[Results of modified submandibular surgical approach usage for the mouth floor phlegmons treatment with respect to dynamic of local non-specific resistance]. / Rezul'taty primeneniya modifitsirovannogo podnizhnechelyustnogo operativnogo dostupa dlya lecheniya odontogennykh flegmon dna polosti rta s uchetom dinamiki lokal'noi nespetsificheskoi rezistentnosti.

THE AIM OF THE STUDY: Was increasing of treatment effectiveness of patients with mouth floor odontogenic phlegmon (MFOP) by modified of surgical approach usage. MATERIALS AND METHODS: The prospective controlled, randomized, simple blinded clinical trial, II b level of evidence, comprised 86 patients with MFOP which formed main and control groups. The main group consisted of 40 patients treated with designed «Method for surgical treatment of odontogenic oral phlegmon of mouth floor with partial dissection of sublingual-submandibular sac¼. The control group involved 46 patients treated with traditional surgical procedure. The differences significance between the values has been evaluated with nonparametric Fisher's exact P-test and parametric Student's t-test for independent samples. RESULTS: The modified surgical approach statistically significantly (p<0.05) decreased the number of inflammatory complications (from 26±7% to 9±4%), terms of secondary sutures application (from 7.9±1.4 to 5.7±1.6 days) and time of hospital stay (from 9.4±1.8 to 8.3±1.7 days). On the 5th day of treatment white blood cells count in the main group was significantly (p<0.05) lower (7.2±1.1·109/l) than in controls (9.4±1.3·109/l) showing improved intoxication syndrome resolution in the main group. Index of reaction of bacteria adsorption to the oral epithelium in the main group on the 5th day of treatment was significantly (p<0.05) higher (77.1±6.9%) than in controls (62.4±7.1%). More successful correction of local non-specific resistance was registered in the main group. CONCLUSION: The proposed modified submandibular surgical approach is more effective for the treatment of patients with MFOP.

[Features of hemodynamics in patients with a local form of odontogenic purulent infection and chronic diseases of the cardiovascular system]. / Osobennosti gemodinamiki u bol'nykh s odontogennoi gnoinoi infektsiei na fone khronicheskoi patologii serdechno-sosudistoi sistemy.

The aim of the study was to study hemodynamic parameters in patients with a local form of odontogenic infection (LFOI) in the presence of diseases of the cardiovascular system and without background pathology. 5 groups were formed: group 1 - patients with LFOI without background diseases (49 patients, mean age 29 [25; 37] years); group 2 - healthy individuals (25 people, mean age 24.7±0.76 years); group 3 - patients with LFOI and diseases of the cardiovascular system (34 patients, mean age 51.2±2.37 years); group 4 - patients without LFOI with diseases of the cardiovascular system (25 patients, mean age - 46 [43; 50] years); group of patients with LFOI without background pathology, comparable in age and sex composition with group 3 (group 5, 28 patients, mean age 48.9±2.30 years). The presence of LFOI in the patient in the absence of background pathology determines the heart rate (78 [72; 82] in 1 min) in comparison with the control group of healthy individuals (68.0±0.85 in 1 min), the values of minute volume of blood circulation (5.25±0.14 l/min) and systolic index (2.87 [2.56; 3.35]) l·m-2·min-1. The development of LFOI in patient with hypertension/ischemic heart disease was not associated with increased blood circulation features, such as the increase in resting heart rate values, the values of minute volume of blood circulation and systolic index.

[Clinical laboratory characteristics, diagnosis, and treatment of acute odontogenic maxillary sinusitis]. / Kliniko-laboratornaia kharakteristika, diagnostika i lechenie ostrykh odontogennykh verkhnecheliustnykh sinusitov.

Clinical laboratory characteristics of acute odontogenic maxillary sinusitis are presented. All the patients (n = 132) were examined in accordance with a special diagnostic protocol. Two variants of acute inflammatory process were distinguished: serous and destructive. Conservative and surgical methods of treatment are suggested, depending on the disease pattern and complications. The treatment efficiency is compared to the results of traditional treatment.

[The current characteristics in the treatment of suppurative diseases of the face and neck]. / Sovremennye osobennosti lecheniia gnoinykh zabolevanii litsa i shei.

Clinical and laboratory criteria of 4 types of acute inflammations in soft tissues of the maxillofacial area and neck are presented. Protocols of surgical and conservative treatment of each type of inflammation are offered.

[The clinico-laboratory characteristics of the forms of suppurative infection in dental patients]. / Kliniko-laboratornaia kharakteristika form gnoinoi infektsii u stomatologicheskikh bol'nykh.

Odontogenic anaerobic sepsis was diagnosed using vapor-phase gas chromatographic analysis (VPGCA) for detecting volatile fatty acids--metabolites of anaerobic bacteria. The method is rapid and therefore diagnostically valuable. Rapid diagnosis of anaerobic odontogenic sepsis is to include detection of the clinical signs of anaerobic inflammation of the primary purulent focus and the clinical laboratory symptom complex of generalized infection and VPGCA of volatile fatty acids in the blood.

