Comprehensive rehabilitation of patients after injuries of the facial region: interaction of dentists and surgeons

Aitadzh R. Gadzhalieva, Elizaveta R. Anzorova, Medina V. Sa-yarsanova, Alisa A. Gostyaeva. Comprehensive rehabilitation of patients after injuries of the facial region: interaction of dentists and surgeons. Cardiometry; Issue No. 33; November 2024; p. 102-109; DOI: 10.18137/cardiometry.2024.33.102109; Available from: сomprehensive-rehabilitation-patients

Injuries to the maxillofacial region are serious medical problems that can cause both functional disorders (difficulty breathing, chewing, speech) and significant aesthetic defects that significantly worsen the patient’s quality of life. The maxillofacial region has a complex anatomical structure, including bone structures, soft tissues, nerve and vascular elements, damage to which requires a multidisciplinary approach to treatment[1].

Almost every patient who has undergone surgery on the maxillofacial region needs the comprehensive supervision of doctors of various profiles. Damage to this area is usually accompanied by impaired functions of breathing, swallowing, chewing, and facial aesthetics. Such patients are observed by maxillofacial surgeons, orthopedic dentists, orthodontists, speech therapists, physiotherapists [1]. The consequences of injuries to the maxillofacial region require many years of rehabilitation, so the topic under consideration remains highly relevant.

The recovery of patients after surgery includes a system of medical measures designed to prevent possible complications, relieve pain, eliminate mobility limitations, accelerate recovery, correct the psy- cho-emotional state and return the patient to a full life or improve his quality of life.

Comprehensive rehabilitation of patients after injuries to the maxillofacial region is a multi-stage process that includes both surgical correction and dental rehabilitation. One of the key aspects of successful treatment is the close interaction between maxillofacial surgeons and dentists. Such cooperation makes it possible to take into account both the functional and aesthetic needs of the patient at all stages of treatment.

Surgical interventions are aimed at restoring the anatomical integrity of tissues and bone structures, eliminating deformities, as well as restoring lost functions. In turn, dental rehabilitation plays a crucial role in restoring occlusion, normalizing bite and restoring dentition, which also affects chewing functions and facial aesthetics.

Modern technologies such as 3D modeling and digital planning make it possible to plan surgical interventions and dental procedures more accurately, which significantly improves the prognosis of treatment. In addition, the use of biomaterials and dental implants opens up new opportunities for the complete reconstruction of both bone and soft tissue structures.

Thus, an integrated approach, including the joint work of surgeons and dentists, is necessary to ensure optimal results in the rehabilitation of patients with injuries of the maxillofacial region.

MATERIALS AND METHODS

In preparing this article, articles and monographs were analyzed within the framework of the research topic, as well as a number of scientific research methods were used. Thus, a systematic analysis of scientific publications, monographs and articles on maxillofacial surgery, dentistry, orthopedics and rehabilitation was carried out, which allowed us to obtain information about modern approaches and methods of treatment, innovative technologies, as well as substantiation of the need for an interdisciplinary approach [2].

In addition, the experience of successful rehabilitation of patients was summarized on the basis of clinical data collected in scientific and medical centers, for example, cases of interaction between dentists and surgeons, analysis of their joint work and results were studied.

Also, using the comparative method, various approaches to the treatment of injuries of the maxillofacial region were compared, depending on the type of injury, the level of damage and the methods used (conservative and surgical methods, traditional and innovative techniques), which made it possible to identify the most effective strategies. Another area of activity was the classification and systematization of injuries of the maxillofacial region by severity, anatomical structures and types of injuries, as well as the systematization of data on diagnostic methods, surgical intervention and dental rehabilitation.

The use of these methods made it possible to study in more depth the problem of rehabilitation of patients with injuries of the maxillofacial region and demonstrate the importance of an interdisciplinary approach in the practice of specialists in the field of medicine.

RESULTS

The key aspects of rehabilitation of patients after injuries to the maxillofacial region include several important steps aimed at restoring lost functions and aesthetics of the face. The restoration of chewing function is one of the key aspects of the comprehensive rehabilitation of patients after injuries to the maxillofacial region, since chewing plays an important role in the digestive process and the general state of human health. Violation of this function not only makes it difficult to eat, but can also lead to disruption of the gastrointestinal tract, poor nutrition, weight loss and general body tone [3].

After injury, chewing function can be impaired for a number of reasons, including fractures of the jaw bones, loss or damage to teeth, displacement of the dentition, as well as damage to the muscles and joints responsible for chewing movements. The restoration of chewing function requires a comprehensive approach, including both surgical treatment and orthopedic and dental correction.

If the injury has led to a fracture or significant deformation of the jaw, reconstruction using osteosynthesis (fixation of bones with metal plates and screws) or the use of bone grafts is necessary. This helps to restore the normal anatomical shape and stability of the jaw bone, which is the basis for the subsequent restoration of chewing functions.

