic phlegmons of oral area

FIELD: medicine, surgical stomatology.

SUBSTANCE: in case of patient's average-severe or severe state before surgical interference or at satisfactory state - after surgical interference one should intravenously once introduce perfluorane at the dosage of 1-3 ml/kg body weight followed by daily treatment of the wound with perfluorane, washing and introducing perfluorane-impregnated gauze tampons till the end of exudation phase. The method enables to widen the number of preparations to treat odontogenic phlegmons of oral area, simplify therapeutic technique due to excluding the work with patient's blood, accelerate the process of purification and regeneration of soft tissues in the region of inflammation and shorten therapy terms.

EFFECT: higher efficiency of therapy.

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The present invention relates to medicine, namely to oral surgery, and can be used in the treatment of odontogenic phlegmon of the maxillofacial area.

The frequency of acute purulent inflammatory diseases of maxillofacial area, including phlegmon, is growing steadily. Noticeably in recent years a growing number of patients with difficult flowing forms of the indicated diseases, which often leads to the development of complications, significant temporary disability, and sometimes disability. All this testifies to the important social significance of the issue.

The development of endogenous intoxication with purulent-necrotic process leads to the violation of water-salt, protein and carbohydrate metabolism, disorders of the peripheral and Central circulatory, cardiovascular system, functional and morphological liver failure and kidney failure, the development of hypoxemia and tissue hypoxia. Patients develop an oxygen debt due to intoxication and microcirculation disorders that impairs the delivery of oxygen to tissues affected by purulent inflammation exacerbates their destruction and slows reparative processes [1, 2].

Today, the treatment of patients with purulent-inflammatory diseases of the face and neck and includes surgery and conservative measures divided into activities General and local effects [1, 2, 3]. The operation involves a wide opening purulent, his full revision, creating a good outflow discharge to prevent further spread of the inflammatory process. Conservative therapy (General and local) aimed at the removal of endogenous intoxication, elimination of tissue hypoxia and hypoxemia, removal of etiological factors (parasite) disease, acceleration of reparative processes in the wound, the immunomodulation of host and others [1, 2, 3]. Increasing the level of technical equipment of medical institutions has opened up new possibilities for surgical treatment and treatment of purulent wounds. There were such treatments as the pulsating stream of fluid, ultrasound, laser, magnetic therapy, cryosurgery, vibromassage, a method of vacuum, hemosorption, UFO, HBO and others In the Arsenal of drug therapy introduced new antiseptics and enzymatic preparations possessing a pronounced anti-inflammatory, fibrinolytic, anti-inflammatory effect that helps to reduce the duration of wound healing. To stimulate the immune system of the proposed treatments purified staphylococcal gamma-globulin, hyperimmune staphylococcal plasma polyvalent staphylococcal bacteriophage, PRODIG Ozanam and other [1, 2, 3]. Despite many researches carried out in this area, many of the methods of treatment aimed at normalizing individual pathogenesis of the disease. Therefore, it is urgent to further the development of a comprehensive treatment of this pathology with the inclusion of tools that simultaneously affect the state of the microorganism and metabolic processes in the festering wound.

A prototype of the invention is selected there is a method of treatment of odontogenic phlegmon of the maxillofacial region by surgical intervention and subsequent parenteral or local administration of drugs [4, 5].

The known method is as follows. After emergency care (opening phlegmon) daily local processing (irrigation) wound surface ozonated distilled water until complete wound healing. The overall effect on the organism consists in injecting ozonated of 0.9% isotonic solution of sodium chloride in 400 ml of carrying autohemotherapy. Procedures are performed in a day, a course of 5 treatments. The method involves the use of antibiotic therapy.

The disadvantage of this method is that it involves multiple (5 treatments) injecting ozonated solution, over the second local drug use (until complete wound healing), and with the blood of the patient (autohemotherapy)that presents additional technical challenges for honey. staff and some discomfort (frequent injections for the patient. Preparation of the ozonized solution requires additional equipment of the Department of maxillofacial surgery (ozonator) and specialization of medical personnel in the use of the instrument. Ozonated solution should be used immediately after production.

The task of the invention is the expansion of the means for the treatment of phlegmon of the maxillofacial area, the simplification of the treatment method, the exception handling of blood of patients, increasing the effectiveness of treatment and reducing treatment time.

