Examination patients with diseases in maxilla-facial region

The purpose of the clinical examination of the child is the desire to correctly identify the diagnosis of the disease, which is the key to successful treatment and prevention of disease bol¬nogo. Oral examination - one of the links ob¬sledovaniya child.

Used in dental research methods can be divided into subjective - and objective inquiry of the patient - examination (palpation, zondi¬rovanie, percussion teeth), thermodiagnostics, instrumental (elektrometric, X-ray), laboratory tests (biochemical, bacteriological, immunobiological, blood analysis, histology, cytology, samples: Blistering, histamine, sample Kavetsky-bazaar, allergy tests).

It is considered that the inquiry of the patient and the physical techniques of objective research, based on the perception of our bodies without the use of tools and equipment difficulty are basic. Methods are based on the achievements of modern physics, chemistry, histology, etc. (Rentgenologiches¬koe, electrometric, cytology, etc.) Is considered optional on the grounds that sometimes can be diagnosed without their use.

5.1. Determination of the general condition of the child

Anamnesis. The important point is the study of the sick child correctly, with sufficient completeness collected history. He almost always allows the doctor to make an assumption about the possible causes and nature of disease severity voznikno¬veniya, severity and the period of its development. It is advisable to find out how and kog¬da developing the disease, how it proceeded to appeal to the doctor, especially the temperature of the reaction, the complaint and the child's behavior, the main manifestations of bolez¬ni. It is also necessary to know what treatment was conducted and its results. Another important factor is the elucidation of epidemiological history. Finding out the history of the disease, it is necessary to obtain information about the history of life. It should be clarified as proceeding pregnancy and birth mother; whether there was a mother and a family allergiche¬skih and hereditary diseases; Do not hurt the mother on W-IV month beremennos¬ti; the child was born at term or preterm, a food produced in the first year of life, how to develop? What illnesses suffered child as they proceeded?

Toxicosis first half of pregnancy, maternal illness during this period influence the growth and formation of tooth primordia milk occlusion.

Body temperature reflects the general state of the patient. Increase temperatu¬ry (temporary and long-term) often occur in children, making it difficult differential diagnosis. Body temperature rises to vyso¬kih numbers marked in acute stomatitis, acute odontogenic osteomyelitis, lymphadenitis, with growth of malignant tumors (sarcomas Jung and some forms of reticular sarcomas in children).

Objective study of the child, as a rule, begins with an assessment of the state of the skin of the face and body. At the same time pay attention to color, texture and skin turgor, and the presence of skin rashes. Thus, in children with acute herpetic stomatitis, skin rash on the face and paronychia may precede or accompany the underlying disease. Under certain systemic diseases, facial skin and other parts of the body is typical for this disease iz¬meneniya. So, in neurofibromatosis (Recklinghausen disease) area of ​​skin in the pathological focus has brown pigmentation, increased the number of wrinkles, it dramatically reduced turgor. When ectodermal dysplasia violation of the structure of skin tissue clinically expressed in paleness, thinning and su¬hosti, increasing the number of wrinkles due to a sharp decline in turgor. Spetsifich¬nye (dry, keratosis, cracks), changes in the skin on the palmar surface and sto¬pah observed in the syndrome Papillons-Lefebvre. When hemangiomas facial skin within the pathological focus has different colors - from bright pink to purplish-red with a bluish tint.

Inspection of the temporo-mandibular joint start with the definition of the range of motion of the lower jaw. Limited mobility may be due to muscle or vospali¬telnoy scar contractures, ankylosis of temporomandibular joint, the result of a fracture of the zygomatic arch or tumor branches and coronary otro¬stka finally fracture of the mandible. In children, the possibility of excessive podvizh¬nost mandible with hyperextension of the joint and ligament apparatus pri¬vychnom dislocation. The displacement at the time of opening of the mouth of the lower jaw to one side the physician should look on the side opposite to the direction smesche¬niya, pathological lesion in the articular processes or medial pterygoid muscle (inflammatory process, fracture of the articular process, habitual vy¬vih one joint, the articular bone tumor head).

