РЕТРОСПЕКТИВНИЙ АНАЛІЗ СТРУКТУРИ ТРАВМАТИЧНИХ ПОШКОДЖЕНЬ ЩЕЛЕПНО-ЛИЦЕВОЇ ДІЛЯНКИ У м. ЛЬВОВІ В ПЕРІОД ЗА 2016-2018 РОКИ 1 Львівський національний медичний університет імені Данила Галицького, Україна 2 Ужгородський національний університет, Україна 3 КНП «Клінічна лікарня швидкої медичної допомоги», Львів, Україна

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Introduction: The most common method of local anesthesia of maxillofacial region in the modern surgical practice is conductive anesthesia of the peripheral branches of trigeminal nerve. In order to reach the total anesthesia of the lateral facial region it is necessary to block not only auriculo-temporal and buccal nerves, but also facial branches of great auricular nerve taking part in the innervation of parotid-masticatory area and the part of the cheek. Topographic-anatomical investigations of corpses revealed the anatomical variability of the branching of great auricular nerve on the neck and the head. Taking into account the topographic-anatomical aspects of variability of innervation of the lateral facial region, we developed the method of conductive anesthesia of the facial branches of great auricular nerve. The aim: To evaluate the clinical effectiveness of the developed method of conductive anesthesia of the facial branches of great auricular nerve taking into account individual anatomical peculiarities of its branching in patients with the different forms of the skull. Materials and methods: Clinical observations were conducted on 69 patients of different age (from 18 to 70) and sex (43 males and 26 females). Under the local anesthesia we conducted surgery in the parotid-masticatory region including: disclosure of the abscesses, excision of migrating granulomas or lymph nodes (in the cases of chronic hyperplastic lymphadenitis); excision of the benign tumors of the soft tissues (atheromas, lipomas, fibromas and keratoacanthomas), excision of the salivary fistulas and keloid scars. Depending on the used methods of local anesthesia of the soft tissues of the parotid-masticatory region the patients were divided into two clinical groups. The first group (30 patients) was exposed to conductive anesthesia of great auricular nerve by the method of P. Raj (2002). according to which the blockade of the nerve is conducted ahead the apex of mastoid process of the temporal bone. 39 patients after the signing of the written agreement were exposed to the developed method of conductive anesthesia of the facial branches of great auricular nerve. In order to detect the individual anatomical features of the facial part of the head in patients, the facial index was determined by the Garson`s formula. Pain sensitivity and perception in patients were studied using subjective and objective methods. The data were analysed by means of the Pearson’s chi–square tests. Results: It is revealed that total anesthesia of the soft tissues of the parotid-masticatory region in all cases was reached in patients with euriprosopic face shape (broad-faced) – in 8 patients of the first clinical group and 10 patients of the second. The least effective was the anesthesia of the anterior branch of great auricular nerve conducted according to P. Raj’s method (2002) in patients with leptoprosopic face shape. In patients with leptoprosopic face shape of the second clinical group after administering anesthesia according to the developed method in 9 cases total anesthesia was reached, in 2 cases pain sensitivity in the inferior-anterior quadrant remained (χ2 = 5,70; р < 0,05). Generally, in patients of the first clinical group the method of conducted anesthesia by P. Raj was effective in 19 cases (63,3 %), and the developed method of conductive anesthesia of the facial branches of great auricular nerve – in 36 cases (92,3 %) – χ2 = 8,85, р < 0,01. Conclusions: The results of the research confirm that the developed method of conductive anesthesia of the facial branches of great auricular nerve is more effective in comparison to methods of anesthesia commonly used in today dentistry surgical practice. It allows to reach the total anesthesia of the soft tissues of the parotid-masticatory region in 92,3 % patients with different face shapes.

Tumours and tumorous lesions of head and neck account for 10% of all oncological pathologies. Branhyogenic cancer is found in 4.5% of patients with lateral cysts in the neck. The article highlights the results of research the clinical case of branhyogenic cancer, provide its clinical and morphological analysis. The aim of our work was to study the clinical case of bronchial cancer, providing clinical and pathomorphological analysis. Examination and treatment was conducted in accordance with the clinical protocol using the diagnostic criteria necessary for management of patients diagnosed with tumours and tumorous lesions in a particular clinical case. We applied ultrasound examination of the locus, angiography of head and neck vessels with tomohexol and with 3D reconstruction, histological examination of surgical specimens (macroscopy and microscopy). On the basis of clinical investigaton, ultrasound examination, angiography clinical diagnosis was formulated – lateral cyst on the left side of the neck. A radical surgical removal of the mass was conducted. Histopathological conclusion: there is a proliferation of cystic transitional cell epithelium with the locus of invasive squamous cell carcinoma in the cystic wall that suggests malignant transformation of bronchogenic cyst. Final diagnosis: branhyogenic cancer. Thorough examination and analysis of a clinical case demonstrates that the development of branhyogenic cancer, is histo-genetically associated with lateral cysts in the neck. Complexity of diagnosing and high percentage of malignancy induces to more early discovery and removal of lateral cysts in the neck .