Vol 10, No 2 (2019)

Background. The prevalence of temporomandibular joint diseases covers about 40% of the population. The main place (from 70 to 82%) among these diseases is occupied by the so-called intracapsular disorders of the temporomandibular joint (TMJ). The lack of consensus on the use of treatment methods and clear protocols for the rehabilitation of patients with intracapsular TMJ disorders was the basis for the conduct of this study.

Objective. The purpose of the study was to analyze the treatment effectiveness in patients with intracapsular disorders of the temporomandibular joint using the complex of pathogenetically substantiated conservative and surgical methods. Methods. The research included 43 patients with complaints to pains and dysfunction of TMJ. Everything fulfilled the uniform protocol of inspection. Depending on disease degree to patients were assigned or a course of conservative treatment with use splint therapy, or surgical correction of defect.

Results. After analyzing the dynamics of patient treatment in the framework of this study, it was found that surgical correction of intracapsular disorders of the temporomandibular joint was effective in all patients examined by us.

Conclusion. To maintain a long-term stable result, this group of patients is shown orthodontic-orthopedic rehabilitation, with the goal of creating and maintaining correct occlusal relationships.

Background. One of the most difficult in the clinical practice patients groups are patients with orofacial pain. A possible cause of pain in the face and mouth can be stylohyoid syndrome or Eagle syndrome. The clinical manifestations of the syndrome are observed in only 4-10.3% of cases among the total number of cases of elongated hyoid processes.

Objective. To develop criteria for the choice of the surgical access for a safe removal of the hyoid process depending on its anatomy.

Methods. In patients with the symptoms of stylohyoid syndrome, in the case of detecting an extended hyoid process during the clinical study, its removal was performed via an intraoral route (n=3). In the other patients (n=10) the removal was performed via an external access along the first cervical fold, or through the vertical retroaural access.

Results. In patients with stylohyoid syndrome, we observed a high efficiency of the surgical treatment and rather short times of postsurgical rehabilitation, that significantly improved the quality of life.

Conclusion. In our opinion, the surgical access through the first cervical fold is the most convenient way both from the technical viewpoint and from the viewpoint of a minimal cosmetic defect.

Background. Myofascial pain syndromes are the most frequent companions of acute and chronic lumbar pain, and the problem of eliminating pain syndrome should be considered in terms of developing an effective program for diagnosis, treatment, physical rehabilitation and its accessibility for all categories of the population.

Аim. To evaluate the effectiveness of complex application of osteopathy and shock wave therapy in the rehabilitation treatment of patients with MPS.

Materials and methods. 120 patients with myofascial pain syndrome (MPS), mean age 49.65±0.89 years, mean disease duration 2.29±0.18 years were examined.

Results. With the combination of standard therapy, osteopathic treatments and extracorporeal shock wave therapy (ESWT), the severity of pain on the scale of visual analogue scale (VAS) after 12 months of observation decreased by an average of 77.1%, in the group of standard therapy in combination with ostepathic treatment, 62.2%, in group of standard therapy and ESWT by 52.8% and in the group of standard therapy by 30.9%. According to the 12-month prospective follow-up, the maximum positive effect on the severity of MPS and emotional disorders was noted in the combination of standard therapy, osteopathic treatments and ESWT.

Conclusion. The combination of these methods of treatment can be considered as a method of choice in complex programs of rehabilitation treatment of patients with MPS.

Introduction. In urgent interventional cardiology practice, combinations of drug-eluting stents and bare-metal stents are sometimes forced to treat extended stenosis in a clinic-dependent artery.

Objective. A comparison of long-term results of treatment of patients with coronary heart disease and multivessel coronary lesions, which performed stenting of the clinic-dependent artery by two successive partially overlapping stents using stents of the 3rd generation with drug coating or a combination of the 3rd generation stent with drug coating and a bare-metal stent for acute coronary syndrome without St segment elevation and later — complete functional myocardial revascularization by endovascular method.