Loss or damage to teeth makes chewing much more difficult. Depending on the degree of damage, various recovery methods can be used: installation of dental implants, removable or non-removable pros-theses, bridge structures. Implants are the preferred method in this case, as they allow you to restore not only the appearance of the teeth, but also their full functionality.

After injuries, the position of the teeth may change and the bite may be disrupted, which negatively affects the quality of chewing. Orthodontic methods, such as braces or aligners, help to correct the position of the teeth, restore the correct bite and ensure an even distribution of the chewing load [4].

Injuries can damage or dislodge the TMJ, which will lead to pain, discomfort and disruption of the normal opening and closing of the mouth. Treatment may include manual therapy, physical therapy, medication, or surgical correction of the joint.

Injuries to the muscles responsible for chewing movements (chewing, temporal, pterygoid muscles) also require restoration. Rehabilitation may include physical exercises, massage, and physiotherapy procedures aimed at strengthening and restoring normal muscle function [5].

In some cases, especially with severe injuries to the jaw bones, temporary splints or orthopedic structures can be used to stabilize and restore chewing function during treatment.

Effective restoration of chewing function requires coordinated work of maxillofacial surgeons, dentists, orthopedists and orthodontists. Surgical intervention should be considered taking into account subsequent orthopedic and orthodontic rehabilitation. For example, after the restoration of the jaw bones by surgeons, dentists and orthodontists begin work on restoring the bite and dentition, which ultimately allows the patient to return to normal chewing and eating.

Thus, the restoration of chewing function is a complex process that requires an individual approach to each patient and the use of modern technologies that ensure high accuracy of treatment and improve the quality of life of the patient.

Bite correction is an important aspect of rehabilitation after injuries to the maxillofacial region, since proper closure of the dentition (occlusion) directly affects functions such as chewing, speech, breathing and even facial aesthetics. Injuries to the jaws, teeth, or maxillofacial bones can lead to dislocation of the dentition, malocclusion, or even complete loss of teeth, which requires a comprehensive approach to restore normal occlusion [6].

In case of injuries to the lower or upper jaw, their displacement or improper bone fusion often occurs, which leads to a change in the location of the denti- 104 | Cardiometry | Issue 33. November 2024

tion. Tooth loss or damage as a result of injury also leads to a violation of the symmetry of the dentition and the distribution of chewing load.

Joint injuries can disrupt its normal operation, causing improper closing of teeth and discomfort when opening and closing the mouth. In case of injuries, the muscles and ligaments involved in chewing may change, which also affects the correctness of the bite [7].

The process of bite correction after injuries includes several stages that require coordinated work by various specialists, such as maxillofacial surgeons, orthodontists and orthopedic dentists. The diagnosis of malocclusion begins with a clinical examination and the use of various imaging methods (X-ray, CT, MRI), which allow you to assess the degree of displacement of the jaws, dentition and damage to the TMJ. Special occlusion tests and methods of recording movements of the mandible are used to accurately identify problems in occlusion.

If malocclusion is associated with fractures of the jaws, surgical intervention is aimed at their restoration. Osteosynthesis methods are used (fixing bones with plates and screws), which allows you to return the jaws to the correct position. In case of damage or displacement of the TMJ, surgical correction of the joint may be required to restore its normal function and, as a result, correct bite [8].

After surgical correction of the bite, orthodontic treatment is often required to accurately align the dentition. Various orthodontic devices are used, such as braces, aligners (mouthguards), which gradually adjust the position of the teeth.

The duration of orthodontic treatment may vary depending on the degree of damage and the characteristics of the patient, but usually this process takes from several months to two years [9].

In cases where an injury has led to the loss of teeth, it is necessary to restore the dentition. This may include the installation of dental implants or prostheses. Implantation is the preferred method, as it allows you to restore the chewing function and aesthetic appearance of teeth. In some cases, bridges or removable structures are used if the installation of implants is impossible for some reason.

Splinting of teeth can be used as a temporary measure to stabilize the bite and prevent tooth displacement during the recovery period. This may be necessary in cases of significant jaw fractures, when support is required until complete healing.

Modern orthodontics offers several effective methods of bite correction that can be applied after the surgical stage of treatment. Traditional metal or ceramic braces are one of the most effective methods to correct tooth misalignment. They create constant pressure on the teeth, gradually moving them to the correct position.

Transparent mouthguards such as Invisalign are gaining popularity as a more aesthetic and convenient way to correct bite. They may be especially useful for patients with mild to moderate occlusion disorders. Lingual braces are installed on the inner surface of the teeth, which makes them almost invisible. This method is effective in complex forms of tooth displacement, while maintaining an aesthetic appearance [10].

Bite correction is also closely related to the restoration of normal functioning of the temporomandibular joint (TMJ). Joint injuries can lead to problems such as difficulty opening the mouth, clicks, and pain when chewing. Treatment of TMJ may include:

Bite correction after injuries to the maxillofacial region requires an interdisciplinary approach, since it combines surgical, orthodontic and dental treatment. Orthodontic procedures, as a rule, take place after surgical stabilization of the jaw bones, which requires close cooperation of specialists to coordinate the stages of treatment. Orthopedic dentists play an important role in restoring dentition and occlusion, as well as in prosthetics of lost teeth [11].