This object is achieved in that in the known method of treatment of odontogenic phlegmon of the maxillofacial region by surgical intervention and subsequent parenteral or local administration of drugs to the patient once before or immediately after surgery intravenous perftoran in a dose of 1-3 ml/kg of body weight with further daily treatment of wounds with perftoran irrigation and the introduction of gauze swabs soaked in the drug until the end phase of exudation.

The present invention meets the criterion of “novelty”, because in the process of conducting patent information the ion research materials, prejudicial to the novelty of the invention, is not revealed.

The present invention meets the criterion of “inventive step”, because in the process of finding technical solutions are not found with the essential features of the proposed method.

Perftoran is about 10. % emulsion based performancesin compounds (PFOS), stable 4% surface-active agent (surfactant) - proxanol is chosen 268 - with an average particle size of the emulsion 0.03-0.15 μm, the electrolyte having the following composition (g/l): sodium chloride 6.0; potassium chloride - 0.39; magnesium chloride - 0.19; sodium bicarbonate - 0.65; sodium phosphate one-deputizing - 0.2; glucose - 2.0. Osmolarity - 280-310 mOsm/l; pH 7.2-7.8. The solubility of oxygen is about 6-7. % (Rho2=760 mm Hg). The emulsion is white with a bluish tinge, odorless. Perftoran - plazmozameschayuschie vehicle with gas transport function was first proposed as an anti-shock and anti-ischemic funds. The drug has rheological, hemodynamic, diuretic, membrane, cardioprotective and sorption properties.

According to the literature [6, 7] even small doses of perftoran (2-8 ml/kg of body weight) have a significant increase of tissue gas exchange in the body of the patient as a result of improved circulation, reduce swelling of the vascular endothelium, increasing ELAST is knosti erythrocytes, contributing to the improvement of the diffusion of gases, providing the transport of oxygen from red blood cells to the vascular wall. It eliminates spasm of peripheral vessels, restores peripheral circulation and microcirculation. Local application of perftoran is becoming more common [8, 9]. In the existing literature [8] is recommended for local treatment of the wound surface with perftoran (irrigation or non-drying bandage) with a relatively clean non-healing wounds. It normalizes the environment of wound, and cytoprotective properties of perfluorocarbons create conditions for improving the local gas exchange. All this and especially the combination with the infusion of perftoran that improve the microcirculation, promotes reparative processes, faster healing of wounds.

The authors first developed a method for the treatment of odontogenic phlegmon of the maxillofacial region with the use of perftoran, experimentally proving the effectiveness of the drug in the suppurative stage of the disease. The claimed sequence of the introduction of the drug in the proposed doses are unknown of scientific and technical information. The applied concentration of perftoran was established empirically. Experimentally proved, that the use of perftoran immediately after surgical treatment for local processing grain the th wound in combination with a single pre - or postoperative intravenous infusion at a dose of 1-3 ml/kg is optimal.

The proposed method is applied in 18 patients with phlegmon of the face and neck. Treatment effectiveness was assessed by the dynamics of clinical symptoms and the number of laboratory tests (biochemical study of blood, half blood serum, histological and cytological examination, FLOOR cloth wound). As a result of the treatment was rapid subsidence of the inflammation - mild symptoms of intoxication, accelerate the cleansing and healing of purulent wounds, the disappearance of alterative changes, more rapid rehabilitation of the patient, which resulted in improved outcomes and reduce treatment time (from 9.1 16.9 days).

Research conducted by the inventors, have found that early combination of local and General effect of perftoran in the treatment of patients with phlegmon of the maxillofacial area leads to the elimination of tissue hypoxia and hypoxemia, has a strong detoxifying effect, stabilizes peroxidation processes in the body, speeds up the cleansing and healing processes in the wound, reduces the period of inpatient treatment 3.2-6.3 days. Due to the application of perftoran is possible to reduce the dose of drug (antibacterial) agents.

Thus, the proposed method allows to solve the problem: to expand the Arsenal of tools for the treatment of odontogenic flegma the maxillofacial region, to simplify the treatment, to exclude the blood of patients, to improve the effectiveness of treatment and reduce treatment time.

The proposed method is low-impact, simple and easily applied in any specialized hospital.

