Roganov G.G., Irza O.L., Kushnir K.G.

Modern etiopathogenic justified approaches to treatment the traumatic osteomyelitis of mandible

The specialist have good reviews to remidies , which used in first phase of inflammation and to preparations, demonstrating multidirectional effect.

Such group of preparations includes Erbisol. Esrbisol has effect of activation the recovery processes and non-specific immunity, increases the functional activity of organs and tissues. Also Erbisol promotes the decrease of intensity of inflammotory reactions, has antioxidant and membrane stabilizing actions. For complex treatment of suppurative destructive complications of fractures of the mandible applies osteoplastic materials, which have stability to infection and have the ability to decrease the local inflammatory reactions. At the same time the opportunity of use the antihypoxic and antimicrobic osteoplastic therapy in complex therapy of

traumatic osteomyelitis of mandible wasn't studied in connection with which was formed the purpose of this study.

The purpose of study: to increase the efficiency of treatment of the patient with traumatic osteomyelitis of mandible by including in complex of treatment the preparations, which have pathogenetic (antihypoxic and local osteoplastic and antimicrobic therapeutic effects

Materials and methods of investigation.

Carried out the examination of 58 patients with osteomyelitis. In additional were 27 people as control group. All examinated were divided into 2 groups: 1 group(27 patients) – healthy people in age 18-25 with no diseases. 2 group (the main) included 2 subgroups. In first (subgroup A) patients with traumatic osteomyelitis of mandible, received traditional complex treatment(with preparation tocopherol ) with local use the hydroxyapatite. In second group( subgroup B) 26 patients with traumatic osteomyelitis of mandible also used Erbisol.

The patients with traumatic osteomyelitis of mandible carried out immobilization of mandible. In remission phase carried out surgical treatment phase(sequestrectomy). During the operation the formed defect of bone filled partly (2/3) by sintetic osteoplastic material.

The drug postoperative therapy included use the antibiotics (lincomycin, cefazolin, augmentin), non-steroidal antiinflammatory remedies(nimesil, movalis),antihistamine preparations (alleron,cetrine), immunocorrector (traumel C) polyvitamins and microelements.

Results of investigation and discussion

All 58 patients with traumatic osteomyelitis had clinical and radiological signs of suppurative and destructive posttraumatic processes , developed in mandible.

The significant changes demonstrated the indexes of general immunity : Ig A decreased in 39 % (p<0,01), IgM - in 24,7%(p<0,05),that pointed out to disturbances in system of general immunity.Identifed also the significant grow of indexes of lipid peroxidation of blood. ( The increase the number of free radicals in blood and mixed saliva)

In this way , the results of examination showed the moderatly expressive local and general inflammatory reactions, which progress against the background of increased proteolytic activity of neutrophiles of peripheral blood, metabolic hypoxia and chronic immunodeficiency. By clinical examination, conducted in dynamics of treatment the patients estimated the severity and rate of extinction of local inflammatory reactions such as edema, hyperaemia, exudation and the condition of regional lymph nodes.

The analysis of received data showed , that in subgroup B against the background of use the Erbisol and osteoplastic material. The significant changes were indicated from second day till 7-10 day.

Conclusions

1. Traumatic osteomyelitis of mandible accompanied by significant increase of intensity of lipid peroxidation and also LDH-activity , decrease of SDH – activity, that evidence the expressive disturbances of redox processes in the body, caused by local hypoxia.

2. The immediate and long-term results of treatment of patients with traumatic osteomyelitis of mandible testified, that the most effective is to close osseous defect by bioresorbable osteoplastic material , doped with silver with next administration immunomodulator and antioxidant Erbisol in postoperative perioud. This indicated by the more immediate terms of recovery the cytobiochemical indicators of blood and saliva ( on 7-14 day, in control – on 14-21),decrease of number of local complications(on 28,4 %) and relapses of disease.