DIFFERENTIAL-DIAGNOSTIC INFORMATIVENESS OF THE MORPHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF PAROTID SALIVARY GLAND CYSTS.

OBJECTIVE: The aim: To conduct a general analysis of the results of the study of the morphological and immunohistochemical structure of cysts of the parotid salivary glands. PATIENTS AND METHODS: Materials and methods: Our study is based on the application of generally accepted, additional and special methods of examination, which concerns 21 patients who underwent surgical intervention to remove cystic formations of the parotid salivary gland. RESULTS: Results: It was established that there are 2-3 HLA-DR+ cells per 100 epithelial cells located in the basal and subbasal layers in the form of their continuous ribbon and their moderate infiltration of tissues within the acinar epithelium. In the epithelium, CD3+ cells were also detected in the number of 1 to 7 per 100 epitheliocytes and they were the most numerous, along with HLA-DR+ cells. Instead, the presence of CD4+ and CD20+ cells was not detected in the epithelium, unlike the subepithelial layer, where they occupied significant areas. In turn, the infiltration of CD8+ cells of the epithelial layer was established in the amount from 1 to 7 per 100 epitheliocytes. A moderate number of them was also determined subepithelially, and they were single directly in the cyst wall. CONCLUSION: Conclusions: Immunohistochemical study of the structural components of cystic formations is this is the direct way to establish the nature of the redistribution of immune cells in it, which is very important when conducting differential diagnosis in difficult and doubtful cases.

PERIODONTAL RESPONSE TO CYTOSTATIC DRUGS IN CHILDREN.

OBJECTIVE: The aim: To study the effect of different types of cytostatic drugs on the periodontium in children with malignant tumors. PATIENTS AND METHODS: Material and methods: The material for generalization was based at the results of examination of 44 patients with malignant tumors of the abdominal cavity who underwent preoperative treatment in the oncohematology department of Poltava Children's City Clinical Hospital. RESULTS: Results: In the absence of proper dental care in patients of this group, under the influence of chemotherapeutic drugs, significantly worsens the level of oral hygiene and the condition of periodontal tissues. There are also changes in the process of differentiation of the epithelial structures of the gingival margin, which is accompanied by an increase in smears - reprints of the number of inflammatory cells of the peripheral blood, both with preserved structure and destructive forms. CONCLUSION: Conclusions: In children with malignant tumors, during antitumor therapy, there is a decrease in the level of hygiene of the oral cavity, accompanied by morphological destructive changes in the integumentary epithelial layer of the gingival margin. The severity of these disorders depends on the type and dose of cytostatic drugs, which should be considered in the formation of treatment and prevention measures for them.

IMPREGNATION OF ORAL MUCOSA OVER IMPACTED TEETH BY SUBPOPULATIONS OF MACROPHAGES M1 AND M2.

OBJECTIVE: The aim: Of the study is to research quantitative parameters of mucous membrane macrophages populations M1 (CD68+) and M2 (CD163+) over vestibularly and palatally impacted teeth. PATIENTS AND METHODS: Materials and methods: A group of 21 people aged from 10 to 16 years was formed to conduct the research. Clinical situation according to diagnostic criteria was identical in all the patients. The group was divided into two groups - control and experimental, which in their turn were fragmented into two subgroups. Immunohistochemical studies of mucosal biopsies were performed in accordance with the recommendations for selection. RESULTS: Results: Study of ratio of CD68+/CD163+ cells revealed imbalance in individuals with vestibularly impacted teeth due to higher infiltration density of CD163+ (p<0,05), compared to CD68+ of control group. In individuals with palatally impacted teeth, ratio of CD68+/CD163+ increased 3,6 times, as well as compared with control group, but due increased infiltration density of CD68+. CONCLUSION: Conclusions: In the epithelium of oral mucosa located over impacted teeth, both on vestibular and palatal surface, number of CD 68+ and CD163+ cells had no significant differences compared to control group. In biopsies of the lamina propria of mucosa over vestibularly impacted teeth, the ratio M1/M2=0,91±0,11 (p<0,05) decreases, with predominance of macrophages CD163+ subpopulation activity, and over palatally impacted teeth balance of M1/ M2 macrophages elevated (M1/M2= 2,10 ± 0,32, p<0,05), due to increased infiltration density of CD68+.

FREQUENCY, STRUCTURE AND CLINICAL MANIFESTATIONS OF THERMAL BURNS OF THE JAW-FACIAL AREA IN CHILDREN.

