Роль антропометричних показників черепа при виборі лікування гангліонітів вушного вузла

Abstract

За допомогою загальноклінічних та спеціальних методів діагностики проведено дослідження захворюваності на гангліоніти у щелепно – лицевій ділянці, визначена ефективність проведеного лікування гангліонтів з урахуванням особливостей розташування вузлів у залежності від типу будови черепа. В результаті проведених досліджень виявлено, що раціональне лікування гангліонітів залежить від правильного проведення блокади, із урахуванням локалізації вегетативних вузлів, що пов’язано з типом будови черепа. Застосування цієї методики дозволяє досягти кращих результатів в лікуванні запалень вегетативних вузлів голови; С помощью общеклинических и специальных методов диагностики проведено исследование заболеваемости ганглионитами в челюстно-лицевой области. Определена эффективность проведенного лечения ганглионитов с учетом особенностей расположения узлов в зависимости от формы черепа. В результате проведенных исследований выявлено, что рациональное лечение ганглионитов зависит от правильно проведеной блокады, с учетом локализации вегетативных узлов в зависимости от типа строения черепа. Применение этой методики позволяет достичь лучших результатов в лечении заболеваний вегетативных узлов головы; Autonomic ganglions of the head, i.e., sphenopalatine, otic, submandibular and sublingual, are crucial in providing of innervations of mucous membrane of nasal and oral cavities, salivary glands. In the clinical conditions inflammations of autonomic ganglions of the head, called ganglionitis, occur. Clinical course of inflammation greatly depends on specific features of topography of this or that ganglion and availability of its interactions with other autonomic ganglions of the head. Disorders of the autonomic ganglions of the head account for 75% of cases among existing pathological syndromes of the face. The clinical picture of autonomic ganglionitis is different. It is reasoned by the fact that autonomic ganglions, nerves and plexuses are located on the large area and functionally interconnected with each other and superior cervical sympathetic ganglion. In ganglionitis of autonomic ganglions of the head the pain is often of the paroxysmal nature: attacks were observed during hours and sometimes even weeks. Specifically, the pain wave goes beyond the borders of areas of anatomical innervations of trigeminal nerve branches. The affection of autonomic ganglion of the head is often manifested by the edemas of facial soft tissues, mucous membrane of tongue and oral mucosa. The study revealed specific availability of typical secretory impairments: in affection of sphenopalatine ganglion lacrimation, drooling and rhinorrhea was observed and in affection of otic, submandibular and sublingual ganglions hypersalivation was typical. The blockade was carried out according to the ganglionitis location, type of skull structure of the patient and probable topographic anatomical ganglion. In treatment of sphenopalatine ganglion the most effective is the modified way of Vaisblat’s infratemporal-sphenopalatine anaesthesia in sphenopalatine fossa. Modification consists in extra tilt of needle up or down by 10°, stipulating by the type of scull of a patient and location of sphenopalatine ganglion in sphenopalatine fossa. According to Rybalko T.I., in people with brachycephalic type of scull the ganglion is located closer to posterior wall of the fossa and, consequently, it is more precise to introduce the needle into the superior parts. In individuals with dolichocephalic shape of the head the ganglion is located closer to anterior wall; therefore it is more precise to introduce the needle into the inferior parts of sphenopalatine fossa. During the introduction of the needle the main focus was the lateral lamina of pterygoid process, and point of injection was the median tragoorbital line. As for the otic autonomic ganglion, it has two locations relative to oval lumen and submabdibular nerve. In individuals with dolichocephalic shape of the head and chemoprosophilic face form, otic ganglion is of posterosuperior location; in dolichocephalic people with leptoprosophilic face form it is of anteroinferior location. Therefore, to introduce the needle with maximal precision to the otic autonomic ganglion, the modification of Vaisblat’s central anaesthesia of mandibular nerve in infratemporal fossa should be applied. The modification consists in extra tilt of needle up or down by 10° according to the type of scull of a patient and ganglion location. In affection of sublingual and submandibular autonomic ganglions the injection was made at the level of last molar under mucosa of sublingual area into the deepest part of mandibulolingual groove, as the ganglion is located on the lateral surface of sublingual salivary gland above the lingual nerve. In treatment of ganglionitis the efficacy was higher when the type of scull shape was considered. Consequently, the effective, rational treatment of ganglionitis depends on correct performance of blockade, taking into account the localization of autonomic ganglions according to the scull shape. Application of such technique benefits to achieving the better success in treatment of impairments of autonomic ganglions of the head.