An important when examining a child is to assess the state of periferiches¬kih lymph nodes. It should be noted the number, size, konsis¬tentsiyu (dense, soft, partially softened), mobility, related to neighboring nodes (palpated in isolation, soldered into packages) related to surrounding tissues, skin and subcutaneous tissue (welded or not) chuvstvi¬telnost (painful, painless). Note the sostoya¬nie skin over them: redness, tripe, fistula, etc.

The increase in submandibular lymph nodes observed during exacerbation of chronic pulpitis, periodontitis, ie in the presence of odontogenic hotbed in¬fektsii in the mouth. Submandibular lymphadenitis simultaneously with catarrhal gingivitis is one of the first symptoms of acute gerpetichesko¬go stomatitis in children.

In the overall condition of the patient is important to establish ha¬raktera breath, finding the depth, rhythm, the number of breaths per minute. Shortness of breath occurs when the total of severe intoxication associated with voyapaleni rd or neoplastic process. Slow breathing can be observed in cherep¬no brain injury, concussion, increased intracranial pressure.

A healthy child the number of breaths per minute is not the same in different periods vozra¬stnye: 40-60 in the newborn, a child 1-2 years 30-35, 5-6 years, 25-30, 20-18 over 7 years. At any age in a healthy child on one breath-Com ditsya 3-4 pulse beats.

Pulse in healthy children average filling, regular, age-incidence of neonatal 140-120, a child 4-6 years 105-95, 90-80 over 6 years of heartbeats per minute. In febrile diseases fever on GS is increased heart rate by 15-20 beats.

Increased heart rate observed in acute inflammatory processes, increased with low filling - in acute blood loss; slowdown indicates traumatic brain injury.

Determination of blood pressure produced machine Riva-Rocci with spe¬tsialnoy child cuff. Normally, the blood pressure in young children is not the same: the newborn maximum pressure of 80 + 16, mini¬malnoe 46 ± 16 mm Hg. Art., in children 1 year - respectively 96 + 030 and 66 ± 25 mm Hg. Art. By V.I.Molchanovu maximum blood pressure in childhood is equal to 80 mm Hg. v. + twice the number of years, minimum, as an adult, so¬stavlyaet about 2 / 3-1 / 2 maximum.

A clinical study of peripheral blood is carried hirurgiches¬kim all patients, as well as children, contact your dentist with different zabole¬vaniyami oral mucosa and periodontal. Picture of peripheral blood of children is age differences.

Important diagnostic and prognostic role in disease sostoya¬niyah plays correctly read CBC.

Increase in the number of white blood cells (leukocytosis) is most common in in-infectious diseases, as in these cases the protective reaction of the organism. Usually increase leukocytosis runs parallel to an active infection. Odna¬ko should not forget that the very serious infectious processes may be bone marrow and develop leukopenia (decrease koliche¬stva leukocytes).

Leukopenia in children is less common than in adults. When leukopenia naru¬shaetsya red blood cells, in this sense, it is always adverse a nice feature. At pronounced leukopenia need to pay particular attention, since it can easily go to agranulocytosis. In general, the prognosis leukopenia favorable.

Determination of the total white blood cell count becomes differential diagnostic value only when comparing it with the data count ley¬kotsitarnoy formula peripheral blood.

One of the major clinical symptoms of formula leykotsitar¬noy study is the so-called formula left shift, i.e. increase in peripheral blood neutrophil immature cells and increased stab cells and young cells appear - myelocytes. This pereme¬schenie blood picture to the left is one of the most important signs of infection in the body, a sign of greater than izme¬nenie white blood cell count. When shifting to the left first increases soderzha¬nie stab cells, then young cells, and finally, there mie¬lotsity. In extreme shift to the left in the peripheral blood may appear promyelocytes, even myeloblasts.

