Complex approach to pathogenetic therapy of patients with lower jaw fractures and their complications

Background/objectives: mandibular fractures and their purulent-inflammatory complications represent significant challenges in maxillofacial surgery.

This study aims to evaluate the effectiveness of a comprehensive pathogenetic therapy in optimizing treatment outcomes for such conditions. Special attention is given to microbial contamination, oral and systemic dysbiosis, and their impact on the development of post-traumatic complications.

Methods: A total of 231 patients with mandibular fractures were analyzed. The patients were divided into two groups: one received traditional therapy (Furacilin, Chlorhexidine, Bifidumbacterin, and standard surgical fixation), while the other underwent a specialized treatment regimen, including Serrata, Sextophag, Azithromycin, and Florbiolact. Microbiological studies were conducted to determine microbial sensitivity to therapeutic agents. Radiological diagnostic methods, including computed tomography (CT) and magnetic resonance imaging (MRI), were used to assess fracture characteristics and treatment dynamics.

Results: the specialized treatment group demonstrated a significant reduction in purulent-inflammatory complications, such as osteomyelitis and phlegmons, compared to the traditional therapy group. By day 21, dysbiosis in the oral cavity was nearly eliminated, and indicators of local immunity (e.g., lysozyme levels and secretory immunoglobulin A) showed substantial improvement. In addition, patients receiving specialized therapy experienced faster resolution of pain and inflammation, with a decrease in temporary disability duration.

Conclusions: the findings confirm that the use of advanced pathogenetic therapy, which combines antimicrobial, probiotic, and enzymatic agents, enhances the treatment of mandibular fractures and reduces the risk of complications. This integrated approach emphasizes the importance of targeted and multidisciplinary strategies in maxillofacial surgery for achieving optimal clinical outcomes. 

1. Rakhimov Z.K., Nazarov J.S.E. Immunocorrection of post-traumatic inflammatory complications in patients with mandibular fractures. World Journal of Pharmaceutical Research, Vol. 9, Issue 9, 2020. pp. 105–116.

2. Rakhimov Z.K., Mahmudov J.K., Pulatova Sh.K. Effectiveness of complex treatment of acute odontogenic inflammatory diseases of the maxillofacial region. Biology and Integrative Medicine, 2019, Issue 3, pp. 105–115.

3. Zhang, F. Clinical and laboratory justification for the effectiveness of mandibular immobilization in fractures using fixed orthodontic techniques (Abstract of dissertation, St. Petersburg, 2012).

4. Rakhimov Z.K. Characterization of microbial sensitivity to specific drugs in vitro. Journal of Natural Remedies, Great Britain, 2021, Issue 1(1), pp. 124–128.

5. Lepelin A.V. Pathogenetic mechanisms of reactive inflammation, reparative osteogenesis, and complications in mandibular fractures (Abstract of dissertation, Moscow, 2018).

6. Rakhimov Z.K., Mahmudov J.K., Pulatova Sh.K. Modern approaches to the complex treatment of acute odontogenic inflammatory diseases of the maxillofacial region. New Day in Medicine, Scientific and Abstract Journal, 2019, Issue 2(26), pp. 265–267.

7. Rakhimov Z.K., Mahmudov J.K., Pulatova Sh.K. Modern approaches to the complex treatment of acute odontogenic inflammatory diseases of the maxillofacial region. Biology and Integrative Medicine, 2019, Issue 3, pp. 79-89.

8. Rakhimov Z.K., Mahmudov J.K., Pulatova Sh.K. Modern approaches to the complex treatment of acute odontogenic inflammatory diseases of the maxillofacial region. Proceedings of the Republican Scientific-Practical Conference on “Actual Problems of Dentistry”, 2019, pp. 158–160.

9. Rakhimov Z.K., Pulatova Sh.K. Long-term results of complex treatment in patients with traumatic osteomyelitis after mandibular fractures. Stomatologiya. Scientific and Practical Journal, Tashkent, 2018, Issue 4(73), pp. 15–18.

10. Rakhimov Z.K., Khamitova F.A., Kambarova Sh.A. Clinical features in mandibular fractures. Academicia and International Multidisciplinary Research Journal, 2019, Issue 22, pp. 101–105.

11. Rakhimov Z.K., Khamitova F.A., Kambarova Sh.A., Pulatova Sh.K. Experience in the treatment of patients with odontogenic jaw cysts. European Science Review, 2018, Issues 11–12, pp. 201.

12. Rakhimov Z.K., Khamitova F.A., Kambarova Sh.A., Pulatova Sh.K. Complex treatment of pain dysfunction syndrome of the temporomandibular joint. European Science Review, 2019, Issues 3–4, pp. 123–124.

13. Rakhimov Z.K., Sulaymanov S.F. Influence of Wobenzym on local immunity in patients with mandibular fractures. Stomatologiya, 2015, pp. 42–45.

