Method for integrated treatment of maxillofacial abscesses and phlegmons in children by ointment with furacilin, lidocaine and dibunol

FIELD: medicine.

SUBSTANCE: offered invention refers to medicine, namely dentistry, and may be used for treating children suffering maxillofacial abscesses and phlegmons. That is ensured by opening of a suppurative focus, wound bathing and drainage. With underlying conventional antibacterial therapy, an ointment containing furacilin, lidocaine and dibunol as active agents and a styrene maleic anhydride copolymer, Lutrol F-127 and purified water in certain proportions as an ointment base is introduced in the suppurative cavity. Furacilin - 0.2, Lidocaine - 5.0, Dibunol - 5.0, Styrene maleic anhydride copolymer - 2.0, Lutrol F-127 2.0 and Purified water to 100.0.

EFFECT: use of the given invention reducing length of wound cleaning and epithelisation in children due to the use of the ointment in presented proportions.

2 ex

The present invention relates to the field of medicine, namely oral and maxillofacial surgery for the treatment of abscesses and phlegmon of the maxillofacial region in children.

There is a method of treatment of abscesses, phlegmon of soft tissues, including the opening of the suppurative focus and drainage, antibiotic therapy, detoxification therapy, subsequent to comprehensive treatment daily treatment of wounds by low-frequency ultrasound (acoustic environment of 0.05%, an aqueous solution of itaperuna) in the first phase of wound process, the second treatment is complemented by local irradiation of the wound surface defocused beam helium-neon laser (power density from 0.1 to 100 mW/cm²) (Dubinin Y.A. treatment of purulent wounds. Diss. ... candles. the honey. Sciences. - 1997. - 119 C.). Disadvantages of the proposed method are the need for expensive equipment, the technical complexity of implementation and the need for appropriate training of personnel.

There is a method of treatment of abscesses and phlegmon of the maxillofacial area through a combination of active surgical tactics therapy monoxide nitrogen. The developed method was to conduct operations from mini-access: evacuation of pus, and then carried out the treatment of a purulent cavity plasma stream of nitrogen monoxide in different is azimah, the operation was completed by applying a primary seams. In the postoperative period, starting from the first day, were airing abscess cavity (phlegmon) through the drainage system cooled plasma stream of nitrogen monoxide and plasma flow, gentle coagulation, post-operative area. Microbiological study of discharge from the wounds and drains found that patients of the main group sterility detachable reached to 3.5±0,7 day, patients of the control group to 8,7±1,5 day (p<0,05). Clinical and cytological analysis allowed to determine the average duration of the first phase of the wound healing process in patients of the main group and 2.5±0.2 days, in the control of 7.9±0.4 days (p<0,05). This technique has reduced the duration of hospital treatment of patients with phlegmon and abscess of the soft tissues of the maxillofacial area (10,6±1,8) to (6,4±1,1) bed-days (39,6%), to reduce the invasiveness of the surgery and bandaging, to reduce the consumption of dressing material. The method of the treatment of patients with abscesses and phlegmon of the soft tissues of the maxillofacial region with application of nitrogen monoxide can significantly speed up the process of reducing microbial contamination purulent, to intensify the cleansing and healing of wounds, shorten the course of the phases of wound healing, to reduce the invasiveness of the surgery (mini-access) and per the viscous to reduce the number of dressing material in comparison with traditional methods of treatment of abscesses and phlegmon of the soft tissues and, ultimately, to reduce the average duration of inpatient treatment (http://www.ekamedcenter.ru/?page=15&article=107).

There is a method of treatment of abscesses, phlegmon of the maxillofacial area (Solov'ev M.M., Bolshakov OP Abscesses, phlegmon of the head and neck. M: Medpress. - 2001. - 230 S.), including the opening of the suppurative focus and drainage, antibiotic and detoxifying therapy, and in the presence giperergicakie nature of acute inflammation - purpose giposensibiliziruyuschey funds (antihistamines: diphenhydramine, suprastin, tavegil, etc.; analgesics-antipyretics: antipyrine, amidopyrine, paracetamol and other), in the presence of giperergicakie nature of acute inflammation - purpose immunostimulating therapy: autohemotherapy, prodigiozan and other