OBJECTIVE: The aim: To establish the frequency, structure and features of the clinical course of facial and neck burns in children. PATIENTS AND METHODS: Materials and methods: During 5 years, 78 patients aged from 6 months to 15 years with isolated burns of the face and neck and in combination with lesions of other anatomical areas were treated. In the dynamics of observation of patients were used classical methods of examination, and in their treatment we followed the protocol of medical care for this category of patients. RESULTS: Results: Thermal injuries of the face and neck accounted for 12.6% of the total number of patients with burns. Their isolated lesion was 26.9%, and in combination with other areas it was 73.1%. The most frequently affected were children of nursery, primary school and preschool age, with a predominance of rural residents (52.6%), mostly boys (78.0%). Anesthesia support had to be used in the treatment of 24 patients (30,8%). The features and nature of the burns depended on the relief of the face and the most damaged are its protruding parts.

EFFECTIVENESS OF CORRECTION OF PSYCHO-EMOTIONAL STRESS IN CHILDREN WITH TRAUMATIC INJURY TO SOFT TISSUES AND FACIAL BONES.

OBJECTIVE: The aim: To study the effectiveness of correction of psycho-emotional stress in children with traumatic injuries of the tissues of the maxillofacial area. PATIENTS AND METHODS: Materials and methods: A comprehensive examination and treatment of 58 children aged 3 to 15 years with traumatic injuries of the maxillofacial area were conducted during the period of 5 years. This applied to soft tissue injuries in 51.7% of cases and in 48.3% - to facial bone injuries. To test the severity of the psycho-emotional state, two homogeneous groups were formed in a total of 41 persons of primary and secondary school age. RESULTS: Results: A comparison of the results of our previous studies, which concerned only the fact of psychological testing and changes in vegetative balance in children with traumatic injuries with a group of patients who underwent comprehensive treatment with additional involvement of targeted psychoneuropharmacological correction allowed to establish, that this approach made it possible to eliminate vegetative disorders and reduce the degree of stress in them for 9-10 days from the time of hospitalization. CONCLUSION: Conclusions: In children with traumatic injuries of soft tissues and bones of the face, dysregulation of vegetative function and intensity of compensatory-adaptive mechanisms of the body with the predominance of the central mechanism of regulation. With the additional involvement of the drug "Noofen®" in the complex of therapeutic measures, it allows to stabilize their psychological state, which indicates its effectiveness.

Bitten wounds of the maxillofacial area in children.

OBJECTIVE: The aim of the work is to determine the frequency, structure, features of clinical manifestations and treatment of bitten wounds of the face and neck in children of Poltava region. PATIENTS AND METHODS: Materials and methods: It has been analyzed 91 histories of disease of thematic patients undergone treatment at the Surgical Department of Pediatric town clinical hospital of Poltava. RESULTS: Results: In the structure of traumatic injuries of maxillofacial area in children 5.3% were patients with bitten wounds of the face and neck. Among the injured were children of the age 7-12 years old (30.2%). In 74.7% of cases, the bites were complicated by acute inflammatory processes. Urban residents accounted for 71.8% of the total number of cases, while rural residents accounted for 28.2%. Boys were injured by 53.6% and girls by 46.4%. Sharps (74.5%), punctures (19.3%) and lacerations (6.2%) differed in form. The comprehensive treatment of patients with bitten maxillofacial area wounds was carried out according to the protocol of care. CONCLUSION: Conclusions: The clinical picture and severity of bitten wounds of maxillofacial area in children have individual features, which are largely due to topographic and anatomical localization of injuries. The choice of the optimal variant of primary surgical treatment of wounds and the amount of surgery should be determined individually depending on the severity of the injury, the time of injury. Special attention should be paid to normalization of psycho-emotional state of patients and prevention of scar formation.

Adverse factors that can affect on the course of chronic parenchimatic parotitis in children.

OBJECTIVE: The aim: The study of the presence of disorders in the ante- and postnatal periods of development of children from 2 months to 15 years with chronic parenchimatic parotitis, which may affect its course. PATIENTS AND METHODS: Materials and methods: It has been examined and treated 88 children, aged from 2 months to 15 years with chronic parenchimatic parotitis, and their mothers were interviewed, who indicated the pathological course of pregnancy, childbirth and indicated the type of breastfeeding babbies. The scope of the survey included general, additional methods, consultations by related specialists and statistical processing of results. RESULTS: Results: 88 children with the exacerbation of chronic parenchimatic parotitis were examined (42 - (47%) with active course and 46 - (53%) with inactive). The exacerbation occurred on the background of acute infectious processes or coincided with the exacerbation of one of the chronic diseases. The first manifestations occurred in spring (55%) and autumn (36%) periods, 44% of children were hospitalized with other diagnoses. The presence of pathological conditions during pregnancy and birth defects in their mothers were recorded more often 3,5 and 3,3 times, respectively, compared with control. 70% of children received mixed and artificial feeding and were more likely to become ill. CONCLUSION: Conclusions: The severity of clinical manifestations of inflammation and disorders of the general condition depended on the activity of the course of chronic parenchimatic parotitis and were more pronounced when active. During the remission period, no apparent clinical manifestations were detected in 72% of observations, however, in 28%, the identified signs indicated a latent course, which required additional treatment and rehabilitation measures.