[Method of plastic replacement of extended laryngopharyngeal and cervical esophagus defects ]. / Sposob plasticheskogo zameshcheniia obshirnykh ziiaiushchikh defektov gortanoglotki i sheinogo otdela pishchevoda.

Filling of extended pharyngoesophagostomas were made in 13 patients operated for advanced laryngeal cancer by means of microsurgical autotransplantation by the forearm radial flap. The latter was created in the form of two cutaneous elements on common fascial base. After transfer of the autotransplant in the recipient's bed, one cutaneous element filled the defect of the laryngopharyngeal and esophageal inner coating, the second filled the defect of the outer coating. This method is reliable, effective, low traumatic, helps to avoid abdominal surgery.

[The diagnosis and treatment of odontogenic mediastinitis]. / Diagnostika i lechenie odontogennogo mediastinita.

A program of early diagnostics of odontogenic mediastinitis was developed on the basis of an analysis of clinico-laboratory manifestations and the evaluation of its clinical efficiency is given. The criteria were established for determining the phases of odontogenic mediastinitis-reactive, toxic and terminal ones. A program of complex treatment was worked out and introduced into practice which included the methods of efferent therapy-hemosorption and perfusion through xenospleen. Substantially decreased lethality (from 39.5% to 15.3%) from odontogenic mediastinitis was obtained.

[The endogenous intoxication syndrome and the procedure for detoxication therapy in the treatment of suppurative diseases of the face and neck]. / Sindrom éndogennoi intoksikatsii i taktika detoksikatsionnoi terapii v lechenii gnoinykh zabolevanii litsa i shei.

A total of 470 patients with inflammatory diseases of the maxillofacial area and neck were examined and treated. Acute inflammatory process was complicated with sepsis in 87 of them. Clinical and laboratory studies revealed that the intensity of endogenous intoxication depended on the phase of inflammatory process. This helped accurately differentiate between the intoxication degrees and develop detoxication strategy for each of them. Such a differentiated approach helped appreciably decrease the mortality in the group of patients with odontogenic and stomatogenic sepsis.

[The use of plasmapheresis in treating Sjögren's disease (syndrome)]. / Primenenie plazmafereza v lechenii bolezni (sindroma) Shegrena.

The efficacy of treatment of stomatological manifestations and visceral diseases in patients with Sjogren's disease (syndrome) by therapeutic complexes including plasmapheresis is assessed. Plasmapheresis was administered to 7 inpatients in an intermittent mode with exfusion of up to 1 liter of plasma per session. A course consisted of one to three sessions, the total duration of treatment was three to four weeks. The efficacy of plasmapheresis in a complex of therapeutic measures was assessed from the time course of the clinical picture, results of studies of the function of salivary glands, and parameters of metabolic processes and immunity. Plasmapheresis helped attain long remissions and improved the general status of the patients, this being paralleled by a positive time course of local symptoms of the disease and the principal homeostasis parameters.

[The diagnosis and treatment of contact odontogenic mediastinitis]. / Diagnostika i lechenie kontaktnogo odontogennogo mediatsinita.

Contact odontogenic mediastinitis is a complication of advanced phlegmons of the face and neck. 22-year experience in the treatment of 107 patients with odontogenic mediastinitis, clinical and laboratory criteria of its diagnosis and differential diagnosis with advanced phlegmons are presented. The programs of intensive therapy adjusted for the disease phase and surgical treatment contributed to lowering of lethality from 50 to 15.3%.

[Ways to prevent and treat disseminated inflammatory diseases of the maxillofacial area and their complications]. / Puti profilaktiki i lecheniia rasprostranennykh vospalitel'nykh zabolevanii cheliustno-litsevoi oblasti i ikh oslozhnenii.

The authors analyze the results of diagnosis and treatment in 1062 patients with diffuse inflammatory diseases of the maxillofacial area and of complications of these diseases, such as mediastinitis, thrombosis of the cavernous sinus of the dura mater, meningoencephalitis. Improvement of the program of diagnosis and treatment helped improve the results: mortality from sepsis reduced from 50 to 26%. Approaches to prevention of progressive purulent infection are outlined.

[Reconstructive operations on the head and neck using a microsurgical technic]. / Vosstanovitel'nye operatsiinagolovei shee s primeneniem mikrokhirurgicheskoi tekhniki.

Eighty-one patients with defects and deformations of the head and neck of various origin were examined and treated. Microsurgical autotransplantation of vascularized tissue complexes was carried out in all the cases. Profound preliminary examinations of patients helped objectively define the indications for the use of this method. Special attention was paid to the choice of donor zone. Due to correct selection of a complex graft, good functional and cosmetic results were attained. Despite repeated corrective operations in 16 patients, virtually complete social and communal rehabilitation was attained in 74 (91.4%) patients by using a limited number of donor areas. The authors persuasively demonstrate the advantages of microsurgery in repair of complex and extensive defects on the head and neck.