There is a method of treatment of phlegmon of the maxillofacial area, providing for the inclusion in the scheme of the traditional treatment of phlegmon of the maxillofacial area immunocorrector T-activin by endolymphatic or subcutaneous injection. The use of T-activin by endolymphatic injection shown in immunodeficient condition, accompanied by a prolonged course of acute purulent will nosplit the high process. Subcutaneous administration is shown in moderately expressed immunodeficient status of patients with less severe inflammatory processes. It is recommended that the introduction of T-activin according to the following scheme: subcutaneous 0.1% solution of T-activin 1 ml 1-2 times a day for 5-7 days; endolymphatic - 1,2-1,6 μg per 1 kg of body weight of the patient; the drug is injected slowly (0.6 to 1.0 ml / min) (Drobyshev, A. Complex treatment of patients with phlegmon of the maxillofacial region with the use of T-activin: author. Diss. ... candles. the honey. Sciences. M - 1996. - 21 S.).

There is a method of treatment of abscesses, phlegmon, where as antibacterial, detoxification and immunotropic tools use a solution of sodium hypochlorite (NGH)which, prior to surgical intervention infiltrate tissue at the periphery of the inflammatory infiltrate. After surgery, before the imposition of secondary sutures produce dialysis festering wounds NGH. At the same time provide the common hemocorrection by intravenous injection of in vitro oxidized autologous blood within 6 hours daily, respectively: 3 ml NGH + 18 ml of blood; 6 ml NGH + 15 ml of blood; 9 ml NGH + 12 ml of blood; 12 ml NGH+9 ml of blood; 15 ml NGH + 6 ml of blood; 18 ml NGH + 3 ml of blood, and after 2 hours the patient through the day intravenous impose additional 0,03% solution NGH estimated 3-4 ml/kg of body weight, performing intracorporeal oxidation of the blood. JV is the FDS provides comprehensive local and General detoxification, immunotropic and reparative effects in the presence of antibiotic resistance, which results in a reduction of treatment time average of 6.9 days, and also the savings for treatment of a patient in the volume 2947 rubles (RF patent No. 2284825, 2006).

Known application in the treatment of abscesses and phlegmon of drugs used for the treatment of wounds of the maxillofacial area and neck, such as ointment "Levocin", used to treat wounds in the first phase of wound healing containing chloramphenicol 1 g, sulfadimetoksin - 4 g, methyluracil - 4 g, trimekain - 3 g polyethylene oxide - up to 100 g (Medmaravis, Medicines, Moscow, 1996, Part II, s). Ointment "Levocin" has antimicrobial, anti-inflammatory and analgesic action. Known ointment the vegetable "levomekol used for the treatment of wounds containing the chloramphenicol - 0.75 g, methyluracil - 4 g polyethylene oxide to 100 g Ointment the vegetable "levomekol has antimicrobial and anti-inflammatory effect (Medmaravis, Medicines, Moscow, 1996, Part II, s). Famous liniment dibunola 5% and 10%, containing BHT and sunflower oil used for the treatment of superficial burns of various origins, frostbite I-II degree (treatment and prevention), ulcers (nonhealing, trophic, radiation), RAS (sluggish granulating, bad cicatrizing, paleoposition the x, traumatic) (Mashkovsky PPM Medicines. 4.2. - M.: Medicine, 1993. - s-215). For the treatment of abscesses and phlegmon are different kinds of sorbents, such as regencos, debrisan; hypertonic solution of sodium chloride: metiluratsilovoy ointment (in the stage of proliferation) and others (Mashkovsky PPM Medicines, 1-2 T., M.: Medicine, 2000. The state register of medicines. M, 1998). Ointment "Flamelet", which is used for the treatment of infected wounds of various localization and etiology in the first (necrotic) phase of wound healing, including accompanied by severe pain (infected burns II-IV century, bedsores, trophic ulcers, postoperative and post-traumatic wounds and fistulas, wounds after opening abscesses, phlegmon, after surgical treatment abstemiously boils, carbuncles, hidradenitis, festering atheroma, lipoma, and so on). The ointment contains ofloxacin - 1 g, dioxotetrahydrofuran (methyluracil) - 4 g, lidocaine hydrochloride monohydrate (in terms of lidocaine hydrochloride) 3 g; excipients: methyl parahydroxybenzoate (nipagin or methylparaben), sodium propyl parahydroxybenzoate (nipazol or propylparaben), propylene glycol, macrogol-1500 (polyethylene glycol of low molecular weight of 1500, polyethylene oxide-1500), macrogol-400 (polyethylene glycol of discobolus the th-400, the polyethylene oxide-400) (http://www.kurgansintez.ru/catalog/view/264/). However, the tool "Flamelet" has antimicrobial, anti-inflammatory, local anesthetic, regenerative effect, has contraindications - children up to 18 years, and has no antiviral activity.

