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Л1тература
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English version: THE ANALYSIS OF FUNCTIONAL DISTURBANCES IN PATIENTS WITH MALIGNANT TUMORS AND WITH DEFECTS OF MAXILLOFACIAL AREA AFTER SURGICAL TREATMENT
Bashtan V.P., MukovozO.Ye., PichkurI.M.
Higher State educational if Ukraine "Ukrainian Medical Dental Academy", Poltava Poltava Regional Clinical Oncological Dispensary
Changes in functions of external respiration, mastication, deglutition, speech disturbance, opening of mouth disturbance, and cosmetic facial deformities - all these disorders are the consequences of surgical treatment by malignant tumors of maxillofacial area. If one evaluates all aftereffects at the pre-surgical stage and simulates the future extent of surgery, whereby forming the retention points in the bones and soft tissues, it will be possible to prevent the significant functional disturbances which in its turn will improve the further rehabilitation of patients and their quality of life.
Key words: functional respiratory disturbances, functional speech disturbances, orthopedic prosthetics, malignant neoplasms, maxillofacial area, retention points
32 patients with post-surgical jaw defects were examined and delivered treatment on the basis of the Branch Office of Head and Neck Tumors at Poltava Regional Clinical Oncological Dispensary (hereinafter PRCOD) and the Department of Prosthetic Dentistry and Implantology of «Ukrainian Medical Stomatological Academy».
Taking into account the necessity to compare the parameters of the dentoalveolar system functional status before the prosthetic procedure with the standard parameters, the control group of individuals with intact masticatory apparatus after the prosthetic care was selected. Thus, three groups of examined individuals were identified: control group - 21; clinical groups: I -patients before prosthetics (7), II - patients after prosthetics (4).
In order to study the frequency, localization and methods of treatment of oncological diseases of jaws in the structure of head and neck cancer, 177 clinical records of Poltava Regional Clinical Oncological Dispensary were analyzed over the period of 2002-2012. The analysis of malignant neoplasms incidence according to the localization of tumors was performed in conformity with the International Classification of Diseases, Tenth Revision (1998) in the following rubrics:
diseases of mouth floor mucosa, soft palate, hard palate, alveolar ridge. In the capacity of primary document, when working in the archives, the consolidated departmental and public annual report forms as to the incidence of malignant tumors (f. # 61-g, f. # 7) were studied. The research also used clinical records (f. # 090-u-566) and out-patient medical records (f. # 25-125) with the results of cytologic findings and histologic studies of biopsic and surgical materials.
The aim of the research was to perform the analyses of spirometry, phonography, and electromyography in patients after surgical interventions, relating to malignant neoplasms of maxillofacial area, who underwent prosthetic care, as well as those who were not delivered prosthetic appliance.
Materials and methods
Upon the physical examination, various defects of maxillofacial area were detected. 27 patients had appearance disorders: the defects of soft tissue, the defects of lips and cheeks with cicatrical changes, stenostomia, etc., 10 patients had difficulty in opening of mouth due to the cicatrical changes of facial soft tissues and contracture resulting from the damage of cheek or lateral pterygoid muscles; 13 patients had speech
* To cite this English version: Bashtan V.P., Mukovoz O.Ye., Pichkur I.M. The analysis of functional disturbances in patients with malignant tumors and with defects of maxillofacial area after surgical treatment // Problemy ekologii ta medytsyny. - 2013. - Vol 17, № 1-2. - P. 45-47.
TOM 17. N 1-2 2013 P.
disturbance and almost all patients had mastication and deglutition disorders.
Results and discussion
Thus, in the clinic the attention was paid to the condition of the remaining teeth, dental arches, the form of alveolar ridge, localization of jaws defects, the amount of facial soft tissues defects, functional disorders. The compressibility and mobility of mucous coat in the area of defect borders, the compliance of soft tissues in the area of defect borders, the condition of facial muscles, the condition of previously fabricated prostheses, and their functional significance were roughly estimated. The state estimation of the remaining teeth, dentitions and dental arches was performed according to the diagnostic models. The condition of alveolar ridge of the upper and lower jaws in the area of extracted teeth, the expressiveness of tubers, and the degree of their atrophy were taken into account [1]. During the examination of oral mucosa, its color, moisture, stiffness, particularly in the area of the defect borders, the attachment of bridles and bands, their size and displaceability were of great significance. The condition of the cicatrical tissue around the defect was important for the prosthetic procedure. It was taken into consideration during the prosthetics of maxillofacial patients after jaw surgeries. After the excision of malignant tumors, the scars corresponded to the limits of surgical intervention and the degree of their deformation depended on the compressibility of mucosa. It conditioned the choice of treatment with allowance for the cicatrical tissue: some scars could be dissected out, some of them could be ignored, and others could be used for the additional retention of the prosthesis bearing [3, 4, 6]. For the uniform distribution of masticating pressure under the prosthetic device, the amplitude of the soft tissues compliance in different parts of the prosthetic bed was determined, especially in the area of the cicatrical tissue boundaries. The disregard of the tissues status in the post-surgical cicatrical area causes its pinching between the bone tissue and dental plate which leads to the impaired circulation with the development of mucous coat inflammation. In order to investigate the functional respiratory disturbances, the spirometry was used. The research was performed at least three times over the period of cicatrization, as well as with replaceable prosthesis. The phonetic study of maxillofacial apparatus was performed before and after the prosthetic care [2]. The electromyographic study was used to explore the functional status of masticatory muscles with post-surgical defects of maxillofacial area. The study was performed before treatment, on the 7th day after the appliance of orthopedic apparatus, in 30 days, 6 and 12 months of using the prostheses.
