No abstract

Today the problem of pathogenesis and rational treatment of purulent-inflammatory odontogenic diseases of the maxillofacial area is quite relevant in the field of medical and SOCIAL problems. In recent years, the number of patients with odontogenic inflammatory does not catch an illness, while the number of complications increases. In case of the development of purulent inflammation the complex of interrelated morphological, biochemical, immunological and other changes is observded. The basis in the complex treatment of phlegmon of the maxillofacial area and neck of any localization is active surgical treatment. General therapy for odontogenic inflammatory diseases of the maxillofacial area primarily provides control of infection and intoxication, aimed at normalization of the impaired functions of organs and systems. The purpose of this research was to increase the effectiveness of comprehensive treatment of patients with odontogenic phlegmon of the maxillofacial localization by the use of cryopreserved placental cells. In most cases, the cause of inflammatory processes of maxillofacial localization was untreated periodontal teeth, retained teeth and negligent behavior of patients. That is why the majority of authors believe that the "cause" tooth should be urgently removed, but the solution depends on the individual features of the patient and in some cases may be postponed until the relief of the inflammatory process [3,4]. The combination of local and general factors is necessary to avoid further development of abscesses and phlegmons of the maxillofacial area and neck. The local factors are aerobic and anaerobic infection (staphylococcus, streptococcus, enterococcus, diplococcus, intestinal, gram-positive and gram-negative rods, but less often - mycoplasmas, the simplest of the family Trichomonas, spirochetes, and fungi of the genus Candida). The concentration of causal microflora, general and local nonspecific and specific protective factors of the body, the state of various organs and systems of the body, as well as anatomical and topographic features of the tissues of the maxillofacial area play a significant role in the development and course of purulent-inflammatory processes of the head and neck. All of the above determines the nature of the inflammatory reaction: normergic, hyperergic, hypoergic, anergic. Currently, placental cryoextract preparations are widely used in various fields of medicine, in particular, in urology, gynecology and general surgery. So, maxillofacial surgeons can be interested in their use in the treatment of patients with inflammatory purulent diseases of the maxillofacial localization. That is why carrying out a detailed analysis of native and foreign literature, we have concluded that it is necessary to continue study and scientifically substantiate the issue of optimizing conservative treatment of patients with odontogenic phlegmons with the use of biologically active substances. In further studies it is planned to investigate the impact on the mechanism of purulent wound healing by cryopreserved placenta and to create a morphological and biochemical evidence base for the effectiveness of the proposed treatment.

The problem of surgical infections is an urgent problem of medicine today. Despite the improvement of the quality of medical care, improvement of known and discovery of new methods of treatment, the number of patients with this pathology has a clear temporary tendency to increase. Features of the anatomical structure of the maxillofacial area determine the clinical originality of purulent inflammatory diseases, which are characterized by rapidly progressing course and spread with the generalization of the process. As etiological factors for purulent inflammatory diseases of the maxillofacial area can be diseases of the skin of the face and neck, lymph nodes, ENT diseases. The leading role in purulent inflammatory diseases of the maxillofacial area is occupied by odontogenic cause. The aim of the study. Investigate the structure and frequency of purulent inflammatory diseases in residents of Poltava region. Material and methods. The Department of Maxillofacial Surgery is located on the basis of Poltava Regional Clinical Hospital, provides specialized and high-tech assistance to residents of Poltava region. During the period 2015-2019, a total of 3927 patients were treated, of which purulent inflammatory diseases of the face and neck occurred in 1281 (30.1%): phlegmon - in 582 (44.4%), abscesses - in 699 (55, 5%). Sepsis was complicated by surgical infection in 9 patients (0.9%). All patients underwent a clinical examination to clarify complaints, medical history, studied the data of objective examination of the general condition, careful assessment of local status (localization of the process, discoloration, skin temperature, edema, tissue infiltration, checked the amplitude of mouth opening, studied dental formula). All patients underwent a general clinical examination, the results of microbiological monitoring of bacterial cultures were studied. Additional instrumental methods of examination were performed: CT of soft tissues in 35 (3.89%), ultrasound of soft tissues of the neck - in 123 (13.76%), orthopantomography - in 640 (52.38%), radiography of the neck - in 43 (5.1%). Among the diseases that form a severe premorbid background, the most significant role is played by HIV and diabetes. Microbiological monitoring has identified as the most common microflora of Staphylococcus aureus, Streptococcus constellatus and Streptococcus mitis. Adequately performed surgery in combination with active complex therapy in the postoperative period, including in addition to traditional therapy “Biocerulin”, allows to reduce the duration of inpatient treatment to 7.3 + 0.3 (in the control group when using traditional dressings - 11 , 5 + 0,5) and ensures the absence of fatalities. Conclusions. Purulent inflammatory diseases of the maxillofacial area are an urgent problem of surgery, accounting for 9.8% of those hospitalized in the department of maxillofacial surgery. A significant predominance of the most able-bodied age group (41.0%) puts the problem of the disease in the category of socially significant. The leading role of odontogenic causes of purulent inflammatory diseases indicates the lateness of patients in dental clinics, the neglect of oral hygiene and the timeliness of remedial measures. Early surgery in combination with antibacterial therapy in accordance with microbiological monitoring and the use of “Biocerulin”, allows to achieve satisfactory immediate results of treatment.