The problem of the treatment of abscesses and phlegmon of the maxillofacial area remains relevant, despite the wide choice of means and methods of treatment of purulent wounds.

The closest analogue of the invention is a method of treatment of patients with purulent wounds after opening of abscesses and phlegmon of the maxillofacial area and neck, which consists in the fact that in addition to the traditional conservative treatment effect on the affected area using the ointment of the following composition, parts by weight: thymol - 1.0; glycerol - 20,0; lanolin - 20,0; petrolatum 60,0; ecdysterone - 0,01-0,001 (RF patent No. 2195195, 2002). The disadvantage of this method is its lack of efficiency due to reduced osmotic activity of the topical composition.

The objective of the invention is to develop a method of complex treatment of abscesses and phlegmon of the maxillofacial region in children, using ointments, providing high efficiency, taking into account the age peculiarities of the child's body, easy to use, no side effect, having effectively prolonging the om.

The technical result - the reduction of the period of purification and epithelialization of wounds in children aged 6 to 18 years through the use of ointments, with a pronounced and prolonged therapeutic effect: improves (conditions drainage cavity), antiviral, antimicrobial, anti-inflammatory, anesthetic, regenerating.

This technical result is achieved in that in the method of complex treatment of abscesses and phlegmon of the maxillofacial region, including the opening of the suppurative focus, lavage and drainage of the purulent cavity, the introduction of a purulent cavity ointment on the background of standard antibiotic therapy, according to the invention using an ointment containing as active ingredients furatsilin, lidocaine and BHT, and as ointment bases copolymer of styrene with maleic anhydride, Lutron F-127 and purified water in the following ratio, wt.%:

A copolymer of styrene with malanova

The proposed method for the treatment of abscesses and phlegmon of the maxillofacial area in children is as follows. After opening the purulent wound washed with furatsilina prepared in the ratio of 1:5000 of isotonic sodium chloride solution of 0.9%, and drain. The wound surface is dried loose gauze swabs and dried on the surface put the ointment in an amount not less than 10 ml directly on the purulent cavity, thin layer, then put a sterile gauze bandage), or ointment is applied to the gauze bandage with subsequent application for purulent cavity, or enter ointment using a syringe under pressure into the cavity after the preliminary cleansing from pus, or tampons impregnated with ointment, loosely fill the cavity wounds after surgical treatment. Ointment applied daily 2 times a day until the end of the period exudation. This method is convenient and hygienic to use, provides a marked prolonged action of drugs, prevent side effects due to the use of ointments, which creates a high concentration of the drug for a short period of time, has osmotic activity, Ulu who violates drainage conditions of the cavity, has a strong prolonged therapeutic effect, namely anti-inflammatory, antimicrobial, anesthetic, regenerating antioxidant, antiviral action, convenient and hygienic to use, with high clinical efficacy.

During the first 3 days ointment contributes to the shortening of the first phase of a purulent process 2±0.02 day.

The proposed method was used in the Department of maxillofacial surgery of the Republican children's clinical hospital in 34 children with abscesses and phlegmon of the maxillofacial area, which were divided according to the severity of the clinical course of inflammatory process into 3 groups. In the first group of patients with a satisfactory condition favorable clinical course of inflammatory process in the maxillofacial region purulent cavity is cleared for 2-3 days, which is clinically manifested by the termination of exudate from the wound. This allows you to apply early secondary seams and even initially delayed in 75% of patients. Stitches were removed on 4-5 days after they are imposed, patients were discharged for 7-8 days, which is almost 1.5-2 times faster than in the control group.

Patients of the second group with moderate clinical course of inflammatory process of the maxillofacial area was more long-term. Purulent cavity was cleared for 4-5 hours, is also allowed to impose early secondary seams for 4-5 hours. The stitches were removed after 4-5 days, the patients were discharged on average 10±0.05 days, which is 2±0.05 days earlier than in the control group.

