EVALUATION OF THE RESULTS OF COMPLEX THERAPY FOR POST-TRAUMATIC OSTEOMYELITIS IN MANDIBULAR FRACTURES
Abstract
The most common complication of mandibular fractures is post-traumatic osteomyelitis, which accounts for 10 to 30% of cases. Analysis of the literature and numerous clinical and expert observations show that factors contributing to the development of post-traumatic osteomyelitis include the presence of teeth with foci of chronic infection in the fracture line, late seeking of specialized medical care by patients with mandibular fractures, as well as deficiencies in medical care at various stages of treatment. At the present stage, it is particularly relevant to highlight issues related to the clinical characteristics of mandibular fractures complicated by post-traumatic osteomyelitis, which aggravates the course of the mandibular fracture and leads to an increase in treatment duration, thereby exacerbating the harm caused to human health [Günter V.E., Khodorenko V.N., Chekalkin T.L. et al., 2018]. The term “post-traumatic osteomyelitis” refers to purulent inflammation of all elements of the bone resulting from trauma. It is a nonspecific purulent-necrotic infectious-allergic inflammatory process in the area of the mandibular fracture, accompanied by necrosis of the wound surfaces of the fragments with the formation of sequestra and regeneration of bone tissue. At the same time, post-traumatic osteomyelitis of the mandible represents a qualitatively new form of the inflammatory process, in which necrosis occurs in areas of bone that showed no signs of damage and are located at a certain distance from the fracture line; self-cleaning of the wound and healing without prolonged specialized treatment do not occur. Most researchers associate the induced pathomorphosis of purulent inflammation with both changes in the etiological structure of pathogens and their properties, and with disturbances in the immune status of the body. Currently, the development of inflammation is noted under the influence of resident flora from odontogenic foci and individual pathogens that potentially possess virulence, invasiveness, and toxicity. An expansion of the species spectrum of pathogens has been observed, where resident and pathogenic infections combine with a sequential change in the dominance of aerobic, obligate anaerobic, and facultative anaerobic organisms. However, it should not be forgotten that the development of an infectious-inflammatory process is determined not only by the relationship “microbial pathogen – immunity,” but also by all physiological systems of the body. The very probability of developing an infectious process, the features of the clinical course, and the prognosis largely depend on the factors that determine these relationships [Efimov Yu.V., Efimova E.Yu., Dolgova I.V., 2016]. Taking into account the above information regarding the complicated clinical course of mandibular fractures, the problem of diagnosis and optimization of complex treatment of post-traumatic osteomyelitis of the mandible remains relevant to this day.