Amendment of the white blood cells in infectious diseases proceeds as follows: 1) in the acute stage of the disease, an increase of polymorphonuclear cells and shift to the left; 2) when the acute effects subside, kolichest¬vo neutrophils decreases and monocytes increases; 3) increased number peri¬od recovery of lymphocytes and eosinophils.

In acute infectious diseases manifested mainly per¬vaya phase, but because in these cases there is mainly neutrophils and shift to the left; the other two phases are in a short time. In chronic diseases in¬fektsionnyh manifested lymphocytosis.

For an infectious disease characterized by the appearance of plasma cells.

Erythrocyte sedimentation rate (ESR) is not specific to any disease, but increase it always indicates the presence of patologiche¬skogo process. In acute inflammation ESR increases after 24 hours and remains increased even for some time after ischezno¬veniya clinical symptoms. Along with the increase in the number of leukocytes and their le¬vym shift ESR is the most reliable laboratory signs of the presence of an inflammatory or infectious process. Increased erythrocyte sedimentation rate at vospali¬telnyh disease usually occurs in accordance with the severity of pato¬logicheskogo process, so in addition to the diagnostic it is also important prognostic value.

Determination of hemoglobin (Hb) is a common laboratory is-route. The reduced concentration of hemoglobin in the blood called oligohronemi rd. What makes it more pronounced the harder the patient's condition.

Along with the definition of hemoglobin count of red blood cells (erythrocytes) - the most important laboratory test. Reducing the number of red blood cells (Oligocene-temiya - eritropeniya) characteristic of anemia.

Color index of red blood cells. Thanks to him, you can get pred¬stavlenie of hemoglobin in red blood cells. This test assesses sostoya¬nie red blood.

Biochemical studies of blood for diagnostic purposes are held by in-dividual indications in systemic diseases, diseases of the oral mucosa and periodontal.

Modern Allergology has a large number of specific diagnostic tests to conduct and interpretation of results which ne¬obhodimy specialists - allergists and related conditions.

In the development of dental diseases allergic nature preimu¬schestvennoe importance of delayed-type reaction, although in practice there are stomatologiches¬koy and immediate allergic reactions. By the nature of emerging diseases, methods and types of immune sensitization fakto¬rov allergic reactions delayed and immediate types have printsi¬pialnye differences. However, these reactions can proceed in parallel, nezavi¬simo from each other; delayed-type hypersensitivity can be a ran¬ney stage allergic response, flowing through the immediate type.

Depending on the prevalence of dental disease in the pathogenesis of some type of allergy, as well as the stage of development of the pathological process the same methodology for the identification of hypersensitivity may have different diagnostic value. In connection with this step and for each type allergiches¬kih manifestations of allergy in modern techniques diagnosti¬cheskih defined complexes.

To establish immediate type allergic reactions used: skin tests with bacterial allergens; leiko- and thrombocytopenic tes¬ty; Shelley basophilic test based on determination of the damaging dey¬stviya allergic to basophilic granulocytes; hemagglutination reaction to Boyd, is to identify the agglutination of red blood cells under the influence of syvo¬rotki homologous to the antigen adsorbed on their surface.

Characterized by delayed type reactions, usually lack any cellular or humoral antibodies.

For this type hypersensitivity diagnosis currently used shiro¬ko allergic skin sample reaction leykotsitoliza test blast transformation of lymphocytes and other small.

Dermatology and allergy tests. In the study of the child's pediatrician or allergo¬loga may be held skin-allergy tests. As allergens is¬polzuyut hemolytic streptococcus, staphylococcus, E. coli and Proteus.

Allergens injected intradermally on the inner surface of the forearm in koli¬chestve 0.1 ml at a distance of 5 cm from each other. The reaction at 24 hours. Di¬agnosticheskoe have positive value and rezkopolozhitelnye reaction.

In order to establish the indications for specific desensitization ispolzu¬yut as laboratory methods: leykotsitoliza reaction, the test-blasttransforma of small lymphocytes, passive hemagglutination reaction and others.

