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19«C@yL@qyiym-J©yrMaL»#®î29),2@19 / MEDICAL SCIENCES
29
Umarov Odiljon Makhmudovich Mahmudbekov Muminmirzo Odiljon o'g'li
Fergana Branch of Tashkent Medical Academy, Fergana, Uzbekistan
DOI: 10.24411/2520-6990-2019-10067 DIAGNOSTIC FEATURES OF COMBINED CRANIO-FACIAL INJURY
Relevance. Recently there has been an increase in the number of combined cranio-facial injuries, the annual increase is from 10 to 15%. The number of damage to the structures of the facial skull has increased over the past decade by 2.4 times. The combination of acute traumatic brain injury with damage to the bones of the facial skeleton according to various authors ranges from 3.2 to 60%, some authors tend to assume that damage to the bones of the facial skeleton is 100% combined with brain damage.
Key words: craniomaxillofacial fractures, craniocerebral trauma, the medical aid organization.
Purpose of the study. To study the features of diagnosis and clinical course in patients with combined craniofacial trauma.
Material and methods. We used a continuous retrospective method to copy 345 archival materials of the Ferghana branch of the Republican Scientific Center for Emergency Medical Aid for 2004-2012, treated in the hospital with a combined maxillofacial trauma. Of these, 216 are men and 129 are women. Patients were examined according to the standard (radiography of the skull and lower jaw in 2 projections, ECOES, MSCT around the clock, examined by related specialists). Standard X-ray examinations were performed for all 345 patients. As a clarifying technique, computed tomography was performed in 208 (60%) cases, the results of which were used to determine the extent of traumatic damage to the maxillofacial area in more detail, and hidden damage to bone structures and soft tissues was detected. Emergency patients were examined by a neurosurgeon, maxillofacial surgeons and other specialists.
Discussion. The results of the distribution of combined cranio-facial injury depending on the location of the damage are as follows: the upper face area - 67 (19.4%), the middle face area - 191 (55.4%), the lower face area - 42 (12.2%) ), multiple fractures - 45 (13%). With this type of injury, the injuries of the midface also prevail, which accounted for 191 (55.4%) cases from among the patients who were diagnosed with a combined injury of the maxillofacial area with a head injury. According to the results of CT studies, small and large comminuted fractures of the anterior walls of the maxillary sinuses were found with severe deformity of the maxillofacial region in 67 (19%), fractures at the level of the cage maze cells in 30 (9%). Intermuscular emphysema was detected in 24 (7%) patients, and retrobulbar emphysema was diagnosed in 6 (2%) patients.
It was noted that TBI was distinguishable by severity and time of disappearance of the neurological deficit. Thus, in 261 cases, patients had concussion of the brain, in 52 - a slight and moderate bruise, and in 32 cases of severe brain contusion. The presence of intra-cranial hematomas was observed in 9 (3%) patients, with fractures of the cranial vault bones - 26 (7.5%) patients. In addition, with fractures of the extremities - 16 (5%); fracture of the pelvic bones - 8 (2.3%); with trauma to the abdominal organs - 8 (2.3%). The results
of the analysis of the distribution of patients, taking into account the injuries received, makes it possible in the future to predict the number of victims admitted to hospital, to conduct more targeted diagnostic activities, in general, improving the quality of care for patients with a combined craniofacial injury.
We believe that the dominant course of cranio-fa-cial injury in most cases smoothes the clinical manifestations of the central nervous system. This circumstance makes it difficult to assess the degree of neurological deficit, and, therefore, does not fully objectify the existing disorders, including that of the nervous system.
Findings. Combined injuries of the brain and bones of the facial skeleton require the earliest, most complete, sparing, and one-step surgical aid for both neurosurgical and maxillofacial.
The use of computed tomography for fractures of the facial bones allowed more detailed diagnosis of the degree of damage to the maxillofacial area, and the magnitude and direction of dislocation of bone fragments. This method of radiation diagnosis has reduced the time of examination of patients, accelerated the provision of medical care and thereby reduce the risk of post-traumatic complications.
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