Methods. The minimum overall length sentiremos section was made 55 mm. In main group included 32 patients for whom revascularization clinic-dependent artery performed endovascular intervention with the use of 2 stents 3-generation drug-coated sirolimus and biodegradable polymer implanted overlap. In 30 patients (control group), clinic-dependent artery revascularization was also performed by a combination of implanted overlap stents, one of which was a 3rd generation stent with sirolimus drug coating and biodegradable polymer, and the other was a bare-metal stent. There were no statistically significant differences between the groups in clinical, demographic and operational characteristics.

Results. The analysis of the results revealed a significant difference between the groups in the frequency of repeated revascularization of the target artery, which were observed more often in the control group.

Conclusion. When performing an extended stenting of the clinic-dependent artery in patients with acute coronary syndrome without ST segment elevation, overlapping of the drug-coated stent and the bare-metal stent should be avoided, since the antirestenotic effect of the drug-coated stent is leveled when overlapping with the bare-metal stent, but this strategy can be used in case of full coverage of the stenotic lesion or closure of the dissection.

The article presents diagnostic criteria, comparative characteristics of short-lasting unilateral neuralgiform headache attacks, including short-term unilateral neuralgic headaches with conjunctival injection and lacrimation (SUNCT) and short-term unilateral neuralgic headaches with cranial autonomic symptoms (SUNA), differential diagnosis with trigeminal neuralgia.

The modern information on the epidemiology, pathogenesis, clinical manifestations, diagnosis and pain management in HHV-3-associated neuro-infection is presented. The criteria for the phased diagnostics and approaches to the rational therapy for shingles and postherpetic neuralgia are presented. The conditions aimed at the prevention of pain due to the damage to peripheral nervous system and stroke due to HHV-3-associated vasculopathy are discussed.

The diagnostics of chronic pelvic pain is a complex interdisciplinary problem. It requires a thorough and detailed clinical examination involving clinicians of various specialties. Neuropathic pain in the structure of chronic pelvic pain is present in 1/3 of patients, which call the need for a close cooperation between the urologist and neurologist at all the stages of the management of these patients. The presented clinical analysis demonstrates an algorithm for such an interdisciplinary interaction, which provides a care for a patient with this complex and debilitating pathology.

Background. Periarticular cysts of the facet joint, due to their rare occurrence, often slip away from the attention of clinicians. However their formation and progression may cause compression of vascular-neural structures with subsequent manifestations of severe neurological disorders.

Description of the clinical case. We present a rare clinical case of surgical treatment of a periarticular cyst of the facet joint. A comprehensive examination of the patient S. revealed: Dorsopathy with degenerative spinal canal stenosis at L_V-S_I level; spondyloarthrosis; periarticular facet cyst at L_V-S_I level on the left; radiculopathy L_V on the left, in the acute stage; pronounced pain and musculo-tonic syndrome. Complaints of the patient: constant pain in the lumbar spine, extending to the left lower extremity and aggravating when walking at a distance of 50-100 meters; feeling numb when walking on the plantar surface of the left foot. When examining the local status, a forced posture with a bowed head and torso forward was noted; smooth lumbar lordosis and antalgic right-sided scoliosis; tension of paravertebral muscles. Neurological examination revealed L_Vradiculopathy on the left with moderate paresis of the extensor muscles of the left foot and ipsilateral Lasègue's positive test. MRI examination revealed spinal canal stenosis, facet joint cyst at the level of L_V-S_I with dimensions of 14×8×8.5 mm. An operative intervention was performed: reconstructive decompressive-stabilizing spinal surgery with a single block removing the articular facet with a periarticular cyst at the left L_V-S_I level with subsequent posterior transpedicular fixation of the vertebral motor segment. Two months after the operation, complete medical and social rehabilitation of the patient was achieved. No complaints.

Conclusion. In case of compression of a periarticular cyst of vascular-neural structures with severe neurological disorders, surgical treatment with the cyst removal is recommended.

According to WHO, about 20% of population suffers from chronic pain. First pain clinics whose purpose was to provide care to such kind of patients started to appear in 1961. There are reportedly about 15 multidisciplinary pain clinics in Russia nowadays.The development of this medical branch in Russia is restrained by several factors: the absence of legal basis for pain specialists, the lack of educational programs, clinical standards and recommendations, as well as absence of state medical insurance rates for chronic pain care.