Early diagnostics of temporomandibular joint structural elements injures caused by traumatic mandibular bone fractures.

A rapidly increasing number of mandibular condylar fractures and some complications related to injuries of temporomandibular elements make this study important. Intra-articular disorders lead to secondary pathological findings such as osteoarthritis, deforming osteoarthrosis, and temporomandibular joint ankylosis that limits mouth opening, mastication, swallowing, breathing, and decreased/lost working capacity or disability. Early diagnosis of intra-articular disorders can prevent from long-lasting functional complications caused by temporomandibular joint injuries. This study was performed for the purpose of early detection and investigation of organic pathological changes in the cartilaginous and osseous tissues of the temporomandibular joint caused by traumatic fractures of the mandibular condyle. Twenty patients underwent a general clinical examination, magnetic resonance imaging (MRI), and immune-enzyme testing for biochemical markers of connective tissue injury (pyridinoline and deoxypyridinoline) in urine. Disk dislocation, deformation, adhesion, perforation or squeeze, tension or disruption of ligaments, and injury of articular surfaces are among complications of mandibular fractures that can be revealed on MRI. As regards biochemical findings, we revealed a sharp rise in the levels of pyridinoline and deoxypyridinoline before treatment and a lack of stabilization within 21 days of treatment.

[Immunological aspects of delayed regeneration of mandibular fractures].

The level of complications in patients with the mandibular fractures does not have a tendency to the decline. A research purposes is a study of the basic laws of immunological reactions and possibility of optimizing processes osteogenesis by drugs-cytokines at patients with the mandibular fractures with delayed consolidation of bone tissue. 46 patients with the mandibular fractures were observed. The maintenance of cytokines IL - 1ß, TNF - α, IL - 4, SICAM-1 in the blood serum, IgA, IgM, IgG in a mouth liquid was probed. It is set that in pathogenesis of delayed consolidation a basic role is played by changes reactivity of organism, which realized in three directions: immunodeficit of humoral immunity, immunodepression of cellular factors of defence, disbalance in functioning of the cytokines system. It is necessary to count the levels of products SICAM-1 and cytokine IL-1ß in the blood serum by the diagnostic criteria of bone repair features at patients with the mandibular fractures: development of delayed consolidation of mandibular fragments is accompanied the increase of their parameters at the control group more than in 2 and in 15 times (668,2±10,3 pg/ml and 363,4 ±6,6 pg/ml relatively). Includding in the complex treatment of the mandibular fractures of immunomodulator Ronkoleukin showed clinico-immunological efficiency for the patients with impaired bone repair.

[Application of immunomodulators in the treatment of mandibular fractures in elderly patients with incomplete secondary adentia].

The aim of the work was to study the experience of using complex pharmacotherapy in the treatment of mandibular fractures in elderly patients with incomplete secondary periodontitis, which were divided into two groups. In the first group, patients (n = 46; average age 69.0 ± 3.6) were treated using the authors' original device combined with application of antimicrobial MetrogilDenta gel onto gums two times a day during ten days. Patients in the second group (n = 52; average age 61.0 ± 3.1) were treated with the same device combined with (i) application of MetrogilDenta antimicrobial gel onto gums two times a day during ten days, (ii) application of 1.5 ml of Cycloferon 5% liniment by cotton pellet for 20 min during the same 10 days (30 minutes after the antimicrobial gel), and (iii) intramuscular injections of 6 mg of synthetic immunomodulator Polyoxidonium once a day for 3 days, then once every two days (for a total of 17 days). It is established that the use of the combination of interferon inducers of immunomodulator group--Cycloferon in the form of liniment and synthetic immunomodulator Polyoksidonium together with MetrogilDenta antimicrobial gel--led to the most pronounced regression of inflammatory and destructive processes in periodontal tissues (in 7.1%, d = 0.05), optimized the state of local immunity of the oral cavity, and normalized microflora in periodontal pockets in elderly patients with incomplete secondary adentia.

Immune status during fracture of lower jaw.