Clinical-morphological characteristics and peculiarities of treatment of paraururicular fistulas in children.

OBJECTIVE: The aim: Determining the frequency of occurrence of paraauricular fistula in children and comparing the results of their own experience regarding their clinical manifestations, treatment principles and morphological features with existing scientific data. PATIENTS AND METHODS: Materials and methods: The results of a comprehensive examination and surgical treatment of 25 children with paraauricular fistulas. RESULTS: Results: Most often, para-auricular fistula was observed in infants 22 - (88%). In 18 persons (72%), they were unilateral, in 10 - (40%) hereditary. In 8 - (32%), fistula was diagnosed immediately after birth. In 17 - (68%) the pathology was not clinically manifested, but was an accidental finding during the next medical examination. Morphological research has shown that congenital paraauricular fistula is a formed canal intimately associated with the epithelium and cartilage, and the presence of epithelial lining on the fistula wall with constant support of the inflammatory process makes it impossible to heal even against the background of multicomponent treatment. CONCLUSION: Conclusions: Due to the topographic-anatomical localization, features of the clinic of the born fistula, surgical treatment does not always allow to achieve the desired results, and requires repeated interventions during recurrence. It is possible to prevent recurrence by the extensive use of additional diagnostic manipulations before surgery and careful wound control during surgical procedures.

Impact of polychemotherapy on the oral soft tissues in children with malignant abdominal tumors.

OBJECTIVE: Introduction: According to modern standards of treatment of malignant neoplasms conducting polychemotherapy requires up to 90% of cancer patients. However, in addition to the expected cytotoxic effects, it is accompanied by disorders in dental health in the vast majority of patients. The aim: To study the effect of cytostatics on soft tissues of the oral cavity in children with malignant tumors of the abdominal cavity. PATIENTS AND METHODS: Materials and methods: Material for writing this scientific work served as a synthesis of results for 25 people aged 7 to 15 years with malignant tumors of the abdominal cavity, in which a comprehensive oral examination was performed to determine the manifestations of dental toxicity cytostatics. RESULTS: Results: At the end of the first course of chemotherapy, all patients had dry redness of the lips, 20 - (80,0%) with eruptions, in 18 - (20,0%) erosion. The Green-Vermillion, PMA, and PBI indices grew by 1,8; 7 and 3,3 times respectively. In cytograms with buccal epithelium an increase in the number of cells of polymorphic sizes and forms with signs of gidropic dystrophy was found. The nuclear-cytoplasmic ratio decreased by 1,4 times compared with the primary examination. CONCLUSION: Conclusions: This situation creates the preconditions for the development of inflammatory process in the tissues of the oral cavity and requires the use in this category of patients of a substantiated pathogenetic correction of existing disorders.

Optimization of surgical-orthodontic treatment tactics in patients with impacted teeth.

OBJECTIVE: Introduction: Impacted teeth is complex anomaly of teeth eruption that requires a balanced approach not only in the differential diagnosis of its forms, but choice of rational methods of treatment. The aim: Optimization of the tactics of orthodontic-surgical treatment of patients with impacted teeth based on the development and implementation of computed tomographic indices (KT) and photometric indices (FM) of opening of surgical access (OSA) to crowns of impacted teeth. PATIENTS AND METHODS: Materials and methods:The results of treatment of 48 patients with delay of permanent teeth eruption have been analyzed. For an objective assessment of treatment results, a group of 24 (aged from 9 to 19 years old ) was formed. All 24 patients had typical clinical situation. RESULTS: Results: Orthodontic correction of patients envisaged, first of all, the elimination of obstacles in the way of teeth eruption, if necessary to provide space in dental arch and simultaneous treatment of associated bite malocclusions. Surgical exposure of impacted tooth crown was carried out and at the same time a triangular shaped guiding channel was formed, base of channel was at the impacted tooth and its angle finished into the dental arch. Precise dimensions and depth of the channel were preliminary planed on computed tomography slices with 3D reconstruction. Mean values of CT width (7,13±0,54mm), and length (6,42±0,78mm) of OSA and CT index (130,79±8,19%) of OSA to impacted teeth crowns were determined. CONCLUSION: Conclusion: To improve the quality of diagnosis and optimization of methodological approaches to treatment of patients with teeth impaction, we have proposed CT and FM OSA indices to the crowns of impacted teeth. The developed indices serve as specific reference points for optimization of diagnostic process, for reducing of probability of repeated surgical interventions and choosing the optimal path for instrumental orthodontic treatment of patients with impacted teeth.

