Local apparatus hypothermia during surgical interventions in the oral cavity

Abstract

Introduction. Dry ice cryotherapy is widely used in all areas of medicine, as this method can reduce swelling, hematoma. However, there are also disadvantages inherent in this method in the form of decompensation of the vascular bed, thereby going beyond the reserve forces of the body. Because of this, it is relevant to develop and apply the method of «soft» sequential cooling of the target area, for a more consistent spastic reaction of the vascular bed. In this clinical study, the technique of local hardware hypothermia was applied, which made it possible to reduce the likelihood of undesirable local decompensatory reactions from the body. Purpose. Clinical rationale for the use of local hardware hypothermia in the postoperative period in patients after complex extractions of 3 molars.Materials and methods. We studied 60 subjects diagnosed with retention and dystopia of the third molars of the n/h (30 control, 30 experimental groups). The experimental group after surgical interventions underwent PAH for 60 minutes with a target temperature of 18°C once, the control group received cryotherapy with an ice pack for 15 minutes (3 minutes exposure, 3 minutes rest 5 times). PAH was performed using the ViTherm apparatus (TsTKh Skolkovo, Moscow). The evaluation criteria in the study were: the type of wound healing, the presence of pain, swelling, lockjaw and discomfort, the use of NSAIDs, the presence of complications. The results of the study were entered into a table, with further statistical comparative analysis. For comparison, the Chi-square test with Yates correction was used. Results. In the control group, edema was observed in 100% of cases, and in the experimental group in 87%. Discomfort was felt by 87% and 83% of patients in the control and experimental groups, respectively. There were no complications in the experimental group, and 17% of patients in the control group (p=0.06). Pain was felt by 100% of patients in the control group and only 60% in the experimental group (p=0.0004). The intake of NSAIDs was 97% and 73%, respectively, in the control and experimental groups (p=0.03). In the experimental group, 73% of patients healed according to the primary type, and in 27% according to the secondary type. In the control group, primary healing occurs in 30% of cases, and secondary in 70% (p=0.002). In the control group, complications were observed in the form of alveolitis on the 3rd day after surgery (control n=5). 3 patients did not receive an injection of DMZ in the postoperative period at the request of the patient. In 31 patients the wound healed by primary intention (control n=9, experimental n=22), in 29 patients the wound healed by secondary intention (control n=20, experimental n=9), collateral edema was visually observed in 56 patients (control n=30 , experimental n=26). 48 patients complained of pain (control n=30, experimental n=18), discomfort when eating and talking, opening the mouth in 46 (control n=25, experimental n=21); 9 patients did not take NSAIDs (control n=1, experimental n=8). Conclusion. According to the statistical analysis and the results of the study, it can be said that the use of PAH in the postoperative period in patients after complex removal of 3 molars in the lower jaw reduces the likelihood of postoperative complications in the experimental group by 100%, pain by 40%, edema by 13%, the likelihood of secondary healing by 73%, trismus and discomfort by 17%, NSAIDs by 27% compared with the control group.