V.O.Kenbayev, K.B.Djusupov

Application of enzymes in complex treatment odontogenic infections

Shymkensky city hospital of the first help

Introduction.

Despite improvements in treatment of inflammatory diseases of the maxillofacial region, the problem of purulent infection continues to be relevant (1,2).

Reduced effectiveness of antibiotics, delayed clearance of necrotic purulent cavities of the masses, which are a kind of barrier to the penetration of drugs into the inflammatory focus, dictate the necessity of finding new treatments for odontogenic inflammatory diseases.

Surgeons have long attracted the attention of the idea of the ability to influence the course of inflammatory processes with biologically active drugs enzymes.

To date, the specified requirements are satisfied polienzimnye drugsand the most known method of application is the systemic enzyme therapy, treatment and prevention through a combination of targeted selected hydrolytic enzymes of animal and vegetable origin, providing co-operative effects on key physiological and pathophysiological processes in the body (3).

Despite the large number of publications reporting on the application of drugs for systemic enzyme therapy, there is no work, summarizing the experience of their use in the maxillofacial region.

The aim of the work was to study the histo-morphological changes of the skin from underlying dermis using the drug "Wobenzym" and its influence on the healing of the wound.

Materials and Methods.

The material of our observations was the 55 patients with acute odontogenic purulent processes of the soft tissues of the maxillofacial area in age from 10 to 70 years (17 women, 38 men).

Admission and in the dynamics of the disease were carried out clinical and laboratory research.

Morphological study of skin exposed to the underlying dermis. Pieces of tissue were fixed in 10% formalin solution and embedded in paraffin.

From these blocks serial sections were prepared, stained them with hematoxylin and eosin and mikroskopirovali.

Results.

In the initial period, sides and bottom of the wounds were presented

purulent-necrotic masses (Figure 1), the thickness of which depended on the extent of tissue damage (Figure 2).

Detritus was closely associated with developing granulation tissue.

Figure 1. Presented pyonecrotic mass. Uv.h200

In some cases, the morphological study of the primary septic wounds reported a mosaic structure developing granulation and marginally located infiltrative tissue impregnated with fibrin containing large amounts of neutrophils.

Figure 2. Contains a large number of neutrophils. Uv.h200

Lumen of blood vessels, the underlying tissues was extended, indicating that the congestion in the area of the inflammatory process, a constant output of neutrophils, macrophages, and fibrin.

Along with an inflammatory erythema resulting mikrotrombozov due to the progression of inflammation, foci of necrosis were observed.

In the area of diffusely infiltrated by neutrophils subcutaneous noted the presence of micro-abscesses and micro phlegmon, which were isolated from the main defect of the wound and remained incomplete after surgical treatment (Figure 3).

The use of "Vobenzima" led to the sequestration of necrotic foci of active soft tissue dissection and readjustment of micro abscesses and micro phlegmon, reducing infiltration and edema of the border areas and the elimination of secondary necrosis of soft tissues.

Along with cleaning the wounds of devitalizirovannyh tissue filling the wound occurred in parallel defect young, well vaskulyarizirovanymi granulations (Figure 4).

Figure 3. In the area of diffusely infiltrated by neutrophils indicated the presence of micro-abscesses. Uv.h200

Figure 4. There is a parallel to the filling of the wound defect young, well vaskulyarizirovanymi granulations. Uv.h200

According to pathological studies in the treatment of wounds shortened the period of purification for 2-3 days, compared with the control group.

The use of "Vobenzima" eliminated major manifestations of acute inflammation in the wound at the time of its purification from necrotic masses and led to the wound cavity filled with granulation tissue at 4-5 days of treatment (Figure 5).

Figure 5. Eliminated the main manifestations of acute inflammation in the wound. Uv.h200

In the initial biopsies of festering wounds and abscesses after autopsy revealed phlegmon large variety of morphological changes.

By the beginning of treatment in foci of purulent inflammation was observed neutrophil infiltration of tissues and foci of necrosis, the presence of numerous micro-abscesses and micro phlegmon, the development of granulation tissue at different stages of maturation until fibrosis.

For this material was characterized by leukocyte infiltration and purulent fusion of the surface layers of granulation, and necrosis melkofokusny leukocytic infiltration in the deeper layers of granulation tissue (Figure 6).

Figure 6. Leukocyte infiltration and purulent fusion of the surface layers of granulation. Uv.h200

Analysis of the individual dynamics of wound healing process with abscesses and purulent processes and comparison of these data show that regardless of the stage of wound healing, in which treatment is started,inflammation subsided under the influence "Vobenzima" is an average of 5 days of starting treatment,whereas in the comparison group to the same result occurs in 7-9 days or more.Filling the wound defect was carried out by young granulation, to be emanating from a more mature granulation tissue (Figure 7), which appeared in populations secreting glikozoaminoglikanov fibroblasts.

Figure 7. Filling the wound defect was carried out by young granulation, to be emanating from a more mature granulation tissue. Uv.h200

Thus, the results indicate a high efficacy of systemic enzyme therapy.

Reference.

1. Avakian, AV, Amiryan SS, TN Akopian, A. Harutyunyan The use of papain with Dimexidum and furatsilinom for the treatment of purulent wounds / / clinical. surgery. - 1987. - № 1. - S. 48-49 -

2. Bednova VN Borisenko KK, TI Novolotskaya et al / / Antibiotics and chemotherapy. - 1998. - № 8. - S. 45-46.

3.Veremeenko KN, VN Kovalenko Systemic enzyme therapy. Theoretical foundations, clinical experience. - Kiev: Morion, 2000. - 320s.