Insect bites as the cause of infectious and allergic inflammatory processes of the maxillofacial area in children.

OBJECTIVE: Introduction: The part of purulent inflammatory processes (IP) of the maxillofacial area (MFA) as a result of insect bites are increased. The aim: To attract attention of the medical community to the problem of the complexity of the diagnosis and treatment of these dermatogenic forms of IP MFA. PATIENTS AND METHODS: Materials and methods: The work is based on the results of 5 year observations of 42 patients with acute IP MFA arising after insect bites, their comprehensive examination and treatment. CONCLUSION: Conclusions:1. IP of MFA, arising as a result of insect bites, is a very urgent problem of pediatric surgical dentistry and require an individual approach in the diagnosis and treatment of patients. 2. A large role in preventing the occurrence of these nosological forms is given to medical workers, a sufficient organization level of sanitary and educational work, and the treatment of such cases becomes a common task of doctors of different profiles. However, much depends on the parents, their level of responsibility and competency, ensuring of timely treatment and provision of qualified medical care to children, preventing the development of severe complications. 3. The issues related to the etiopathogenesis of this pathology require profound scientific research.

Diagnostic information of computed tomography of the upper jaw in patients required implant rehabilitation.

OBJECTIVE: Introduction: Dental implantation in conditions of bone deficiency in the loss of lateral group of teeth of the upper jaw is impossible without the maxillary sinus floor augmentation. Preparation for surgical intervention requires a thorough assessment of the anatomical features of the sinus, relationship between the sinus and adjacent teeth, detection of foci of chronic infection of the Schneiderian membrane. In the complex of the objective methods of investigation, computed tomography is the most informative approach to study the state of the bone and soft tissue structure of the sinus. The aim of the paper is to evaluate the state of the bone structures and maxillary sinus membrane to determine the technique for selection the optimum alternative for management of patients, who required sinus lift, based on the computed tomography. PATIENTS AND METHODS: Materials and methods: Computed tomographic examination of 206 patients with bounded and free-end edentulous spaces in the lateral area of the upper jaw was carried out over a period of 2010-2017 to evaluate the appropriateness of sinus lift approach and selection of its technique. The state of the bone tissue and presence of the auxiliary septa, intranasal structures, including ostiomeatal complex, presence of edema and exudates, lesions of the mucosa, as well as the state of ostium maxillaris has been estimated. RESULTS: Results: In the projection of the maxillary sinus the thickness of the bone tissue ranged within 1 mm to 10,5 mm; the density of bone tissues was of the D3-D4 type. Inflammatory events were detected in 60,1&, including: thickening of the mucous membrane on the right and on the left (40,6& and 41,1&, respectively), the total edema (8,6& and 9,7&, respectively). Bilateral thickening was found in 38,8&, and bilateral total edema in 28,0& of cases. Remnants of the filling material were found in 1,4& of sinuses on the right and in 2,8& on the left. Bone septum was visualized on the right in 18,8&, and in 17,4& on the left, bilateral in the 31,8&. Cystic masses were detected on the right in 4,2& of cases and in 6,2& on the left, bilateral in 16,7&. CONCLUSION: Conclusions: Computed tomographic examination provides thorough evaluation of the parameters of the bone tissues, state of mucous membrane and peculiarities of architectonics of maxillary sinuses at the pre-implantation stage.

[Methods of diagnosis of non-specific and specific lymphideniates of the jaw-facial part in children (literature review)].

