INTEGRAL INDICATOR OF THE LOCAL STATUS COMPLEXITY OF MAXILLOFACIAL LOCALIZATION PYOINFLAMMATORY PROCESS
Journal Title: Український журнал медицини, біології та спорту - Year 2017, Vol 7, Issue 5
Abstract
The system of assessing intensity of osteomyelitis’ manifestations in various forms was presented in current research paper. When analyzing clinical signs of osteomyelites (ICD Х, М 86) we have come to conclusion that patients’ complaints concerning general weakness, headakes, increase of body temperature, atony, slowed response, appetite disorders, sleep disorders can be observed in case of such diseases as periodontitis (ICD Х, К 04.5), periostitis (ICD Х, М 86.9, М 90.1), abscesses (ICD Х, L 02.0), phlegmons (ICD Х, L 03.2) etc., i.e. They belong to non-specific ones. Intensity of the local pain syndrome is the most natural index in case of abscesses and phlegmons of maxillofacial area. At the same time, in conditions of chronic forms of osteomyelitis (especially that one of traumatic nature) pains have a fading nature and bear a brightly expressed subjective imprint, and due to this fact their assessment becomes much more difficult. In case of external examination of the maxillofacial area (such as in case of an acute odontogenic osteomyelitis of the lower jaw as well as in case of a traumatic osteomyelitis of the lower jaw) the following points can be pointed out: 1) edema, local thickening or “swelling” of the jaw-bone; 2) infiltration of the surrounding soft tissues; 3) thinning and increased tension of skin over the infiltrate; 4) availability of fistula which can cause pus and abundant granulations. Availability and intensity of edema also requires differentiation of osteomyelitis from periodontitis, lymphadenitis and other infectious inflammatory diseases of the maxillofacial area, but edema availability and intensity belongs to the most stable signs of the studied pathology forms. Infiltration of soft tissues can be noticed not only in case with purulent inflammatory jaws’ diseases (including such diseases as osteomyelitis, abscesses and phlegmons) but it also reflexes severity of these diseases; and that of course requires the severity of this parameter to be taken into account. Nowadays availability of a fistula and nature of the released substance are considered to be pathognomic signs of osteomyelitis and in particular osteomyelitis of the lower jaw. When observing oral cavity the mucous membrane of transitional fold is usually of blue-purple color. It is edematous and thickened in a muffle way. There are granulations and thick puss at necks of mobile teeth, and in case of lower jaw traumatic osteomyelitis this fact contributes to smoothing out the clinical picture severity as well as to transition of the disease to its chronic form. From our point of view, the status of mucous membrane deserves a peculiar attention due to the fact that it may also accompany, for example, the widespread forms of periostitis or festered cysts (ICD Х, К 09). Another significant feature accompanying lymphadenites (ICD Х, L 04.2) or sialoadenites (ICD Х, К 11.2) consists in the status of local (submaxillary and submental) lymph nodes. In conditions of lower jaw osteomyelitis this parameter will reflect the level of involvement of the adjacent tissues into the pathological process. On the basis of the above-presented information we have defined the following severity signs of local manifestations of lower jaw osteomyelitis (these signs were subdivided according to the level of their intensity): the level of edema of soft tissues on the side of the disease; volumes and consistency of their infiltration; color of skin over the infiltrate; availability of a fistula in the focal point of the substance produced by the fistula; status of the transition fold mucous membrane in the oral cavity on the side of the disease; status and mobility of mandibular and submental lymph nodes. The local clinical picture of the disease was supplemented with the data of X-ray examination. For carrying out the examination digital dental X-ray unit was used (ORTHOPHOS Plus DS Ceph) with the multiimpulse generator, a roentgen tube (SR 90/15 FN) and the system for digital processing of images (SIDEXIS, produced by SIRONA Dental Systems GmbH). During the X-ray examination of patients with odontogenous lower jaw osteomyelitis the following items were defined: porous and uneven bone areas; foci of its destruction; changed structures and seques tral capsules. In conditions of lower jaw traumatic osteomyelitis the width, peculiarities of borders of the fracture gap, presence of fracture rearrangements in the system of bone tissue, rearrangement of sequestral capsule, jaw deformation, availability of broken fragments and status of their borders were characterized by means of orthopantomograms. An integral index of severity of the patient’s status before the lanned surgical intervention and variations of this status on stages of postoperative treatment is presented as an arithmetic sum of grades.
Authors and Affiliations
M. Komskiy, O. Drozdov, A. Buzoveria
Keywords
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