The method is as follows.

The patient after a diagnosis on the basis of clinical, medical history and laboratory data to determine the need for preoperative preparation. In the case of preoperative preparation (for medium-heavy and heavy condition of the patient or for pediatric indications) before opening phlegmons in the maxillofacial region in addition to the traditional conduct of preoperative single parenteral administration of perftoran in a dose of 1-3 ml/kg when the patient's condition is assessed closer to a satisfactory and does not require preoperative preparation of the patient after surgery intravenously once imposed perftoran in a dose of 1-3 ml/kg of Operation provides a wide opening purulent, his full revision, creating a good outflow discharge to prevent further spread of the inflammatory process. In the future immediately after the operation of opening phlegmon and in the next day the wound is washed with perftoran (to clean the wash water). Ligation is performed daily. The outfit is with a tubular drainage to enhance the effect in the wound impose gauze swabs, moistened with perftoran. Local treatment of purulent wounds spend up to cleanse it from exudate.

An example of a specific use.

Statement of medical history: the Patient K. 27 years hospitalized in the Department of maxillofacial surgery, Moscow Clinical hospital №39”. With a diagnosis of odontogenic rotten-necrotizing cellulitis of floor of mouth.

Complaints at admission: General weakness, malaise, chills, pain when swallowing, difficulty breathing, limited mouth opening, limited tongue movement, the presence of swelling in the left submandibular and podvodburstroy areas.

History: considers himself sick 5 days, when first appeared constant aching pain in 37 tooth, the doctor didn't came through the day moderately painful swelling in the left submandibular region, pain in the tooth decreased out on day 3 after onset of the disease used a warm compress, the swelling increased, appeared discomfort when swallowing, due to significant deterioration (General weakness, malaise, fever to 39,3°pain when swallowing, difficulty breathing, limited mouth opening, limited tongue movement). SMEs delivered in “Clinical hospital №39”, was hospitalized in the emergency order.

Admission: state of the medium-heavy severity, sotn is the clear, the position forced (seated, when you try to take a horizontal position notes the deterioration of swallowing and breathing). Body temperature 39,4°WITH, HELL 135/90 mm Hg, heart rate of 104 per minute, rhythmic, intense, satisfactory filling the same on both hands. Lung auscultation of several weakened vesicular breathing, wheezing no. The abdomen is soft, painless, physiological functions are normal. Local configuration of the face is changed due to the diffuse edema and infiltration of the soft tissues in podvodburstroy and left submandibular areas (elongated face), mouth half-open. Palpation: the size of the infiltration about 4,5x5,5 cm, leather above it hyperemic, tense, in the fold is not going to, in the centre of infiltration is determined by the symptom fluctuations, when the puncturing infiltrate the liquid with the putrid smell of exudate. The mouth opening is limited to 2 cm, the bite is not broken, the language is elevated, covered with gray fibrous coating, swollen, left in the sublingual area infiltration of soft tissue, mucous brightly hyperemic, palpation - a sharp pain, a 37 - significantly destroyed, percussion weakly positive. In the blood: leukocytosis (to 13.8×109/l), with stab shift to the left, lymphopenia, accelerated erythrocyte sedimentation rate (40 mm/h). The urine analysis showed proteinuria.

On the radiograph: Determined by the hearth destructicons tissue around the root apex 37 of the tooth without clear boundaries in diameter up to 3 mm

Treatment

1. Before surgical treatment patients received infusion therapy: intravenous infusion of glucose 5% to 400 ml of 5% ascorbic acid solution 5 ml, perftoran 200 ml. Started antibiotics (lincomycin 30% - 2 mlm, gentamicin 80 mg 2 mlm).

2. Surgery opening phlegmon: Under intravenous anesthesia produced 2 external skin incision, subcutaneous, m. platysma: in the left submandibular region 6 cm parallel to the bottom edge of the lower jaw is indented 2 cm down, podvodburstroy area 4.5 cm perpendicular to the edge of the lower jaw, stupidly divorced soft tissue, to the inner surface of the lower jaw, received scant liquid with a putrid odor discharge, tissue in the wound of gray. After finger revision wound treated with 3% hydrogen peroxide solution, perftoran, introduced into the wound gauze swabs moistened with perftoran. Removed 37 tooth.

