ANALYSIS OF IMMUNE CHANGES AND THEIR ROLE IN THE DEVELOPMENT OF ORAL AND OROPHARYNGEAL CANCER.

Numerous studies of the immune system in cancer patients at the cellular and molecular levels indicate a persistent violation of natural and acquired mechanisms of immune defense. This article reveals changes in the immune system of patients with cancer of the oral cavity and oropharynx. It was determined that the levels of cytokines IL-6, IL-10, HGF and VEGF in high concentrations in the serum of patients correlate with an unsatisfactory prognosis and are independent indicators of low survival and correlate with relapse. Different immune cells provide a complex defense system with effective communication through cytokines. The inflammatory component of the microenvironment of the tumor of the oral cavity and oropharynx is important in the immune response, because its main component is immunosuppressive cytokines. There is an imbalance of Th1 / Th2 cytokine types and increased levels of Tregs. Among Th1 types of cytokines - IFN-γ, IL-12, TNF-α, the levels of which are reduced, and Th2-cytokines - IL-4, IL-10 - are increased, while the norm is the opposite. The tumor uses various mechanisms to induce changes in the system to avoid an immune response to its development. In fact, a malignant cell of the mouth or oropharynx suppresses the immune response by producing vascular endothelial growth factor (VEGF), prostaglandin E2 (PGE2), TGFß, IL-6 and IL-10. The tumor environment also releases pro-inflammatory mediators, including a receptor such as IL-15 alpha subunit (IL15RA). It in combination with IL-15 carries out the strengthened synthesis of proinflammatory cytokines - IL-6, TNF-α and IL-17 that influences insufficiency of the immune response and accordingly low prognosis of survival. It was found that the number of NK cells is reduced in patients with oral and oropharyngeal cancer, respectively, there is a low control of iNKT tumor cells in the regional collector, which correlates with low survival rates. Increased concentration of dendritic cells in the blood correlates with a positive prognosis and greater survival of patients with cancer of the oral cavity and oropharynx, reduced metastasis to the cervical lymph nodes. An effective antitumor immune response involves many components of the immune system, but T-cells remain the most important cells involved in antitumor immunity. Therefore, T-cell defects reduce the effectiveness of antitumor immunity. CD4 + CD25 + T-cells play a central role in initiating and maintaining the antitumor immune response. Detection of them and CD4 + CD69 +, CD3 + T cells in large numbers is associated with a good prognosis. More detailed changes in the cellular composition of immunity and the effector link are presented in the article.

[ASSESSMENT OF COMBINED PROPHYLAXIS OF PATHOLOGICAL POSTOPERATIVE FACE SKIN SCARS ACCORDING TO THE VANCOUVER SCALE].

The aim of the research was to study the effectiveness of combined prophylaxis of pathological postoperative face skin scars according to the Vancouver scale. The research involved 29 patients, aging 16-48 years old, who underwent maxillofacial surgery by extraoral accesses with wound primary intention healing. The patients were divided into three groups: the control group, which involved the patients, who after the surgery did not undergo any preventive measures to avoid pathological skin scars development, and two study groups. The patients of the first study group underwent the monotherapy comprising three sessions of extracorporeal shock wave therapy once every 4-5 days. The patients of the second study group underwent three sessions of extracorporeal shock wave therapy once every 4-5 days and local use of silicone gel Strataderm. The Vancouver scale was used to evaluate clinically the effectiveness of the suggested methods of pathological scars development prevention. It involved evaluation (in points) of their consistency, pigmentation, and vascularization. The scars were assessed on the 7th, 30th day after the surgery and in 6 months. Positive results were attained in the patients of both study groups; they were manifested by increased elasticity and compliance of scars, pigmentation becoming of just about surrounding skin natural color, normalization of blood supply to scars, and more rapid disappearance of suture marks. However, these positive signs were more significant in the patients of the second study group that allowed us concluding that combined use of extracorporeal shock wave therapy and local applying of silicone gel Strataderm was advisable.

[JUSTIFICATION OF CHOICE OF THE POSITION OF THE REINFORCEMENT ELEMENT OF A GLASS-FIBER ADHESIVE TIRE BASED ON THE STUDY OF DIAGNOSTIC MODELS IN THE ARTICULATOR AND THE FOLLOWING PARALLELMETRIC RESEARCH].

The aim of the study was to develop the most optimal variant for placing the reinforcing element of a fiberglass splint with the mobility of the anterior teeth on the basis of a parallelometric study of the diagnostic models of the jaws depending on the type of occlusion and the degree of bone resorption. For the most optimal variant of the placement of the reinforcing element of the adhesive splint with orthognathic bite and deep incisal overlap, the front slope of the model was selected with the transfer of the reinforcing element of the adhesive splint onto the lingual surface. With direct, prognathic and progenic bite and bone resorption up to » height (according to retrography data), the back slope of the model was selected with the placement of the reinforcing element of the adhesive splint on the vestibular surface of the lower jaw. The disadvantage of locating the reinforcing element on the lingual surface when the incisors were crowded was that after the application of the splint and inter-proximal adaptation, the change in the position of the teeth was not corrected. On the contrary, when applying an adhesive splint on the vestibular surface with the help of restoration, it was possible to completely restore the original position of the teeth and fix it for a long time.

[APPLICATION OF SYNTHETIC OSTEOPLASTIC MATERIAL EASYGRAFT® IN MAXILLA SUBANTRAL AUGMENTATION (SINUS-LIFT)].

The problem of complex dental rehabilitation of a patient after partial or complete teeth loss is an urgent issue for dental practice. The most of patients coming to dentist with to make dentures on dental implants after tooth loss in lateral part of maxilla are often observed with atrophy of the alveolar bone resulting in maxillary sinus (sinus Haymori) enlargement. Creating an additional space for dental implant placement in the maxilla is possible by performing a sinus lift (subantral maxilla augmentation) - artificially thickening the lower and outer wall of the maxillary sinus with usage of osteoplastic materials. A clinical case of lateral (open) sinus-lifting performed by "grind-out" technique with the DASK® kit (Dentium Advanced Sinus Kit®) is described. As an osteoplastic material was used an alloplastic self- hardening in wound material easygraft®.