Сучасні методи діагностики та корекції рубців голови та шиї

Abstract

У статті здійснено огляд сучасних іноземних та вітчизняних наукових публікацій, присвячених вивченню актуального питання щелепно-лицевої хірургії - обстеження та лікування хворих із рубцями голови та шиї. Автори переконливо доводять доцільність подальшої розробки єдиного алгоритму диференційної діагностики різних типів рубців та пошуку оптимальних методик оперативного та консервативного лікування цієї категорії пацієнтів.

The article provides an overview of modern foreign and domestic scientific publications devoted to the study of such a topical issue of maxillofacial surgery as the examination and treatment of patients with head and neck scars. The authors convincingly prove the feasibility of further development of a single algorithm for differential diagnosis of different types of scarring and the search for optimal methods for operative and conservative treatment of this category of patients. In modern surgical dentistry the problem of improving the quality of diagnosis and treatment of patients with abnormal scars of the head and neck, which are formed as a result of planned and urgent surgical interventions, burn and mechanical injuries, is actively developed. This is due not only to the increase of aesthetic requirements of society to the appearance of man, but also to the fact that pathological varieties of scars can significantly reduce the quality of life, and their correction often does not give the desired therapeutic effect. The development of a general algorithm for the examination and treatment of patients with pathological scars of the head and neck continues to be an important task for maxillofacial surgery. The purpose of the paper is to analyze and generalize a sufficiently large array of scientific publications, both in foreign and native editions devoted to the issue of diagnosis and treatment of head and neck scars. Materials and methods. The search and study of scientific publications on the mentioned issues in library sources and search systems (National Scientific Medical Library of Ukraine, PubMed, Google Scholar, CyberLeninka) was conducted. Research results. Despite of the considerable number of attempts to systematize scars according to the clinical and histological picture, there is not yet a single classification that would dissuade doctors of all specialties. Specialists are offered an extremely wide range of additional methods for scar investigation, among which special attention is attracted by such methods as elastometry, biophotometry, spectrocolorimetry, dielectrometry, biopsy, spiral computed tomography. However, these methods are not sufficiently effective in clinical practice due to some disadvantages. Under modern conditions, scientific interest in the study of anatomical structures by means of ultrasound research during lifetime increase considerably. Treatment of head and neck scarring is an extremely complicated and topical issue that causes a large number of publications on its development. At early stage, the means of internal and local therapy, which accelerates healing of wounds such as enzymes, antibiotics, retinoids, vitamin therapy, and trace elements, are used. To prevent the formation of pathological scars, remedies that improve microcirculation and metabolic processes to eliminate hypoxia of tissues and to stimulate the immune properties of the skin are recommended. In the process of scar maturation, a good effect is provided by therapeutic methods - the treatment of wound surfaces with ointments, which promote healing in combination with physiotherapeutic methods, such as the introduction of fermentol or collagenase by phonophoresis or electrophoresis, Bukki therapy, magnetotherapy and microcurrent therapy etc. However, most researchers point out that the therapeutic treatment of formed scars often does not lead to noticeable changes in their clinical picture. In order to correct the continued existing scarring in thecaseof ineffectiveness of conservative treatment, a variety of advanced surgical techniques are offered. Among them the combination of methods of dermabrasion and transplantation of autologous or algal keratinocytes is quite positive. Most experts are unanimous in the opinion that the most expedient is the integrated approach to the treatment of pathological scars. Surgical intervention should be preceded by therapeutic training. Thus, it becomes clear that the development of treatment algorithms is difficult due to the uncertainty of the criteria for differential diagnosis of different types of scars. In turn, the treatment, without taking into account the clinical and morphological structure of scars, leads, as a rule, to the absence of a significant therapeutic effect, relapses and increased growth of scar tissue.