Immune status during fracture of lower jaw is a very important factor of pathogenesis. Immune depression is developing shortly after the trauma and it turns out to be a bad prognostic sign, during which the risk of developing the bone wound complications and traumatic osteomyelitis increase, and in case of absence of such complications we are faced with significant extension of a term of healing of bone wounds. We have carried out immune studies in 20 patients with lower jaw fractures. To study SlgA and lysozyme activity we took saliva and studied percentage of T- and B-lymphocytes (and their sub-populations) in blood by the use of micro method. Immunoglobulins were defined by the method of radial immuno diffusion; we determined the interferon system by in vitro stimulation of leucocytes; neutrophilic phagocyte activity was studied by the method of Kost U.A. and Stepko M.I. According to the obtained results, during fractures of lower jaw sharp decrease of interferon system and significant decrease of phagocyte activity was observed. Likewise was decreased lysozyme and SlgA indices, which refer to the depression of immune status of mouth cavity. From the cell immunity indices the decrease of T-activators and T-helpers and reduction of immunoregulation index should be emphasized. Quantity of B-lymphocytes was decreased by 10%. With the practical point of view the obtained results refer, alongside with carrying out the surgical, orthopedic and anti-microbial treatments, to the urgency of application of activators of phagocytosis, interferon and lysozyme immunomodulators. With the view of correction of cell immunity it is necessary to correct factors of T-lymphocytes and to increase activity of SigA and lysozyme, as the factors determining local resistance. The results obtained by us are rather important with the view of both immunology and applied, practical medicine. It enables us to lead the substantiated immune therapy, which will be harmonized with other etiotropic anti microbial therapy and will help us to improve significantly the results of anti-inflammation therapy and to decrease cases of purulent complications.

[Diagnostic and prognostic clinical immunological criteria for evaluating the course of the posttraumatic period in patients with open mandibular fractures]. / Diagnosticheskie i prognosticheskie kliniko-immunologicheskie kriterii kharaktera techeniia posttravmaticheskogo perioda u lits s otkrytymi perelomami nizhnei cheliusti.

A total of 136 patients with open mandibular fractures were examined, 53 of these at risk of inflammatory complications in the posttraumatic period. Analysis of the wound cytology, hematological changes, local and system immunity reactions suggest that phagocytosis dysfunction, imbalance of local immunity factors (primarily production, complex formation, and secretion of serum IgA) are significant factors in the development of posttraumatic immune deficiency. Statistical analysis showed clear-cut correlation between local immunity parameters (serum IgA, salivary IgG, levels of circulating immune complexes and medium-weight molecules in the saliva) and hematological values (leukocyte and lymphocyte counts, leukocytic intoxication index, and Rietes coefficient), which confirmed the reliability of prediction of inflammatory complications and necessity of immunocorrection in this patient population.

[Changes in the local nonspecific immune response to post-traumatic inflammation during treatment]. / Zminy mistsevoï nespetsyfichnoï rezystentnosti u posttravmatychnomu vohnyshchi v dynamitsi likuvannia.

Clinical investigation have been done in adult patients with broken mandible during 3 weeks of conservative treatment with aluminum splints (1st group, n = 17) or steel splints (2nd group, n = 16) in comparison with health adults (control group, n = 18). The neutrophil emigration into alterative locus and their degranulation as well as phagocytic activity of peripheral blood neutrophils were tested. It was found that aluminum splint application caused the intensive inflammation and then the depression of local host defense reactions. Treatment with steel splints did not lead to neutrophil function depletion or to hyper-intensification of inflammatory reaction in patients. The increased values of neutrophil reactions were normalized in this group at the final period of the treatment. The examined trial ensures our accurate method in treatment of patients with broken mandible. The determination of local host defense state may be proposed as preferable simple express-method of evaluation of immune status, treatment efficiency and prognosis in these patients.

[The dynamics of the immune indices with the use of immunomudulin in patients with a mandibular fracture]. / Dinamika immunnykh pokazatelei pri primenenii immunomodulina u bol'nykh s perelomom nizhnei cheliusti.

Forty-one patients with fractures of the lower jaw and 20 health donors have been examined. Patients with unilateral mandibular fractures received a conventional treatment (group 1) patients with bilateral mandibular fractures received a conventional treatment and immunomodulin (group 2). Results of investigations showed that immunity indices in patients of group 1 at admission to the hospital were in the normal limits, and reduced by the discharge. Immunity findings in patients of group 2 were rather decreased at admission, and normal after use of immunomodulin. Complications in group 2 were less frequent than in group 1.

