Резюме
Григорова А.О. Клініко-патогенетичний аналіз реабілітаційної тактики хірурга-стоматолога при запальних захворюваннях щелепно-лицевої ділянки: проблемні питання та інноваційне удосконалення.
Узагальнено існуючий досвід етапів застосування реабілітаційних програм для пацієнтів з запальними захворюваннями ЩЛД. Визначені показники адекватності безпосередньої дії фізичних навантажень при контролі досягнення безпеки і позитивного кумулятивного ефекту, а також клініко-патогенетичні індикатори кумулятивного ефекту реабілітаційної програми. Інноваційно вирішено проблему індивідуалізації комплексного лікування за рахунок ранньої реабілітаційної тактики ведення пацієнтів з запальними захворюваннями ЩЛД.
Ключові слова: хірургічна стоматологія, запальні захворювання, реабілітація.

Резюме
Григорова А.А. Клинико-патогенетический анализ реабилитационной тактики хирурга стоматолога при воспалительных заболеваниях челюстно-лицевой области: проблемные вопросы и инновационное совершенствование.
Обобщён существующий опыт применения реабилитационных программ для пациентов с воспалительными заболеваниями челюстно-лицевой области в зависимости от вида и объёма хирургического вмешательства. Определены показатели адекватности непосредстьвенного влияния физических факторов при контроле достижения безопасности и позитивного кумулятивного эффекта, а также клинико-патогенетические индикаторы кумулятивного эффекта реабилитационной программы. Инновационно решена проблема индивидуализации комплексного лечения за счёт ранней реабилитационной тактики ведения пациентов специализированного стационара хирургической стоматологии.
Ключевые слова: хирургическая стоматология, воспалительные заболевания, реабилитация.

Summary
Grigorova A.O. Сlinical pathogenetic analysis of surgeon-dentist’s rehabilitation management at the inflammatory diseases of maxillofacilal area: problem questions and innovative improvement.
It is generalized the existent experience of application of the rehabilitation programs for patients with inflammatory diseases of maxillofacilal area depending on the kind and volume of surgical interference. It is determined the indexes of adequacy of direct influence of physical factors at control of safety achievement and positive cumulative effect, and also it is determined clinical pathogenetic indicators of cumulative effect of the rehabilitation program. The problem of individualization of integrated treatment is decided innovative due to early rehabilitation policy of case management of the specialized in-patient department of maxillofacial surgery.
Key words: maxillofacilal surgery, inflammatory diseases, rehabilitation.

Рецензент: д.мед.н., проф. І.І. Зєльоний

УДК 616.+612.75] - 053.5/.6 : 616.2/.6-036.12(477)

Харківський національний медичний університет МОЗ України

Харьковский национальный медицинский университет

проспект Ленина, 4, Харьков, 61022,Украина 

Kharkiv National Medical University,

4 Lenin Avenue, Kharkiv,61022,Ukraine

serg_shklyar@ukr.net

The goal of the work consisted of existent experience generalization concerning the reasoning of the stages of the rehabilitation programs application for patients with inflammatory diseases of maxillofacilal area (ID MFA) depending on the kind and volume of surgical interferences.

Published results of clinical and experimental researches for the last few years on the issue of rehabilitation programs reasoning for patients with ID MFA depending on the kind and volume of surgical interferences became the research material.

The main principles for the application of physical rehabilitation facilities in the structure of integrated treatment are timeliness, individualization of physical activities in accordance with clinical implications, patient's physical fitness, and also gradualness of intensity increase and duration of physical activities, their systematic character.

The special tasks of rehabilitation at ID MFA consist in the improvement of blood and lymph circulation in the area of damage, acceleration of inflammatory exudate and hematoma resorption and also improvement of inflammatory exudate outflow through drain tube. At the same time it is provided activation of reparative regenerative processes and prophylaxis of rough brace swordcuts progression  in the area of mucous coat of mouth and skin covers, prophylaxis of contracture progression in SNS, muscle atrophy. Compensating of defects of mastication, swallowing, speech functions take place due to the undamaged telas with gradual renewal of the broken function of mimic and masticatory muscles, tongue, volume of motions in  temporo-mandibular joint with abolition of defects of mastication, swallowing, mimic and speech.

General tasks of rehabilitation are prophylaxis of pneumonias, thromboembolic disorders, stimulation of activity of blood circulatory system, respiratory and digestive systems, and also normalization of psychoemotional state  of patient with continuation of  сommon and professional possibility.

Methods and forms of rehabilitation and dosage of physical activities: kinesthesiology method is prescribed after surgical treatment the area of inflammation, depression of pain syndrome and gain of the patient’s general state that comes usually in  1-2 periods of 24 hours after the surgery. Subfebrile temperature and moderate increase of ESR, that have some patients, are not precautions for prescription of the kinesthesiology program : methodology is based on periods that reflect the clinical state of patient and dynamics of  the postoperative wound healing process.

There are corresponding periods of application of rehabilitation actions for ID MFA. Particularly, in an early postoperative period on the first stage, under control of pulse it is executed the diaphragmatic breathing and static and dynamic exercises during 5-7 min in the distal parts of limbs; on the second stage, during 10-12 min, without a catch of breathing and additional stress it is executed exercises for the dorsum muscles, prelum abdominale muscles and head movements; on the third stage, during 2-3 min and in a slow rate it is executed dynamic respiratory exercises with the simultaneous weakening of muscles of upper and lower limbs and implementation of the diaphragmatic breathing with participation of buccal region and mouth muscles   to complete pulse restitution. In a late postoperative period, on the 5-10th period of 24 hours after the elimination of raphes, the free motion operation is appointed for a patient and also exercises for mimic and masticatory muscles with maximal amplitude of motions, including exercises for the muscles attracted in a pathological process. In a remote postoperative period 1-2 times in the period of 24 hours during 30-45 min it is executed form building exercises with maximal amplitude in a middle and rapid pace.

So, it  is generalized the existent experience concerning the reasoning of the stages of the rehabilitation programs application for patients with the ID MFA depending on the kind and volume of surgical interferences. It is determined the periods, tasks and indicators of the rehabilitation program efficiency at ID MFA. It is defined the indexes of adequacy of direct action of physical activity at operative control for the sake of achievement of safety and positive cumulative effect and also clinical pathogenetic indicators of cumulative effect of the rehabilitation program. The problem of individualization of treatment is decided innovative due to early rehabilitation tactics of case management with ID MFA.

Future trends for researches of problematics of the rehabilitation programs improvement for the patients of in-patient department of maxillofacial surgery are associated with the including of psychophysiological rehabilitation component in the integrated treatment of patients with inflammatory disease of MFA.

Література

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