Совершенствование методов ортопедического стоматологического лечения больных после онкологических операций челюстно-лицевой области

Abstract

Relevance. Rehabilitation of patients with malignant tumors (MT) and defects of the maxillofacial region (MFR) is a very big problem for society. Restoring defects in the maxillofacial area with the use of orthopedic prostheses can cause tumor relapse, and the prosthesis can cause infection of the tissues of the wound bed. It has been established that the presence and level of expression of matrix metalloproteinases (MMPs) tissue inhibitors (TIMPs) are actively used to study oral hygiene (OH) in determining MMP-8 in gingival fluid and studying chronic periodontitis. Loss of control over MMP expression/activity in various pathologies is associated with the immune response to injury and contributes to disease progression and significant tissue damage. Therefore, it is relevant to study the significance of biomarkers of oral fluid (OF) both for additional diagnostics and for assessing the effectiveness of complex and reconstructive treatment of acquired defects of the maxillofacial region (MFR).
Purpose of the study. To assess the clinical characteristics of the state of PR after restorative orthopedic prosthetics of the maxillofacial area using different methods of manufactured prostheses to optimize the orthopedic rehabilitation of patients.
Material and methods. The study was conducted in cancer patients (CP) with various defects and deformations of the maxillofacial region. 33 patients were selected for a number of rehabilitation measures, including: - 13 inpatients (group 1) with postoperative defects of the maxillofacial region restored by autoplasty methods; combined prostheses, - 20 patients (group 2a) and 10 patients with acrylic plastic + Vertex termosens (group 2b). The level of oral fluid (OF) biomarkers was studied using enzyme-linked immunosorbent assay (ELISA) and the obtained data was processed in accordance with standard Student's methods in the Microsoft Excel 2017 computer program.
Results. It was established, by localization and structure of the tumor in 36.8% of cases - the right half of the upper jaw; 35.2% - the left half of the upper jaw; 8.9% - cells of the ethmoid labyrinth; 10% - the right and left halves of the upper jaw; 5.6% of cases - the lower jaw and - 3.6% of cases - the skin of the nose; while it was established, by nosology of cancer - 60.8%; sarcoma - 15.2%; melanoma - 0.6%; cylindroma - 18.8% and other neoplasms - 0.4%. It was determined, the level of the biomarker MMP-2 in GC with autoplasts is 2.4±0.5 ng/ml; - with titanium - 3.8±0.6 ng/ml and with acrylic+Vertex termosens - 4.4±0.8 ng/ml, while MMP-2 on average before prosthetics was - 3.1±1.1 ng/ml: the same characteristic deviation of the digital indicators on 1 gr., 2a gr., and 2b gr. - 287.2±82.1 ng/ml; - 708.4±146.2 ng/ml; - 844.6±224 ng/ml and 376.8±119.4 ng/ml, respectively, is noted on MPP-8. At the same time, certain ineffective changes are noted in the quantitative indicators of biomarkers and tissue inhibitors in the NSRI depending on the type of orthopedic prosthesis.
Conclusion. Thus, restorative operations of the maxillofacial region with orthopedic prosthetics; methods of autoplastics, also using CT titanium and acrylic plastic + Vertex termosens in all cases are effective, while certain efficiency of quantitative indicators of biomarkers and tissue inhibitors in the NSRI are noted depending on the type of orthopedic prosthesis.