Modern Approaches to Surgical Treatment of Fractures of the Zyno-Orbital Region
AlisherShаvkatovichAkhrorov - assistant of the Department of Maxillo facial surgery,Samarkand State Medical Institute, e-mail: [email protected]
BarnoZhurakhonovnaPulatova - Associate Professor of the Department of Oral and Maxillofacial Surgery, Tashkent State Dental Institute, DSc, e-mail: [email protected]
KhatamovErkinBeknazarovich - assistant of the Department of Maxillo facial surgerySamarkand State Medical Institute, e-mail: [email protected]
NarzievaDilfuzaBakhtiyorovna - assistant of the Department of Maxillo facial surgery Samarkand State Medical Institute, e-mail: [email protected]
Annotation. The scheme of complex treatment of fractures of the zygomatic-orbital region included local ozone therapy by washing the cavity of the maxillary sinus on the side of the injury with ozonized distilled water. The results of clinical, radiological and microbiological studies indicate the high efficiency of the use of local ozone therapy for the prevention of post-traumatic maxillary sinusitis.
Relevance of the topic. The problem of surgical treatment of patients with fractures of the zygomatic and arch is far from its final resolution, due to the lack of rational surgical methods that meet all the necessary requirements, which determined the purpose of this study and showed the feasibility of searching for new methods of treating such injuries in surgical practice [1,3,4,10-13].
Materials and research methods
In the period from 2018 to 2020, 73 patients aged from 18 to 55 years old with traumatic injuries of the COO of various localizations were treated. Of these, left-sided fractures accounted for 53.6% (44 people), right-sided - 46.4% (29 people). All patients, depending on the choice of treatment method, were divided into 2 groups: - the main group (45 people) who underwent complex treatment using local ozone therapy according to the method we developed. - control group (28 people), who were treated according to the traditional scheme. The research methods were: X-ray examination of the bones of the facial skeleton in the pre- and postoperative period; ultrasound Doppler sonography of the blood flow of the external carotid artery on the side of the injury and on the opposite side; microbiological examination of the lavage water of the maxillary sinus on the side of the injury before and after treatment; clinical analysis of blood and urine. The digital material was processed using the Microsoft Excel 2000 software product. The method of variation statistics was used with the calculation of mean values and standard deviation. To assess the significance of differences, the Student's coefficient was used.
Results and its discussion.
The nature of the complaints presented in the main (1) and control (2) groups and their dynamics in the postoperative period are presented in Table 1 (in% of patients).
Distribution of patients in% by the nature of the complaints presented in the main (1) and control (2) groups.
Before operation In 7-10 days. In 1 month
1 2 1 2 1 2
1 2 3 4 5 6 7
Not determined by edema 15,15 3,45 20,0 6,90
No fall 3,03 77,14 68,97 100 97,14
Minor 12,13 10,34 2,86 10,34 2,86
Moderately pronounced 33,33 10,34 3,45
Minor 36,36 89,66
Present 6,06 13,79 2,86 6,90
Absent 96,97 86,21 94,29 93,1 100 2,86
Swelling and bruising
Absent 36,36 44,83 77,14 100 100,0
Expressedslightly 42,42 10,34 22,86 3,45
Significally expressed 12,12 10,34 3,45
Numbness in the area of innervation of the item decreased
21,21 57,14 27,59 77,78 62,86 Impaired nasal breathing on the side of the injury
Present 9,09 3,45 2,86 17,24
Absent 90,91 89,66 97,14 79,31 100 100
Difficulty opening the mouth
Present 75,76 82,76 14,29 34,48 2,86
Absent 30,30 17,24 85,71 65,52 100 97,14
Present 6,06 10,34 2,86 6,90
Absent 96,97 86,21 97,14 79,31 100 100,0
As follows from the presented table, the leading complaints in fractures of the zygomatic-orbital region included depression in the zygomatic and infraorbital regions, the presence of edema and hematomas, difficulty opening the mouth, numbness in the zone of innervation of the infraorbital nerve. All the patients examined by us were in a satisfactory condition, clear consciousness, and an active position. No significant symptoms of internal organs were found.
The nature of local changes in the main (1) and control (2) groups and their dynamics in the postoperative period are presented in Table 2 (in% of patients).
The nature of local changes in fractures of the zygomatic - orbital area in% of patients for the main (1) and control (2) groups.