14. Rakhimov Z.K., Pulatova Sh.K., Kambarova Sh.A. Features of the effectiveness of treatment for inflammatory complications of mandibular fractures and therapy principles. New Day in Medicine, 2015, pp. 61–65.

15. Rakhimov Z.K., Badriddinov B.B. Immunological effects of enzyme therapy in mandibular fractures. Youth, Science, Medicine, Proceedings of the 61st All-Russian Interuniversity Student Scientific Conference with international participation, dedicated to the 70th anniversary of the Great Patriotic War, 2015, pp. 409–410.

16. Rakhimov Z.K., Pulatova Sh.K., Safarova M.S. Long-term results of using Wobenzym in the complex treatment of purulent-inflammatory complications of mandibular fractures. Proceedings of the All-Russian Scientific-Practical Conference “Actual Issues in Dentistry”, Ufa, 2015, pp. 183–186.

17. Rakhimov Z.K., Pulatova Sh.K., Zamonova G.Sh. Improving the scheme of pathogenetic therapy for complicated mandibular fractures. Herald of SMUS 74, Council of Young Scientists and Specialists, Chelyabinsk, 2015, Issue 2(9), pp. 77–83.

18. Rakhimov Z.K., Pulatova Sh.K., Kambarova Sh.A. Pathogenesis of purulent-inflammatory complications in mandibular fractures and therapy principles. Materials of the 11th Siberian Congress “Dentistry and Maxillofacial Surgery” with international participation, All-Russian Symposium “New Technologies in Dentistry”, Novosibirsk, 2016, pp. 189–195.

19. Rakhimov Z.K., Pulatova Sh.K., Kambarova Sh.A., Kuldasheva V.B. Some aspects of treatment for purulent-inflammatory complications in mandibular fractures using Wobenzym. Actual Problems in the Treatment and Prophylaxis of Dental Diseases, Bukhara, 2016, pp. 68–69.

20. Hamrayev S.J., Rakhimov Z.K. Evaluation of the functional state of vascular walls in patients with diseases of the salivary glands. New Day in Medicine, 3(35), 2021, pp. 10–14. [https://Cutt.ly/Smvhvbl]

21. Rakhimov Z.K., Pulatova Sh.K., Kambarova Sh.A., Kuldasheva V.B. Some aspects of treatment for purulent-inflammatory complications in mandibular fractures using Wobenzym. Actual Problems in the Treatment and Prophylaxis of Dental Diseases, Bukhara, 2016, pp. 68–69.

22. Hamrayev S.J. Complex treatment of patients with various forms of sialadenosis. Academic Research in Educational Sciences, 2021, Vol. 2, Issue 9, pp. 858–863.

23. Temurov F.T., Ashirbekov G.K., Suyunbay D.M., Adilbek Zh.A. Features of diagnostic and treatment methods for jaw fractures in children. Herald of the West Kazakhstan Medical University, “Innovations in Dentistry: Today, Tomorrow”, Vol. XIX, Aktobe, Kazakhstan, 2022.

24. Temurov F.T., Masadykov Sh.G. Features of diagnostic and treatment methods for jaw fractures in children. Actual Problems in Dentistry and Maxillofacial Surgery, Tashkent, 2021.

25. Rakhimov Z.K., Pulatova Sh.K., Zhuraev Zh.M., Iskandarov. Effectiveness of enzyme therapy in patients with mandibular fractures with complicated course. Proceedings of the First Interregional Dental Conference of Students and Young Scientists with International Participation, Russia, 2015, pp. 69.

26. Rakhimov Z.K., Sulaymanov S.F., Olimov S.Sh. Immunological effects of enzyme therapy in mandibular fractures. Actual Problems in Dentistry, Scientific-Practical Conference, Bukhara, 2017, pp. 95.

27. Rakhimov Z.K., Olimov S.Sh., Sulaymanov S.F. Use of serrata preparation in mandibular fractures. Actual Problems in Dentistry, Scientific-Practical Conference, Bukhara, 2017, pp. 96-97.

28. Rakhimov Z.K., Pulatova Sh.K., Saidova M.A. Surgical treatment of patients with widespread phlegmon of the maxillofacial region. Problems of Biology and Medicine, International Scientific Journal, 2017, Issue 2(95), pp. 102.

29. Rakhimov Z.K., Pulatova Sh.K., Safarova M.S., Ruzibaeva D.I. Longterm results of complex treatment in patients with traumatic osteomyelitis following mandibular fractures. Stomatologiya, 2018, Issue 4(73), pp. 15-19.

30. Rakhimov Z.K. Clinical features in mandibular fractures. Academicia and International Multidisciplinary Research Journal, 2019, Vol. 9, Issue 1, pp. 101–105.

31. Rakhimov Z.K., Saidova G.Sh. Features of immune status and possibilities for immunocorrection in post-traumatic inflammatory complications in patients with mandibular fractures. Series “Science” Medicine to Humanity: Contemporary Issues of Pharmacotherapy and Prescription of Drugs, Materials of the IV International Scientific-Practical Conference, 2020, Vol. 2, pp. 12–13.