Chepurnyi Y. Clinical and experimental study of the complex treatment of the zigoma and orbiatal defects and deformities

The dissertation presents a theoretical background and practical solution of an actual scientific problem - increasing the efficacy of treatment of patients with defects and deformities of the zygomatic complex and orbit, reducing the frequency of postoperative complications and rehabilitation time by clinical and experimental substantiation of a new concept of their complex treatment using digital technologies and achievements of regenerative medicine. The dissertation is devoted to a complex estimation of topographic and anatomical features of defects and deformations of an orbit and zygomatic complex, to improvement of reconstruction procedures, based on application of CAD/CAM solutions, combined with neural crest derived stem cells influence to reparative regeneration of the orbital soft tissues. In accordance with the objectives, the work was performed in several stages, the first of which analyzed the effectiveness of traditional treatment protocols, their inherent shortcomings and the causes of unsatisfactory results. At the next stage, treatment modalities, based on CAD/CAM solutions, were developed, and their clinical effectiveness in the treatment of defects and deformations of the zygomatic complex and orbit was proved. In addition, an experimental study of the neural crest derived stem cells influence on reparative regeneration of the orbital soft tissue content was performed. At the final stage, a strategy of complex treatment of the zigoma and orbital defects and deformations was developed. It involves the choice of reconstruction method and the optimal period for surgery depending on the etiology, topographic and anatomical features of defects and deformations, including the use of applied CAD/CAM solutions for accurate orbit shape and the position of the zygomatic complex reconstruction, as well as providing optimal conditions for the reparative regeneration of soft tissues content of the of the orbit. The novelty of the work is in the proposal of new algorithms for the orbit and zygomatic complex reconstruction with application of patient-specific implants and surgical guides. The influence of autologic neural crest derived stem cells on the reparative regeneration of various types of orbital soft tissues was investigated. For the first time, the possibilities of automated systems for CAD procedures during design and manufacturing of patient-specific implants and endoprostheses were evaluated and their clinical efficacy was determined. On the basis of experimental research, the unique algorithm of clinical, therapeutic application of autologous neural crest stem cells was developed. Based on the study of long-term treatment results and the degree of functional recovery of patients, a new strategy for comprehensive treatment of patients with defects and deformities of the orbit and zygomatic complex was developed and scientifically substantiated. The obtained results were implemented in practice of maxillofacial departments of Ukraine. Clinical results have shown that the study solves an important scientific problem by reducing the incidence of postoperative complications and rehabilitation time in patients with defects and deformities of the zygomatic complex and the orbit.