No. in se-quenc e Disorder In patients who were not delivered prosthetic appliance In patients who underwent prosthetic care
1. External respiration 26 1
2. Mastication 32 1
3. Deglutition 28 1
4. Speech disturbance 22 -
5. Opening of mouth 10 -
6. Cosmetic facial deformities 32 4
Thus, after the upper and lower jaws surgeries, the need for complex maxillofacial prosthetics was 74.0%, but only 26.0% of patients received it. This need is associated with the complex and multistage prosthetic procedure, the cost of prosthetic devices, as well as the lack of strict continuity in the work of surgeon and dentist-orthopedist. Great significance in complex rehabilitation of orthopedic patients belongs to their age, functional status of surrounding tissues and organs, as well as psychological and moral condition of a patient.
During the examination of 32 male and female patients with defects of upper and lower jaw and palate of various etiologies, it was found that surgeries cause the formation of various defects, and their size and localization depend on the type of surgery. The soft tissues, surrounding the defect, are characterized by varying degrees of compliance: from subtle atrophic mucosa to the hypertrophic one. The compressibility of mucosa was determined by the condition of cicatrical tissue and its deformation in the area of surgery. It is the compliance of tissues in the surgery area that differs much in comparison with other areas of measurements. The objective examination of patients displayed the appearance disorders due to the cicatricial and postsurgical changes in facial soft tissues. Opening of mouth in 22 cases was undisturbed, and in 10 cases it was restricted due to the contraction of facial muscles after radiation therapy or damage of buccal and masticatory muscles during the surgery. Depending on the defect prevalence, the defective articulation involved the sounds which are formed on the border of localization area. In comparison with normal speech apparatus, the pronunciation function became significantly worse after surgery, there was an ambiguous pronunciation of individual sounds, loss of individual words or the substitution of one sound with another, overlapping of sound effects, the time for reading a specific text significantly increased due to the fatigue of patients [5, 7]. The patients' breath became shallow and rapid which was associated with the amount of air, exhaled through the nose. This amount increased to 70% of the total amount of exhaled air. The speech exhalation was irregularly distributed over the spoken word, and halfway of the word the air was exhausted. In order to determine the degree of functional disturbances of the masticatory apparatus in patients with defects of jaws and palate, 32 people were examined using electromyography (EMG). It was found that by the arbitrary mastication there is no clear segmentation of bioelectrical activity volleys and bioelectrical inactivity periods, as well as low power of excitation processes at EMG. The most serious disorder in coordinating interaction of masticatory muscles was the lack of chewing sides alternation over one period which can be explained by the persistent stereotype, developed on account of prolonged unilateral mastication. In patients with soft palate defects or on the verge of transition of the hard palate into the soft one, various deglutition disorders were observed, outpouring of liquid and food through nose due to the palatopharyngeal lock disorder.
The production of the immediate prosthetic appliance promotes the formation of proper speech articulation and other resonators of oral cavity. After 1 month of using the prosthetic device, the new speech stereotype is developed. The spirometry data (the spirometer indicators almost reach the standard rate after 6 months of using the
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prosthetic devices) may be indicative of the oral cavity hermetization and successful prosthetic care, while in 12 months they slightly decrease due to the changes in prosthetic bed tissues, owing to the atrophic phenomena.
Conclusions
Thus, the functional methods objectively indicate the pronounced tendency to normalization of lost functions after prosthetic care which can be traced at electromyographies, phonograms and spirometry parameters. The observational data justify the feasibility of operational and restorative measures for creation of retention points for the subsequent prosthetic care, aimed at the recovery of physiological functions, elimination of anatomical and functional disorders, esthetic appearance recovery, as well as rehabilitation of mental and emotional condition of patients with complex maxillofacial pathology.
References
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