[Immunocorrective treatment in mandibular fractures in inhabitants of the European North]. / Immunokorrigiruiushchee lechenie pri perelomakh nizhnei cheliusti u zhitelei evropeiskogo Severa.

Consolidation of mandibular fragments in 120 patients with fractures of different location was evaluated by clinical, x-ray, and functional methods (rheography and myography). After conventional treatment the fragments consolidated in 34.5 +/- 0.6 days in unilateral fractures and in 39.3 +/- 0.7 days in bilateral fractures. After combined therapy including immuno-correcting and vasodilating agents recovery was attained 4-5 days earlier.

[The comparative clinico-immunological characteristics of the course of mandibular fractures in patients in Yakutsk and Moscow]. / Sravnitel'naia kliniko-immunologicheskaia kharakteristika techeniia perelomov nizhnei cheliusti u bol'nykh Iakutska i Moskvy.

Ninety-seven patients with mandibular fractures were examined: 55 in Yakutsk and 42 in Moscow. In the Yakutsk patients the inflammatory process much more frequently progressed to the development of infectious inflammatory complications at the site of fracture than in Moscow. More expressed shifts in the immunogram were observed mainly in the patients who later developed infectious inflammatory complications.

[The optimization of the reparative processes in a mandibular bone wound in patients with chronic alcoholism]. / Optimizatsiia reparativnykh protsessov v kostnoi rane nizhnei cheliusti u bol'nykh khronicheskim alkogolizmom.

A total of 148 chronic alcoholics with mandibular fractures were treated. Hydroxyapol and colapol were inserted in bone wounds for improving the reparative osteogenesis. Clinical, immunological, and echo-osteometric data demonstrated the efficacy of both preparations, which promoted bone repair and reduced the incidence of pyoinflammatory complications.

[The use of intravenous laser irradiation of the blood for the prevention and treatment of suppurative infectious complications in mandibular fractures]. / Primenenie vnutrivennogo lazernogo oblucheniia krovi dlia profilaktiki i lecheniia gnoino-infektsionnykh oslozhnenii perelomov nizhnei cheliusti.

Fifty-nine patients with mandibular fractures were treated making use of intravenous laser irradiation of the blood. Laser exposure had a marked antiinflammatory and analgesic effect, compensated for changes in disordered immunity status, and normalized red cell membrane structure and function as well as its energy supply.

[The practical importance of assessing the immune status of patients with complicated and uncomplicated mandibular fractures]. / Prakticheskaia znachimost' otsenki immunnogo statusa u bol'nykh s oslozhnennymi i neoslozhnennymi perelomami nizhnei cheliusti.

The authors sum up the practically important general regularities in changes of a number of immunologic parameters associated with the clinical picture of the processes coursing after mandibular fractures. The knowledge of these regularities will help the physicians reduce the incidence of complications by improving the immunologic reactivity of the body using a variety of immunity modulators.

[Immunological and biochemical indices during the use of hyperbaric oxygenation for treating patients with jaw deformities]. / Immunologicheskie i biokhimicheskie pokazateli pri ispol'zovanii giperbaricheskoi oksigenatsii dlia lecheniia bol'nykh s deformatsiiami cheliustei.

Analysis of changes in the immunologic and biochemical parameters in the patients operated on for congenital deformations of the maxillary bones and poorly joined fractures has shown an increase of the immunologic reactivity under the effect of hyperbaric oxygenation therapy administered after surgery to patients with initially reduced levels of these parameters. Urinary excretion of hydroxyproline was found unchanged in patients with maxillary deformations.

[Evaluation of immunologic status in mandibular fractures]. / Otsenka immunologicheskogo statusa pri perelomakh nizhnei cheliusti.

Immunity state was assessed in patients with uncomplicated course of mandibular fractures with resorption and regeneration of osseous tissues. The data allowed one to characterize the relevant disorders as a syndrome of immune system overload. This is a potent criterion for evaluation of the fractures' severity. Under the overload general shifts are detected most pronouncedly in the local oral cavity immunity. Characteristic profiles of immunity interrelations are combined with the immunity strain changes within the interconnection system. This is of major prognostic importance for the course of mandibular fractures and inflammatory complications.