The methodology of the skin-reaction with allergic aktinolizate. On internal surface of the forearm, near the elbow joint, the right and left internal 

rikozhno administered diagnostic aktinolizat in a volume of 0.3 ml. To control ot¬stupya 8-10 cm from the first injections are administered the same dose of the sterile meat-peptone broth (pH 7.0). The result of the reaction is evaluated after 24 hours.

Reaction leykotsitoliza. Carried out according to the procedure and P.P.Saharova E.I.Gudko¬voy. Blood taken from patients in finger volume of 1 ml in a sterile tube, 0.3 ml soder¬zhaschuyu rasvora 5% sodium citrate.

0.15 citrated blood is dispensed into 5 ml vials (number of subjects al¬lergenov 1 vial - control). In 4 tubes allergens added 1 drop (or 0.05 ml) dose of 10 cutaneous doses: hemolytic streptococcus, staphylococcus ge¬molitichesky, E. coli, Proteus, the control probir¬ku - 0.05 ml of buffer solution (pH 8 , 0). The tubes are thoroughly but gently mixed and placed in a thermostat for 1 hour. (37 ° C).

Then, from each tube was prepared by 3 strokes that paint method Kryu¬kova or Romanovsky-Giemsa and examined under an immersion system with increasing 10x90. Leukocyte count (100 cells) is carried out in sections where the leukocytes were isolated from the erythrocytes.

Allergen, which has a specific action, destroying at least 14% of leukocytes. In the control destroyed leukocytes should be no more than 10.

Test blast transformation of small lymphocytes. Carried out to determine the number of transformed cells in influenced by blasts antigens. Counting is performed at 1000 cells of lymphocytes and the result expressed in pro¬tsentah. For this test, blood is taken from a vein in an amount of 5 ml.

Clinical experience suggests that the development of recurrent stomatologi¬cheskih diseases in children may play a role food allergens that pro¬yavlyayutsya alone or combined with bacterial-toxic allergies.

The most affordable way to identify this etiological factor yav¬lyaetsya filling special medical history, which allows to determine the disposition of the body al¬lergicheskuyu child, and keeping a food diary, which is an exemplary diagram and instructions developed by the Laboratory of Allergy AMS USSR and can be obtained at the allergist (tab. 6 ).

Table B chart conducting a food diary

Date and Time Diet Products Symptoms to treat itching for power to Ms. Where? rash, blisters. Where? swelled up a little cavity-to-Ms. Where? feeling the heat. Where? what? how much? what? how much?

Headache. Where? General symptoms sostoya¬nie Le car-tion-changing, of

hoarse voice-cavity zatrud¬nenie respiratory-of-tion made difficult swallowing and vomiting. What time? stomach ache

Where? Burch-Chair of the stomach. What time? in the nose

As additional methods of diagnosing food allergies based on a food diary can recommend leykopenichesky index Vidal-in-Ghana and thrombotic thrombocytopenic test. Skin tests in this case are less di¬agnosticheskoe value.

Leykopenichesky index Vidal-Vaughan performed with provocative zavtra¬kom. Fasting determine the number of leucocytes in 1 ml of blood through the re-hour count the number of leukocytes, while the difference does not exceed 300 cells per 1 ml. Then the patient eats 50-100 g allergenic foods. After 30-40 min. again count of leukocytes in peripheral blood. The sample is considered positive if the number of leukocytes after pri¬ema food allergens to decrease by 1,000 cells or more. In healthy people, naobo¬rot, after a meal usually white blood cell count increases (so-called Vai digestive leukocytosis).

Thrombocytopenic test. First, count the number of platelets in peripheral blood ne-fasting, and then again after 50, 60 and 90 min. pro¬vokatsionnogo after breakfast. The test is considered positive if the number of trombo¬tsitov reduced by 15-25% after administration of allergenic breakfast.

