Morozova M. Odontogenic abscesses and phlegmons: criteria of diagnosing of the course severity, treatment and prognosing of complications

Dissertation is aimed to the solvation of the scientific problem of stratification of patients with оdontogenic abscesses and phlegmons (OA and OP). The unifyed clinical criteria were determined and the scales for marks of the condition severity were worked out. It was determined that during hospitalization all patients with OA and OP had the increased markers of endotoxicosis and the functional activity of neutrophile granulocytes was increased. It was estimated that the absence of positive dynamics during the first days following the operation was the unfavourable prognostic sign. The studies revealed that patients with OP, accomponied with severe and extremely severe syndrom of systemic inflammatory reaction against the background of the increasing markers of endotoxicosis, develop functional and structural immune disbalance, which can be associated with gyperreactivity of neutrophile granulocytes or their hypo/ areactivity. There was drawn a conclusion that the traditional complex examination of the patients with a high risk of the development of complications should be accompanied with the studying of the dynamics of the most informative immunity parameters. The possible causes and mechanisms of occurence and development of odontogenic abscesses and phlegmons were analysed. The concept of endotoxin-dependent pathogenesis was worked out and suggested. The concrete schemes of treatment depending on the degree of the severity of the patient's condition were elaborated. They were aimed at the decrease of endotoxicosis and reduction of the neutrophile granulocytes activation.