No abstract

Selection of medications to apply locally for treatment of abscessive forms of boils and carbuncles of maxillofacial area still remains a debatable issue, despite their wide range. Alternative means for application use in surgical interventions in maxillofacial area are medications of natural origin. Drugs of natural origin that have anesthetic and anti-inflammatory properties include cayenne pepper fruits (Capsicum annuum). Therapeutic properties are caused by the presence in their structure of the main active ingredient – capsaicin alkaloid and other biologically active compounds (vitamins, flavonoids, minerals, etc.) which influence the main pathogenetic inflammation bonds. Capsaicin has a distinct keratoplastic effect and normalizes microcirculation in the tissues. Phytogel with anti-inflammatory and anesthetic action (patent for utility model No. 30032 “Phytogel with anti-inflammatory and anesthetic action”) was developed for clinical use based on phytosubstance of pepper cayenne fruits (patent for utility model No. 19547 “Method of obtaining phytosubstance with anti-inflammatory action”). The purpose of the study was to increase treatment efficiency of boils and carbuncles of maxillofacial area by using a medication based on the capsicum annuum fruits. Materials and methods. The analysis of inspection and treatment results of 45 patients having boils and carbuncles of maxillofacial area at abscessing stage is carried out. On the first, third, seventh and tenth day of treatment, a number of clinical indicators (presence and intensity of edema and infiltrate, condition of regional lymph nodes, presence and intensity of pain in the inflammation site, time of wound exudate clearance, intensity of regeneration, length of hospital stay treatment) and indicators obtained by laboratory methods (total number of leukocytes, leukocyte intoxication index, erythrocyte sedimentation rate) were studied and compared with the same parameters in the control group, where traditional treatment was carried out; and when using the comparison medication - 3% propolis ointment. Results and discussion. Analysis of the results showed that despite the similarity of the clinical picture and laboratory parameters on admission to the hospital, the healing of purulent wounds under the influence of capsicum annuum phytogel was more effective comparing with traditional methods of surgical treatment. Thus, wound epithelialization of patients in the experimental group No. 1 was observed on average on the seventh day, which was significantly faster than in other experimental groups. Sanation of the inflammatory focus also decreased body intoxication, which can be traced by the dynamics of changes in the degree of leukocytosis, leukocyte intoxication index, erythrocyte sedimentation rate. On the tenth day, the clinical blood parameters of patients of the experimental group No. 1 were close to the average norm. As a result, the length of stay in hospital was significantly reduced. The average bed-day for the experimental group No. 1 was 7.5 days, which is authentically less than for patients of the control and experimental group No. 2. Conclusion. According to the results of clinical and laboratory studies, the efficiency of the proposed method has been proved in comparison with traditional treatment of boils and carbuncles of maxillofacial area

The purpose of the study was to conduct a scientific and practical analysis of clinical sonographic results of examination of patients with different face types in the process of planning the reconstruction of facial soft tissues with the involvement of buccal fat pad. Materials and methods. The study was conducted on 28 patients of different age groups (from 20 to 45 years old) with defects and deformities of the tissues of the dental system. Instrumental sonographic analysis of the thickness of the buccal fat body was performed using an ultrasound scanner GE Logiq E (USA), transducer frequency 7.5-12 MHz. The types of buccal fat pad of correct (oval) or irregular (“hourglass”) shapes were determined, as well as its localization in relation to the median axial location of the crown of the first upper molars and the average value of the buccal fat pad thickness with an accuracy of 0.01 mm. Results and discussion. The results of a clinical study of the average value of the thickness of the cheek of patients with mesofacial type of face allowed to establish that on the left its value is 8.94±0.89 mm, on the right side – 9.05±0.82 mm. In patients with brachyfacial type of face on the left the value of the thickness of the cheek is 12.33±1.63 mm, and on the right side – 12.44±1.54 mm. In patients with dolichofacial type of face on the left, the index of the thickness of the cheek reaches the value of 7.53±0.61 mm, on the right side – 8.58±1.093 mm. Statistical significance was determined in comparison with data from the group of patients with mesofacial facial type. The obtained statistical results show mediocre values of buccal fat pad thickness in patients with mesofacial type of face, which are 1.117 times larger than in dolichofacials and 0.73 times smaller than in brachyfacials, which should be taken into account when conducting sonographic studies. Differences in the quantitative values of buccal fat pad thickness, which are established by clinical and sonographic studies conducted in patients with different types of faces is recommended to take into account when choosing surgical approaches during surgical closure of tissue defects of the alveolar processes of the jaws with autologous buccal fat pad. Conclusion. Buccal fat pad has morphological advantages associated with its saturation with cell complexes that have significant degree of vascularization, pliable texture, plasticity and direct participation in the implementation of the basic functions of the maxillofacial area