Biopsy

Biopsy - vivo excision tkayey for later gistologi¬cheskogo study in order to establish the diagnosis. The following types of bi¬opsy: open, puncture and aspiration.

The most common method of open biopsy, comprising isseche¬nii with a scalpel or a portion of the entire pathological tissue under anestezi¬ey. Coagulate the wound surface, it is possible to impose a 1-2 catgut suture. Is¬sekaemy block material should contain not only the pathological tissue ocha¬ga, but peripheral areas surrounding together with a part apparently neizme¬nennyh tissues.

Biopsiruemy piece of tissue should not be subjected to unnecessary injury or rastya¬zheniyu compression and size, with few exceptions, should not be me¬nee 1 cm3.

Fixation material is carried out in a clean glass container with a ground prob¬koy.

Fixing the amount of fluid to exceed the amount fixed by mate-rial at least 10-20 times.

In an accompanying form indicate the name of the institution's name, child's name, age, gender, medical history number, a brief clinical data and diagnosis. Form must be dated and signed by the doctor.

With biopsy trocar different diameter column removed tissue a few millimeters thick, which is embedded in paraffin and celloidin.

Aspiration biopsy produce a thick needle. The resulting material is punctate, which can be subjected only sitological study.

Byopsiynoe study in some cases can be performed ex-friction within 20-40 min. Express biopsy is usually done at the beginning of ope¬ratsii providing for removal of the tumor. On diagnostic and postoperative biopsy Zion response can be obtained in 2-3 days. And the study of hard tissues of the tooth or bone - only 5-7 th day.

5.4. Cytological examination

Cytological method consists in studying cellular elements, structural features and combinations. Material for the study can be polu¬chat via print, scraping, puncture and rinsing the mouth for oral liquid sludge.

Smear mark was prepared as follows: student's gum nare¬zayut narrow columns with a working part of 5x5 cm and sterilized by boiling. Is Followed-site in the mouth with gauze and dried him with gum-imposes. Thereafter, the resultant material was printed onto a dry glass obezzhi-Renn, causing 4-8 prints. This way you can get only in surfactant, it separates the cells.

Scraping from different parts of the surface under study done with the help of me-metallic spatula or spoon kyuretazhnoy.

Punctate obtained by introducing into the study area the needle, put on dry ste-sterile syringe. Gaining material and placed on a glass slide, distribution, Breaking up with a thin layer with another slide.

Oral liquid precipitate obtained by successive rinsing in saline oral cavity. In special tsentrifugiru¬yut tubes, the supernatant was decanted and the pellet drop placed on a microscope slide. The method for producing a material can be YASYNIVSKY uses van leukocytes for determining active and for rapid diagnosis VJ retroviral diseases by immunofluorescence.

Detection of specific cellular elements during tsitologiche¬skogo study may have diagnostic value. So, akantolitiche-cal cells is small in size and have large, "monstrous" core surrounded by a bright perinuclear and dark blue zona¬mi peripheral cytoplasm.

Giant cells are formed by ballooning degeneration and acantholysis dystrophy cellular elements, manifested their merger, partial dis-fusion of cell membranes. They differ polymorphism large size. Contain from 2 to several hundred nuclei collected in the center, okra, are suspended in a blue or purple color.

Characterized by tumor cells and cell nuclear polymorphism forms ati pichnye fission frequently found in mitosis them. In tumor tissue, usually found "naked nuclei" due to the instability of the cytoplasm glue-current.

If nonspecific inflammation in formulations exhibit lymphocytes, neutrophils, plasma, epithelial cells are destroyed or imeyu¬schie conventional structure, microorganisms and other elements. Identification of these elements, in fact, has no direct diagnostic value, nevertheless conclude lab "picture nonspecific inflammation" yavlyaet¬sya insufficient. Detailed description of the cytological picture indicating the predominance of certain elements, events completed or perverted phagocytosis, the number of different cells at each stage in the dynamics of investigation-tion allows the dental specialist an idea of ​​the trends in the development process and the effectiveness of its treatment.