Kushta A. Restoration of the function of oral cavity organs and the pharynx in patients with maxillofacial tumors, considering the pathogenesis of swallowing disorders (experimental and clinical study)

A new clinical and diagnostic complex has been developed, which objectively assesses the presence and intensity of pain syndrome, functional activity and potential opportunities for the recovery of neuromuscular complexes that take part in chewing food and the act of swallowing in patients in the perioperative period, which is new direction in clinical observations and diagnosis of functional disorders in the pre- and postoperative period in patients with malignant tumors of the oral cavity and oropharynx. For the first time, systematization of degrees of severity and objectification of clinical assessment of dysphagia of the oral cavity and oropharynx in postoperative defects was carried out. For the first time, the concept of the fascial-ligamentous case of the oropharynx was introduced as an anatomical structure that contributes to the act of swallowing. A new lingual-palatine reflex was identified as an essential factor in the act of swallowing. For the first time, a functional test with the use of two-color rubber bands and its evaluation during the formation of a food lump in the usual areas in patients with tumors of the oral cavity was proposed individually. For the first time, a method of ultrasound diagnosis of functional disorders of the neuromuscular complexes of the oral cavity for functional swallowing disorders was developed and successfully applied in the clinic. The use of ultrasound diagnostics for the first time made it possible to objectively assess the functional activity of the muscles of the tongue and the floor of the mouth, which contributed to the most accurate determination of the timing of the appearance of the ability to swallow and the completion of tube feeding with the transition of the patient to normal nutrition. Manifestations of psycho-emotional stress, which leads to a decrease in the quality of life in patients with tumors of the oral cavity and oropharynx in the pre- and postoperative period due to the severity of pain and difficulty swallowing, were monitored. The method of long-term postoperative conductive analgesia of the maxillofacial area in patients with tumors of the oral cavity and oropharynx in the postoperative period was developed and implemented in the clinic. A model of partial food deprivation was developed, which corresponds to the nutritional deficiency of patients in the clinic and can serve as a basis for further experimental studies of the influence of drugs and various factors against the background of alimentary dystrophy. For the first time, the effectiveness of the proposed scheme of combined clinical enteral nutrition on the processes of regeneration of postoperative wounds was experimentally proven on the model of partial food deprivation and confirmed in clinical conditions. A method of correction of the immunological properties of the oral cavity (non-specific local immunity) with the help of Lysozyme phytogel in patients with cancer of the oral cavity and oropharynx has been proposed and implemented. A new concept of complex treatment and rehabilitation of patients with malignant tumors of the oral cavity and oropharynx has been developed, which includes reconstructive operations, long-term postoperative conductive analgesia, the use of combined clinical general nutrition and Lysozyme phytogel in the oral cavity as an immunocorrector.