In modern surgical dental practice, doctors often face the necessity to close the soft tissue defects of the oral cavity. In recent years numerous studies are aimed at developing such surgical techniques, which and promote the would provide sanation of the inflammatory focus, support physiological processes on sites of soft tissue defects or promote their recovery and normal functioning. The easy access to buccal fat pad continues to attract interest regarding its application for the closure of defects. The aim of work is to analyze and study the literature data on various techniques of application of buccal fat pad in autotransplantation for closing defects of the maxillofacial area in comparison with the use of other transplants. Results. In recent years, the reconstructive plastic surgery techniques in using autotransplantats have been paid much attention. In the literature there are data on the positive results of surgical closure of tissue defects by autotransplantation of adipose tissue and, in particular, the buccal fat pad. The buccal fat pad has its own connective tissue capsule and well-developed vascular net, provides nutrition to the transplant and rapid healing of the postoperative wound; does not require prior preparation and adaptation to the recipient's bed. It allows to use it in maxillofacial surgery to close the defects of the upper jaw, elimination of oral-antral connection, in the reconstruction of intraoral defects such as oral-antral fistula, with loss of bone mass of the lower jaw in the area of molars and premolars, to eliminate defects in cancer pathology of the face. Conclusions. Advantageous anatomical position, a good blood circulation and lack of innervation of buccal fat pad facilitates the task of surgeon and gives better results of operations. The study has shown the process of wound epithelialization occurs within a week after surgery as well as a stable clinical course without complications in the long-term follow-up that proves the relevance of the use of buccal fat pad in modern maxillofacial surgery in order to improve conventional methods of autotransplantation and to develop new ones.

Резюме. В сучасній хірургічній стоматологічній практиці лікарі часто стикаються з необхідністю закриття дефектів м’яких тканин ротової порожнини. Дослідження останніх років спрямовані на розробку таких методів операції, які б забезпечували санацію запального вогнища, відродження фізіологічних процесів на місці дефекту м’яких тканин, або ж створювали умови для їх відновлення і забезпечували б повноцінну функцію. Мета дослідження – проаналізувати і вивчити літературні дані різних методів застосування жирового тіла щоки (ЖТЩ) для аутотрансплантації при закритті дефектів щелепно-лицевої ділянки порівняно з використанням інших трансплантатів. За останні роки великого поширення набули методи реконструктивної пластики шляхом використання аутотранс­плантатів. У літературі є дані про позитивні результати хірургічного закриття дефектів тканин за допомогою аутотрансплантації жирової тканини і, зокрема, жирового тіла щоки. Жирове тіло щоки має власну сполучнотканинну капсулу та добре розвинену судинну сітку, що забезпечує живлення трансплантата і швидке загоєння післяопераційної рани; не потребує попередньої підготовки та адаптації до реципієнтного ложа. Це дозволяє використовувати його у щелепно-лицевій хірургії для закриття дефектів верхньої щелепи, усунення орально-антрального з’єднання, при реконструкції інтраоральних дефектів, таких, як орально-антральна фістула, при втраті кісткової маси нижньої щелепи у ділянках молярів та премолярів, для усунення дефектів при онкологічних патологіях обличчя. Вигідне анатомічне розташування, добре кровопостачання і практично повна відсутність іннервації жирового тіла щоки полегшує завдання хірурга і дає кращі результати операцій. Дослідження доводять процес епітелізації ран на один тиждень після операційного втручання і стабільний клінічний перебіг без ускладнень у віддалені терміни спостереження, що є актуальним у використанні жирового тіла щоки у сучасній щелепно-лицевій хірургії з метою удосконалення існуючих та розробки нових методів аутотрансплантації.