OBJECTIVE: Introduction: Insufficient basic knowledge on the mechanisms of the multifactoral etiology and pathogenesis of various forms of maxillofacial lymphadenitis of odontogenic and non-odontogenic nature in children causes difficulties in making differential diagnosis. The algorithm of their examination involves a large number of methods, each of which has its own advantages and disadvantages with variable informativeness, depending on the particular situation. The aim: The paper is aimed atfamiliarization of broad medical public with informativeness of diagnostic measures in the nonspecific and specific affection of lymph nodes of the maxillofacial area in children. PATIENTS AND METHODS: Materials and methods: A thorough comprehensive analysis and generalization of scientific achievements elucidated in the fundamental and periodical publications, relating to diseases of the lymphatic system, has been carried out. RESULTS: Results: It has been establishedthat, despite a large variety of diseases accompanied by the reaction of the lymph nodes of different anatomic localization, current diagnostic possibilities are potent to establish a clinical diagnosis in most cases. In this way, the current diagnostic model requires the interaction of clinicians, infectiologists, molecular biologists, geneticists and morphologists. In this regard, the issues of efficient organization of the diagnostic process, detailing all stages of the search for accurate diagnosis, are crucial. CONCLUSION: Conclusions: The collected material on various forms of lymphadenitis and their secondary affection is fragmentary to date due to the absence of the unified methodological approach to carrying out differential diagnosis, which requires generalization and systematization of scientific groundwork. Unfortunately, the algorithms of examination of this category of patients, especially with lymphadenopathy, are not sufficiently developed to date, indicating the need for further search and optimization of diagnostic criteria taking into account modern realities.

[Statistical information about the inflammatory processes of the jaw-facial part in children].

OBJECTIVE: Introduction: The acute and chronic inflammatory processes prevail in the structure of the dental surgical diseases in children. Notably, various forms of lymphadenitis, adenophlegmon and odontogenous osteomyelitis dominate in the specialized surgical units; however, it is not possible to resolve a number of organizational problems without clear understanding of the statistical situation. The aim: The paper is aimed at the analysis of the incidence rate of major nosological forms of the acute suppurative inflammations of the maxillofacial area in children for the prospective planning of arrangements to provide them with high-quality specialized care. PATIENTS AND METHODS: Materials and methods: The paper involves findings of comprehensive examination and treatment of 537children with acute purulent lymphadenitis, adenophlegmon and odontogenous osteomyelitis that was carried out within 6 years. RESULTS: Results: The resulting clinical data have shown that three abovementioned nosological forms of the disease accounted for 42% of the overall number of the inpatient dental patients and 11% of the total number of children with acute surgical pathology. Out of 537 patients, 240 patients (44.8%) with acute purulent lymphadenitis, 150 (27,9%) patients with adenophlegmon and 147 (27.3%) patients with acute odontogenous osteomyelitis have been observed (318 (59,2%) boys and 219 (40,8%) girls aged from 2 months to 15 years). The study of the past history of the disease has established that in the majority of patients burdened premorbid history and occurrence of concomitant chronic general somatic diseases was presented prior to the onset of acute inflammation. CONCLUSION: Conclusions: The factors, mentioned above, greatly contributed to increase in protective-adaptive properties of child body and create the prerequisites for the formation of pathological symptomocomplex in children, which can be implemented even in the minimal effect of antigen load on the tissues of maxillofacial area. Such situation requires a balanced multidisciplinary approach to the planning of preventive measures in this category of patients at all stages of the observation.

Differences in clinical manifestations of odontogenic and non-odontogenic lymphadenitis.

INTRODUCTION: The acute suppurative lymphadenitis and its chronic forms prevail in the structure of inflammatory processes of the maxillofacial area in children. High incidence of the acute and chronic forms of lymphadenitis of both odontogenic and nonodontogenic origin is caused by the anotomophysiological peculiarities of the structure of the teeth and soft tissues in children in different age periods. THE AIM: The paper was aimed at comparison of clinical manifestations of the acute and chronic odontogenic and non-odontogenic lymphadenitis. MATERIALS AND METHODS: The results of the checkup and 5-year-period treatment of 324 children with the acute and chronic forms of the nonspecific lymphadenitis of the maxilifacial area have been used. Four study groups have been formed. The first and the second group included 16 (38,0%) and 26 (62%) children with the acute submandibular suppurative lymphadenitis of the odontogenic and nonodontogenic origin, respectively. 12 (35,3%) and 22 (64,7) individuals with chronic hyperplastic lymphadenitis have been assigned to the third and the fourth group, respectively. RESULTS: The clinical course of the acute submandibular suppurative lymphadenitis of various etiologies is different. Rapid development of the local clinical manifestations with its dramatic progressing is specific to odontogenic lymphadenitis. Its clinical course is characterized by the more apparent overall response of the body, increase of the body temperature, and these symptoms are more manifested than in nonodontogenic lymphadenitis. The clinical course of chronic hyperplastic lymphadenitis is accompanied by the enlarged regional lymph nodes of various size and shapes and dense-elastic consistency. Clinical manifestations of nonodontogenic lymphadenitis were less apparent and the overall sate was normal in both forms of lymphadenitis. CONCLUSIONS: Nonodontogenic lymphadenitis prevailed in all nosological forms of the acute and chronic nonspecific lymphadenitis.