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7ТИББИЕТ ФАНЛАРИ МЕДИЦИНСКИЕ НАУКИ MEDICAL SCIENCES
УДК: 617.51:617.53-006-039.74
REHABILITATION TREATMENT AND ORTHOPEDIC PROSTHETICS OF CANCER PATIENTS WITH POSTOPERATIVE DEFECTS OF THE MAXILLOFACIAL REGION
Ubaidullaev Khamidulla Asatullaevich,
Candidate of Medical Sciences, Researcher of the Oncology and Dentistry Department,
Member of the Oncologists and Dentists Association of Russia and the Republic of Uzbekistan, E-mail: dr.khamid@mail.ru;
Gaffarov Sunnatulla Amrullaevich,
Doctor of Medical Sciences, Professor, Head of the Department of Dentistry,
pediatric dentistry and orthodontics, DM. Tashkent Institute of Postgraduate Medical Education,
E-mail: sunnatullogafforov@mail.ru;
Gafur-Okhunov Mirza-Ali Allayarovich,
Doctor of Medical Sciences, Professor, Head of the Department of Oncology Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology, Tashkent Institute for Advanced Training of Doctors E-mail: drgofurokhunov@gmail.com
Abstract. The study is aimed at demonstrating the usefulness of the rehabilitation program after extensive surgeries in patients with maxillofacial area (MFA) and neck tumors. Data from patients who underwent surgery in the clinics of the Republican Oncological Research Center and the Tashkent Institute of Postgraduate Medical Educationfor MFA and neck tumors were retrospectively analyzed. The patients were enrolled to the rehabilitation program, which consisted of a three-staged technique involving a complex prosthesis, and several physical therapies for damaged functions, such as chewing, swallowing and breathing. A total of 107 oncological patients with postsurgical defects werefitted with various types of prosthesis. The introduction of the rehabilitation program was performed at an interval between initial surgery and prosthesis formation of 10-15 days, and between initial surgery andpreparation of the final prosthesis of26-30 days. A restoration of the Karnofsky performance status to 80-85 % was observed. The present study demonstrates that the proposed rehabilitation program is useful for shortening the postoperative con-valescentperiod and improving the quality of life ofpatients with defects of the MFA and neck.
Keywords: maxillofacial tumor, prosthesis, defect, plasty, rehabilitation.
ЮЗ-ЖAF СОХДСИ ОПЕРAЦИЯСИДAН КЕЙИН Hy^CORtfAPH БУЛ^Н ОНКОЛОГИК БЕМOPЛAPHИ PЕAБИЛИТAЦИЯ КИЛИШ BA ОРТОПЕДИК ПPOТЕЗЛAШ
Убайдуллаев Хамидулла Асатуллаевич,
тиббиёт фанлари номзоди, Онкология ва стоматология" кафедрасининг илмий ходими,
Россия ва Узбекистан Республикаси онкологлари ва стоматологлари уюшмаси аъзоси;
ТИББИЁТ ФАНЛАРИ МЕДИЦИНСКИЕ НАУКИ MEDICAL SCIENCES
Гаффоров Суннатулла Амруллаевич,
тиббиёт фанлари доктори, профессор, 'Стоматология, болалар стоматологияси ва ортодонтикаси" кафедраси мудири;
Гафур-Охунов Мирза-Али Аллаярович,
тиббиёт фанлари доктори, профессор, "Онкология" кафедраси мудири, Тошкент врачлар малакасини ошириш институти, Республика ихтисослаштирилган онкология ва радиология илмий-амалий тиббиёт маркази
Аннотация. Муаллифлар жарроулик операцияларидан кейин юз-жаг соуасидаги нуц-сонларни реабилитация цилиш самарадорлигини урганиб, нуцсонни бартараф этиш учун мураккаб эндо- ва экзоортопедик протезлардан фойдаланган. Жарроулик амалиётидан сунг юз-жаг соуасида хавфли усмалари булган беморларни реабилитация цилиш жараё-нида комплекс протезлаш усули ишлаб чицилган ва жорий цилинган. Юз-жаг соуасида нуцсонлари булган 107 нафар саратон касаллиги билан огриган беморларнинг касаллик тарихи ва амбулатор карталари таулил цилинди, уларда протезлашнинг турли усулла-ри цулланилди. Тадцицот натижаларига кура, полиуретан пластмассадан фойдаланган уолда, юз-жаг соуасида нуцсонларни комплекс протезлаштириш методикаси яхшилан-ди, бу эса жарроулик кунида уимоя пластиналарини ишлаб чициш имконини берди. Кенг цамровли реабилитациядан сунг хавфли усмалар ва юз-жаг соуасида нуцсонлари булган беморлар доктор Карновскийнинг улчови буйича 80-85 %гача согайди.