3. In the postoperative period was conducted antibacterial (lincomycin 30%-2 ml 3 times a daym №7 days, gentamicin 80 mg 2 ml 3 times a daym №6 days), detoxification (glucose 5% -200,0 R-R ringer 200.0 indrip №4 days), analgin 50%-2 ml diphenhydramine 1%-1 mlm 2 times a day # 5 days.

4. In the postoperative period were made daily washing of wounds with perftoran to complete cleansing of the wound with the introduction of gauze swabs soaked perfer the om.

Results

As a result of treatment of inflammation were stopped for 6 days: 1 day General condition of moderate severity, body temperature up to 37.9, breathing normal, discomfort when swallowing, decreased edema and infiltration of the soft tissues decreased, the amplitude of the movement of the tongue has increased, there has been a decrease in the amount of purulent discharge, in separate sections of wounds on the background of necrosis, there are Islands of bleeding granulations, on the 3rd day of the General condition is satisfactory, the body temperature up to 37,1, swallowing in normal, edema and infiltration of the soft tissues was significantly reduced, the wound was cleansed from malodorous exudate, the amount of granulation in the wound to 65%at the edges of the wound signs of epithelialization, Gen. an. blood: leukocytes to 8.2×109/l, neutrophils up to 66%, lymphocytes up to 23%, accelerated erythrocyte sedimentation rate (up to 31 mm/h). 8 day overlay secondary seams, pit 37 healed by first intention. At discharge (13 days) the General condition is satisfactory, the body temperature up to 36.7, swallowing in normal, swelling of the soft tissues has practically disappeared, the sutures were removed - wounds healed by secondary intention. General. an. blood: leukocytes to 6.8×109/l, neutrophils%to 62%, lymphocytes up to 21%, ESR 8 mm/hour urinalysis showed no pathological alterations.

At the control examination after 3 months of complaints, the patient does not present, the General condition is satisfactory is, in the area of RAS - linear inconspicuous scars.

References:

1. Bazhanov N.N., Chicory A.K., Alexandrov M.L. Odontogenic phlegmon of the maxillofacial area and neck. The state of the problem (literature review) - M., 1985. - 40 S. (Dept.-in NIIMI the USSR Ministry of health No. 9637-85).

2. Karandashev VI Etiology, clinic and treatment of odontogenic spilled purulent-inflammatory diseases of the face and neck.: Abstract. Diss.... Dr. med. Sciences.- M., 1988. - 33 S.

3. Shargorodsky A.G. Inflammatory diseases of maxillofacial area and neck. - M., 1985 - 352 S.

4. Movsesian GV Application of medical ozone in the treatment of phlegmon of the maxillofacial area: author. Diss...Kida. the honey. Sciences), 2001. -22 C.

5. Durnovo E.A., Sinapine I.D., Kontorshikova KN. Treatment of odontogenic phlegmon of the maxillofacial area. RF patent №2140769 published BI No. 31 from 10.11.99.

6. Ivanitsky GV As perftoran provides transportation function// Performancesee compounds in biology and medicine. - Pushchino, 1999. - S-243.

7. Sofronov GA, Selivanov E.A., Hanewich PPM, Verbitsky VG, Dudko S.M., Tikanoja A.D., Lazarenko DUE Application of perftoran in operations on the abdominal organs // Performancesee compounds in biology and medicine. - Pushchino, 1999. - P.32 - 37.

8. Krupkin V., Moroz V.V., Pisarenko L.V., Khomenchuk A.I. Using emulsions of perfluorocarbons in double the m treatment of wounds, complicated surgical infection// journal of surgery. - 1997. No. 7. - P.53-55.

9. Zytkow M., A.S. Orlov, Grigorian A.S., Ippolitov VP, Chupakhin PV study of the protective action of perftoran on skin flap. Dentistry No. 5), 2002, - C.11-14.

Treatment of odontogenic phlegmon of the maxillofacial region by surgical intervention and subsequent parenteral or local administration of drugs, characterized in that a patient with medium-heavy or heavy condition before surgery or in satisfactory condition after surgery impose perftoran intravenous single dose of 1-3 ml/kg of body weight with further daily treatment of wounds with perftoran irrigation and the introduction of gauze swabs soaked with perftoran until the end phase of exudation.



 

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