In 7-10 days In 1 month
1 2 1 2 1 2
1 2 3 4 5 6 7
Absent 30,30 34,48 80,0 10,34 100,0 75,86
Lower eyelid 18,18 13,79 8,57 27,59 10,34
Sclera+lower eyelid 18,18 13,79 5,71 10,34
Upper and lower eyelids 6,06 13,79 6,90
12,12 10,34 5,71 31,03 3,45
Multiplehemorrhages 9,09 17,24 10,34
Thenatureofbonedeformities 1. Thepresenceofbonyprotrusions
Not palpable 91,4 86,21 88,6 70,64
Along the lower orbital edge 45,45 10,34 2,86 10,34 5,71 13,79 Alongthecheekbone - alveolarridge 84,85 78,3 5,71 3,45 5,71
Along the outer edge of the orbit 30,30 6,90 5,34 In the area of the zygomatic arch 15,15 3,45
At 2 points 45,45 47,93 3,32
At 3 and more points 54,55 52,57
Not determined 77,2 27,59 88,6 31,03
Not determined by edema 3,03 13,79 22,9 48,28
In the projection of the zygomatic bone or arch slight
36,36 3,45 11,4 10,34
Moderate 9,09 31,03 6,90 10,34
Expressed 18,18 51,72
Enophthalm 33,33 13,79 2,86 6,90 2,86 6,90
Overcorrection 6,06 10,34
no 15,15 13,79 85,7 34,48 97,1 68,97
3-5 sm 36,36 37,93 11,4 51,72 2,86 20,69
1-3 sm 45,45 34,48 2,86 6,90 3,45
Less than 1 sm 9,09 13,79
As follows from this table, the main clinical symptoms of fractures of the bones of the zygomatic-orbital region are edema and hematomas in the zygomatic and infraorbital regions, hemorrhages under the sclera and skin of the eyelids, the presence of bony protrusions at 2-3 points, retraction in the projection of the zygomatic bone and difficulty opening the mouth up to 1-3 cm.
The X-ray picture of fractures of the zygomatic-orbital complex in the examined patients for the main (1) and control (2) groups is presented in Table 3 (in% of patients).
X-ray picture of fractures of the zygomatic-orbital complex at the stages of treatment in% of patients for the main (1) and control (2) groups.
In 7-10 days In1month.
1 2 1 2 1 2
There is not secondary
displacement 94,2 72,4 88,5 62,1 1 point offset
8,57 6,9 Minor 5,71 6,9 Н,4 13,8
At 2 points 48,6 24,1
violationofappearance 10,3 20,7
At 3 points 34,3 55,2
Comminuted 2,86 10,3
Fracture of the lower wall of
the orbit 5,71 10,3
From the presented table it follows that in most cases there are fractures of the zygomatic-orbital region at 2-3 points; secondary displacement of fragments was more often observed in the long-term period in the control group.
The results of a microbiological study showed significant differences in the composition of the microflora of the sinuses on the side of the injury compared to the opposite side, depending on the duration of the injury.
With fresh fractures of the zygomatic-orbital region, quantitative counting of microorganisms showed a significant increase in their concentration: 1.2 x 103 CFU / ml (at a rate of 0.22-0.35x103 CFU / ml) (P
<0.01) [2,5,8,9]. No differences in the species composition of microflora were observed: as well as from the intact sinus, St. saprophiticus, St. epidermidis, Str. viridans, in isolated cases -St. aureus, enterococcus in single quantities. Histological examination of the mucous membrane of the maxillary sinus in this group of patients showed the presence of hemorrhages, foci of necrosis, stromal edema.
To control the effectiveness of the local ozone therapy, a repeated microbiological study of the wash water was carried out after the end of the course of treatment. The results of the study showed the high efficiency of local ozone therapy: When using this technique, in the case of fresh fractures, there was a decrease in the microbial colonization of the sinus from 1.2x103 to 0.85x103 CFU / ml (by 41%) (Fig.2).
When using local ozone therapy in the complex treatment of old and viciously consolidated fractures, a decrease in microbial colonization of the sinus from 3.2x105 CFU / ml to 2.9x103 CFU / ml (P <0.001) was found. The species composition of the microflora has also changed with the predominance of St.
epidermidis, Str. viridans at low concentrations.
Fig. 2 The ratio of the number of microorganisms in the flushing water from the maxillary sinus on the side of the injury before and after local ozone therapy for fractures of the zygomatic-orbital complex a- with fresh fractures. When using local ozone therapy, a favorable course of the postoperative period is noted: the absence of diffuse postoperative edema and hematomas, their rapid resorption, and a low level of postoperative pain in the wound. The results of the study of LPO (lipid peroxidation) of flush waters from the maxillary sinus on the side of the injury with fractures of the zygomatic-orbital complex are presented in table. 3.
0 10000 20000 30000
before treatment after local ozone therapy
for chronic fractures (CFU / ml)
with fresh fractures (CFU / ml)
Change in LPO level before and after a course of local ozone therapy
ОЛ 0,15±0,04 0,16±0,03
Р>0,05 OR, rel. units / mg OL 3,67±0,27 4,00±0,15
ДК опт. пл.
ТК 0,24±0,03 0,25±0,01
I max 2,11 ±0,05 0,91±0,01 Р<0,001
I max/S 0,09±0,015 0,22±0,01 Р<0,001
It can be seen from the presented table that no significant changes in the level of both initial (DC, TC) and final LPO products (OR) were found. At the same time, biochemiluminescence data indicate a significant (P <0.001) decrease in the level of maximum luminescence intensity Imax (by 2.3 times) and a statistically significant ((P <0.001) increase in the Imax / S indicator (by 2.4 times) characterizing the antioxidant activity of the studied biosubstrate.
1. According to the data of clinical and radiological examination of patients with trauma to the zygomatic-orbital region, it was found that in most cases fractures are multiple in nature and are combined with a violation of the integrity of the bony walls of the maxillary sinus on the side of the injury.
2. The results of clinical and radiological, microbiological and biochemical studies indicate the high efficiency of the use of local ozone therapy according to the technique developed by us for the prevention of post-traumatic maxillary sinusitis in the complex treatment of patients with fractures of the bones of the zygomatic-orbital region.
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