Калит сузлар: саратонга чалинган беморлар, реабилитация, юз-жаг соуаси нуцсонла-ри, эндо ва экзо-ортопедия протезлар.
РЕАБИЛИТАЦИОННОЕ ЛЕЧЕНИЕ И ОРТОПЕДИЧЕСКОЕ ПРОТЕЗИРОВАНИЕ ОНКОЛОГИЧЕСКИХ БОЛЬНЫХ С ПОСЛЕОПЕРАЦИОННЫМИ ДЕФЕКТАМИ ЧЕЛЮСТНО-ЛИЦЕВОЙ
ОБЛАСТИ
Убайдуллаев Хамидулла Асатуллаевич,
кандидат медицинских наук, научный сотрудник отделения онкологии и стоматологии, член Ассоциации онкологов и стоматологов России и Республики Узбекистан;
Гаффаров Суннатулла Амруллаевич,
доктор медицинских наук, профессор, заведующий кафедрой стоматологии, детской стоматологии и ортодонтии;
Гафур-Охунов Мирза-Али Аллаярович,
доктор медицинских наук, профессор, заведующий отделением онкологии,
Республиканский специализированный научно-практический медицинский центр онкологии и радиологии, Ташкентский институт усовершенствования врачей
À
ISSN 2181-9637
17
ТИББИЁТ ФАНЛАРИ МЕДИЦИНСКИЕ НАУКИ MEDICAL SCIENCES
Я
Аннотация. Авторами изучена эффективность восстановительного лечения дефектов челюстно-лицевой области после хирургических вмешательств с использованием сложных эндо- и экзоортопедических протезов для устранения дефектов. В процессе реабилитации больных со злокачественными новообразованиями челюстно-лицевой области после хирургического вмешательства разработан и внедрен комплексный метод протезирования. Проанализированы истории болезни и амбулаторные карты 107 онкологических больных с дефектами лица и челюсти, в них использованы различные методы протезирования. По результатам исследования усовершенствована методика комплексного протезирования дефектов лица и челюсти с использованием полиуретановой пластмассы, что позволяет изготовлять защитные пластины в день операции. Пациенты со злокачественными опухолями и поражениями лица и челюстно-лицевой области выздоравливают после обширной реабилитации на 80-85 % по шкале доктора Карнов-ского.
Ключевые слова: онкологические больные, реабилитация, дефекты челюстно-лицевой области, эндо- и экзоортопедические аппараты.
Introduction
Tumors of the maxillofacial area (MFA) and neck are one of the most important health problems worldwide [1-4]. In our country (Uzbekistan), approximately 82 % of patients with MFA and neck tumors are referred to otorhinolaryngologists, 10-11% to stomatologists, and 7-8% to oncologists. After referral from physicians, these specialists appropriately diagnose and evaluate the extent of the disease. However, doctors in the emergency room setting may not pay much attention to the related symptoms, and the complexity of the differential diagnosis may result in delayed diagnosis of head and neck tumors [5-8]. The best results, in terms of survival, are obtained through a combination of chemotherapy, radiation and surgical treatment. However, surgery on the MFA is often accompanied by complex and serious defects, which can result in disturbance of the functions of chewing, swallowing, respiration, and speech [9-14]. Furthermore, cosmetic changes to the face may have a negative influence on the patients' mental state, and their return to society is another major problem of MFA and neck tumors.
An effective method of early rehabilitation is the correction of the defects with a prosthesis. In addition, orthopedic treatment is used along with reconstructive surgeries to adjust the prosthesis so that several related problems such
as infection, immunity attenuation and/or unfitted braces can be prevented. Early intervention to address the defects is important because the early preparation of a prosthesis allows restoration of the lost functions and even improves the patient's psychological condition [4, 15-20].
In our institutes, early rehabilitation consists of a three-step reconstruction process, improvement in complex exercises, articulating gymnastics, mechanotherapy directed at the accurate alignment of the lower jaw, and restoration of the damaged functions of chewing, swallowing, and breathing. This program has been utilized to improve the quality of life (QOL) of patients with MFA and neck tumors. In the present study, we will demonstrate the results of our rehabilitation program.
Material and methods
In all, 107 patients from the clinics of the Republican Oncological Research Center and the Tashkent Institute of Postgraduate Medical Education, who had postoperative defects of the MFA due to tumors, were included in the present study. Traditional methods of clinical examination, surgical interventions, radiation therapy, chemotherapy, immunological reactivity and psycho-neurological body resistance, as well as methods of study of complex jaw prostheses were applied during the research.
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Table 1
Classifi cation of maxillofacial area defects in the present study
Definition n
Group 1 Patients with defects of the upper jaw with the intact dentition of the remaining upper jaw 61
Group 2 Patients with defects of the upper and lower jaw with partial defect of the dentition of the remaining upper and lower jaw 4З
Group 3 Patients with extensive defects of the upper jaw, facial soft tissues and full secondary adentia of the alveolar bone on the remaining upper jaw З
Table 2
Important fi ndings and implications of the present study
1 Group 3 had unfavorable conditions for fixation and stabilization of the removable prosthesis with obturators on the soft tissues of their faces. Patients in Group 3 need more intensive care and rehabilitation.
2 Obstacles for subsequent plastic surgery include the disease itself, presence of scar tissue around the defect, infection, patient refusal, and delay in prosthesis preparation. Some of these factors could be addressed, such as patient refusal and/or delay in prosthesis preparation.
З The three-staged technique is practical and useful.
4 Restoration of Karnofsky performance status was observed
These 107 patients were divided into three groups according to the locations of their defects: Group 1, patients with defects of the upper jaw with the intact dentition of the remaining upper jaw; Group 2, patients with defects of the upper and lower jaw with a partial defect of the dentition of the remaining upper and lower jaw; and Group 3, patients with extensive defects of the upper jaw, facial soft tissues and full secondary adentia of the alveolar bone on the remaining upper jaw. This categorization allows us to plan the appropriate rehabilitation program for each patient.
Results
107 oncological patients with postoperative defects of the MFA were fitted with various types of prosthesis. Patients were both men and women, aged between 20 and 70 years of age, with the majority having Stage III or IV disease, while a small percentage had Stage I or II diseases. The pathological diagnoses included cancer, sarcoma, melanoma, and other malignant tumors of the MFA and neck. The author received two patents for endo-prosthesis and exo-prosthesis (Certificate #000875, #000876 - 09.09.2018).
Thirteen patients had extensive defects of the upper jaw, facial soft tissues and full
secondary adentia of the alveolar bone on the remaining upper jaw (Table 1). Consequently, these patients had defects of the right and left parts of the maxilla, large defects of the eye and soft tissues of the face, defects of the alveolar process of the mandible, and/or defects of the nose and ear skin. We found that the patients in Group 1 and 2 had the most favorable conditions for fixation of the removable pros-thesis with obturators, while patients in Group 3 had unfavorable conditions for fixation and stabilization of the removable prosthesis with obturators on the soft tissues of their faces.
The indications for the complex prosthesis differed between patients because of various states of postoperative defects found in the patients after surgery. The plastic surgery operations were often prevented or delayed due to several reasons, including the disease itself, presence of scar tissue around the defect, infection, refusal of the patient to have further intervention, or delay in the preparation of the prosthesis. Nevertheless, orthopedic prostheses were used in the majority of patients to facilitate independent eating and preservation of speech. In terms of the three-staged technique for prosthesis fitting, the preliminary prosthesis (defensive plate) was made during
ТИББИЕТ ФАНЛАРИ МЕДИЦИНСКИЕ НАУКИ MEDICAL SCIENCES
the initial treatment for the removal of the tumors, the prosthesis was made in the 25-30 days after the operation, and the final prosthesis was prepared approximately 60-70 days after the operation. Thus, our improved technique to prepare the complex prosthesis allows
patients to return to their occupations 12-13 months after radical treatment (see Pictures 1-6 below, patient before and after rehabilitation). The patients showed a restoration of Karnofsky performance status to 80 %.
Figure 4. Before surgery
Figure 2. Before rehabilitation
Figure 3. After rehabilitation
Conclusion
In the present study, we have found several important results (Table 2). First, Group 3 had unfavorable conditions for fixation and stabilization of the removable prosthesis. Because the patients in Group 3 had severe defects of the MFA, there is no argument that preparing prostheses for these patients is much more difficult than for other patients. However, confirming this result is quite important, because the patient categorization used in the present study is useful for identifying patients needing closer attention.
Second, some patients had difficulties undergoing early plastic surgeries due to several clinical and non-clinical reasons.
In the future, these problems need to be prevented. Especially, the cause of patient refusal and the delay in preparing prostheses should be addressed because a quick improvement in the result would be expected. Third, we have found that the three-staged technique is practical and useful. Also, the QOL score recorded in the present study could be utilized as a baseline score for studies in the future.
In conclusion, the present study demonstrates that the provided rehabilitation program is useful for shortening the post-operative convalescent period and improving the QOL of patients with defects of the MFA due to cancer surgery.
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Reviewers:
Pulatova D., Doctor of Medical Sciences, Head of the Chair of "Stomatology 1", Tashkent Institute for Post-Graduate Medical Education;
Alimov A., Doctor of Medical Sciences, professor, Head of the Chair of "Cancer diseases", Tashkent State Institute of Stomatology.