In the third group of patients with severe clinical course of inflammatory process in abscesses and phlegmon of the maxillofacial area exudate from the wound continued in the period from 4 to 7 nights, ointment continued to apply until epithelialization of the wound, which occurred on average 12±0.15 days, and the secondary seams imposed not always, and patients were discharged 1.5±0.34 days earlier than in the control group. All discharged patients of the group treated with the method proposed, formed a smooth scar. All patients during the procedure felt anaesthetic effect ointments, and any adverse effects were recorded. During treatment ointment patients in all groups reported a decrease in pain for 2±0.03 day. In 78% of patients already by the end of 1 day of treatment was observed more pronounced positive dynamics in comparison with the control group. Control in the treatment of patients was carried out by clinical signs: the exudation from the wound, the severity of edema, hyperthermia, terms epithelialization; results of clinical tests: the General analysis of blood, urine. In the three groups was observed beneficial effect on the course of wound healing inflammatory protsessov tissues of the maxillofacial region: already after the first procedure started fast relief of inflammation, reducing bleeding, sickness, the disappearance of the discomfort.

The invention is illustrated by the following examples.

Example 1. Patient C., 12 years old, was hospitalized in the Department of maxillofacial surgery of the Republican children's clinical hospital (RCCH) 08.01.10, after 4 days from onset of disease to diagnosis of cellulitis of the submandibular region. The General state of moderate severity, the body temperature of 38.2°C.

08.01.10 - under General anesthesia an autopsy cellulitis of the submandibular access. The resulting pus in an amount of 5 ml with fetid odor. Left drain. In the mouth removed 36 tooth. Had a course of antibiotic therapy (Cefazolin 2 times a day), desensitizing therapy (diphenhydramine 1%-1,0 at night), bandages, ointment with furatsilina, lidocaine and BHT 2 times a day, physical: UHF No. 5. The dynamics of changes in blood composition was as follows: 9.01.10 - erythrocytes 4,0, hemoglobin 135 g/l, leukocytes 13,0·10¹², ESR 35 mm Hg, eosinophils 4, segmented neutrophils 61%, lymphocytes 26%, monocytes 13%.

14.01.10 - erythrocytes 3,7·10⁹, hemoglobin 127 g/l, WBC 8.0·10¹²,Erythrocyte sedimentation rate, 33 mm Hg, eosinophils 4, stab neutrophils 2%, segmented neutrophils 43%, lymphocytes 41%, monocytes 10% In the General analysis of urine from 10.01.10 pathological changes except for a slight reduction of the specific weight on the 1020, is not defined. The patient was discharged 24.01.10 in satisfactory condition, with the recovery. The wound defect was closed by secondary intention. Hospital bed days 9.

Example 2. Patient K., aged 5, was hospitalized in the Department of maxillofacial surgery of our hospital 22.02.10, 3 days after the onset of the disease, diagnosis of abscess podvodburstroy area. The General state of moderate severity, the body temperature of 38.5°C. Under General anesthesia an autopsy abscess podvodburstroy area. The resulting pus in the amount of 6 ml Left drainage. Had a course of antibiotic therapy (Cefazolin 300 mg 3 times a day), desensitizing therapy (diphenhydramine 1%and 0.5 at night), bandages, ointment with furatsilina, lidocaine, BHT daily 2 times a day.

The dynamics of changes in blood composition was as follows: 23.02.10 - erythrocytes 3,74, hemoglobin 100 g/l, leukocyte count of 9.2·10¹², ESR 35 mm Hg, eosinophils 4, segmented neutrophils and 47.5%, lymphocytes 45%, monocytes of 7.5%.

25.02.10 - erythrocytes 4,01·10⁹, hemoglobin 105 g/l, leukocyte count of 8.3·10¹², Erythrocyte sedimentation rate, 33 mm Hg, eosinophils 4, stab neutrophils 2%, segmented neutrophils 43%, lymphocytes 41%, monocytes 10%.

In the General analysis of urine from 24.02.10 pathological changes is not defined.

The patient was discharged 7.03.10 in satisfactory condition, with the recovery. The wound defect was closed Deut who cnym tension. Hospital bed days 8.

Thus, the tactics of complex treatment of children with abscesses and phlegmon of the maxillofacial region have allowed us to significantly accelerate the process of purification purulent, to intensify the cleansing and healing of wounds, reduce the course of the wound process, the number of dressings and bandages, as well as the period of inpatient treatment compared to conventional treatment methods.

The method of complex treatment of abscesses and phlegmon of the maxillofacial region, including the opening of the suppurative focus, lavage and drainage of the purulent cavity, the introduction of a purulent cavity ointment against the standard antibacterial therapy, characterized in that use ointment containing as active ingredients furatsilin, lidocaine and BHT, and as ointment bases copolymer of styrene with maleic anhydride, Lutron F-127 and purified water in the following ratio, wt.%: