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26THE EFFECT OF OZONOTHERAPY OF PURULENT INFLAMMATORY DISEASES OF THE
HEAD, FACE AND NECK IN CHILDREN
Shamsiev A.M.,
Department of pediatric surgery №1, MD, DSc, professor Samarkand State Medical Institute Shamsiev J.A.,
Department of pediatric surgery, anesthesiology and intensive care of postgraduate education, head of the department, MD, DSc, professor
Samarkand State Medical Institute Yusupov Sh.A.,
Department ofpediatric surgery №1, head of the department, MD, DSc
Samarkand State Medical Institute Boyjigitov N.I.
Department of pediatric surgery №1, assistant Samarkand State Medical Institute
Makhmudov Z.M.
Department of pediatric surgery, anesthesiology and intensive care of
postgraduate education, PhD, assistant Samarkand State Medical Institute 140100, 18, Amir Temur st. Samarkand, Republic of Uzbekistan
Abstract
The aim of the work was to study the effect of ozone therapy on the dynamics of the timing of wound healing in children with purulent-inflammatory diseases of the head, face and neck. 580 patients with purulent-inflammatory diseases of the head, face and neck were under observation. The patients, taking into account the applied therapy, were randomized into two groups: the main group - 271 patients, in whose complex treatment ozone therapy was included, and the comparison group - 309 patients, in whose complex treatment medical ozone was not used.Complex treatment with the inclusion of ozone therapy contributed to the positive dynamics of clinical manifestations, the normalization of indicators of the course of wound healing, a change in the types of cytograms from degenerative-inflammatory to regenerative in terms determined by the biological regularities of the course of the wound process. This led to a decrease in the time for relief of the purulent-inflammatory process by 3.4 ± 0.45 days, in comparison with traditional methods of treatment.
Keywords: purulent-inflammatory diseases of the head, face and neck, ozone therapy, children.
Relevance. Purulent-inflammatory diseases of the maxillofacial region and neck in children are the most common nosology in the hospital of children's maxillofacial surgery (from 40 to 55 %) [1, 3, 6]. For inflammatory diseases of the maxillofacial region, there is seasonal activity in the spring and autumn period [2, 4]. Most often, inflammatory processes occur in the age group from 2 to 9 years, with the most pronounced clinical manifestations. The severity of inflammatory processes in the maxillofacial region is due to the anatomical and physiological features of the tissues of the face and neck in children and the age-related features of the child's body, namely, the immaturity of the nervous, immune and neuroendocrine systems [5]. In recent years, there has been not only an increase in the number of children with inflammatory processes of the maxil-lofacial region, but also a change in the nature of their clinical course [2, 4, 5]. The number of cases of prolonged course of inflammatory processes, chronization and development of local and general complications has increased. The reason for this may be changes in the immunological reactivity of the child's body due to eating disorders, adverse environmental conditions, stress, concomitant diseases, etc. [6]. The successful use of ozone therapy in the treatment of purulent
wounds was made possible by numerous experimental and clinical studies that revealed a variety of biological effects of medical ozone, however, the issues of its influence on the dynamics of wound healing in children with purulent-inflammatory diseases of the head, face and neck, have not been sufficiently studied, which led to the purpose of this study [5, 6].
Purpose of the research: to study the effect of ozone therapy on the dynamics of wound healing time in children with purulent-inflammatory diseases of the head, face and neck.
Materials and methods of the research: This research is based on the analysis of the results of the examination and treatment of 580 patients with purulent-inflammatory diseases of the head, face and neck, treated in the 2-clinic of the Samarkand State Medical Institute for the period from 2010 to 2020. There were 301 boys and 279 girls. Thus, children with purulent-inflammatory diseases of the head, face and neck of primary school age (6-11 years) they made up 47.2% (294), middle school age (12-15 years) - 31.6% (183) and older age (15-18 years) - 21.2% (103). The majority of children, 85.1%, were admitted no later than 3 days after the onset of the disease. In 176 (30.3%) patients, adenoflegmon of the submandibular region was
diagnosed, and adenoflegmon of the chin region was found in 141 (24.3%) children. Pseudofurunculosis of the scalp was diagnosed in 183 (31.6%) children, boils of various parts of the head, face and neck occurred in 80 (13.8%). The patients, taking into account the applied therapy, were randomized into two groups: the main group - 271 patients, whose complex treatment (surgical aid, antibacterial, detoxification therapy) included ozone therapy (local treatment of a purulent wound with an ozone-oxygen-gas mixture at an exposure of 5 minutes, using the medical ozonizer "OTRI-1"), and the comparison group - 309 patients, in whose complex treatment medical ozone was not used.
Research results and their discussion. After 1-2 sessions of ozone therapy, all patients showed improvement in their general condition, reduction of pain, normalization of pulse and temperature. The main dynamics of local changes in the comparison group was recorded by 8-9 days, in the main group - by 4-5 days, which corresponded to the conduct of 2-3 procedures. The use of ozone therapy contributed to the early, in comparison with traditional treatment, relief of collateral edema, the disappearance of soreness and hypere-mia of the parotid zone, and a decrease in the amount of purulent discharge. The first signs of the appearance of granulation tissue were recorded on the 5th day after surgical treatment in 77% of patients of the main group, and the height of granulation-in 97% of patients on the 8th day. In 68% of patients of the main group, the positive dynamics of the wound process was the basis for applying secondary sutures on the 10th-11th day, which is 3-4 days earlier than in the comparison group. The results of bacteriological studies obtained by us confirm the pronounced bactericidal effect of ozone on various types of microorganisms. After the first procedure of ozone therapy, 68% of patients had sterile crops, and 94% had them on the 7th day of the study. In the comparison group, on day 10, sterile cultures were detected in 43% of patients. Prior to treatment, the microbial landscape of the purulent wound was dominated by staphylococci (81%). After the first ozone therapy procedure (day 3 of the study), staphylococci were seeded in 14% of cases, and on day 7-in 2% of cases. On the 10th day, staphylococci and other bacteria were not seeded. By acting on the bacterial envelope, ozone breaks the associative links between microorganisms, destroys the resistance factors associated with the bacterial cell membrane, thereby increasing their sensitivity to antibiotic therapy. With standard treatment, the seeding rate of staphylococci on the 3rd day of the study was 32%, on the 7th-29%, on the 10th-16%. After the first procedure of ozone therapy, microbial associations were detected in 28% of cases, on the 7th day-in 5%, on the 10th day, microbial associations were not
detected in the wound. In the traditional treatment group, microbial associations were detected in 62%, 48% and 24% of cases, respectively. Cytological examination of smears-prints from the wound surface on the 10th day of the study showed clear differences in the course of the wound process in patients of the comparison groups. The inclusion of ozone therapy in the complex treatment of purulent-inflammatory diseases of the head, face and neck, promotes the activation of the macrophage reaction and the stimulation of reparative processes.
Conclusions. Complex treatment with the inclusion of ozone therapy in children with purulent-inflammatory diseases of the head, face and neck, contributed to the positive dynamics of clinical manifestations, normalization of wound healing indicators, change of cy-togram types from degenerative-inflammatory to regenerative in terms determined by the biological patterns of the wound process, which led to a reduction in the time of relief of the purulent-inflammatory process by 3.4±0.45 days in comparison with traditional methods of treatment.
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