Effective bite correction allows patients not only to restore full-fledged chewing function, but also to improve facial aesthetics. Normalization of occlusion contributes to the uniform distribution of the chewing load, which prevents further problems with the teeth, such as enamel wear or periodontal disease. Restoring the correct bite also reduces the load on the TMJ, which reduces the risk of chronic pain and discomfort in the future.

Thus, bite correction is an important stage in the rehabilitation of patients after injuries to the maxillofacial region. Modern technologies and treatment methods make it possible to achieve high results in restoring occlusion and chewing function, which improves the patient’s quality of life.

Reconstruction of soft tissues and bone structures of the maxillofacial region is one of the most difficult and important aspects of comprehensive rehabilitation of patients after injuries. As a result of injury, both the bones of the jaw and skull can be damaged, as well as the surrounding soft tissues: muscles, skin, nerves and blood vessels. These injuries can lead to serious functional and aesthetic disorders, which makes reconstructive surgery key to restoring normal facial anatomy and functions [12].

Reconstruction of facial bone structures is a complex and multi—stage process that requires the use of various surgical methods and modern technologies. Osteosynthesis is a method of surgical fixation of bones using metal plates, screws or wire. This method is used for fractures of the jaws, zygomatic bones, orbits and other bone structures of the face. The purpose of osteosynthesis is to restore the correct position of bone fragments and stabilize them for fusion. Modern titanium plates have high biocompatibility and allow bones to be securely fixed in the desired position, ensuring minimal risks of complications. In cases where injury has led to the loss of significant amounts of bone tissue, bone transplantation is used [13].

Modern technologies, such as 3D modeling and printing, make it possible to accurately reproduce the anatomical features of the patient and create individual implants to restore bone structures. This is especially important in complex injuries, when high precision is required to restore facial symmetry and functionality. 3D printing is also used to create surgical templates that allow the surgeon to plan the intervention in advance and minimize the risks of errors during surgery.

The restoration of soft tissues after injuries is also an important part of rehabilitation, since facial movements, chewing and external aesthetics of the face depend on the condition of muscles, skin and ligaments. After injuries to the maxillofacial region, the primary task of the surgeon is to close the wounds and restore the integrity of the skin. For this, plastic surgery techniques can be used, such as flap operations (moving tissues from other parts of the body) and applying cosmetic sutures to minimize scars [14].

In case of damage to the chewing and facial muscles, operations are performed to restore muscle function. This may include stitching muscles or transplanting muscle tissue from other parts of the body to restore facial movements. The restoration of chewing function is directly related to the rehabilitation of muscles, as they play a key role in jaw movement [15].

One of the key points of reconstruction is the restoration of normal blood supply and sensitivity of the damaged areas of the face. Microsurgery allows you to repair damaged blood vessels and nerves, which contributes to better tissue healing and restoration of sen-

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sitivity. In case of significant damage to nerve endings, nerve transplantation or the use of neuroprostheses may be required to partially restore lost functions.

After wound healing, noticeable scars and deformities often remain, which can negatively affect the patient’s appearance. Various techniques are used to correct scars, including laser therapy, steroid injections and plastic surgery to excise scars. An important task of the surgeon is to restore the symmetry of the face, which is especially critical for improving the appearance of the patient and his psychological state.

Modern technologies and materials play an important role in the reconstruction of both bone structures and soft tissues. The use of biocompatible materials (titanium, polymers) to create implants and fixation structures minimizes the risk of rejection and accelerates the healing process.

The use of stem cells to stimulate the regeneration of bone and soft tissue tissue opens up new opportunities for the restoration of damaged areas after injury. Computer technologies and 3D modeling make it possible not only to accurately plan operations, but also to create individual solutions for each patient, which improves the results of reconstruction [16].

Effective reconstruction of soft tissues and bones requires close cooperation of various specialists: maxillofacial surgeons, plastic surgeons, dentists, orthodontists and other doctors. The coordination of their work provides a comprehensive approach to restoring the anatomy and functions of the face, which significantly increases the success of rehabilitation.

Successful reconstruction of soft tissues and bones allows not only to restore the functions of chewing, speech, facial expressions and breathing, but also to significantly improve the aesthetic appearance of the patient. This, in turn, has a positive effect on the patient’s psychological state and quality of life, helping him to return to normal social and professional activities [17].

Thus, the reconstruction of soft tissues and bones is a multi-stage process that requires the use of modern technologies and highly qualified work of an interdisciplinary team to achieve the best results in the rehabilitation of patients with injuries of the maxillofacial region.

Modern technologies and innovative materials play a critical role in the rehabilitation of patients after injuries to the maxillofacial region. These achievements make it possible to significantly improve the results of 106 | Cardiometry | Issue 33. November 2024

treatment, increase safety and comfort for the patient, as well as optimize the processes of restoring facial functions and aesthetics.

The use of specialized software for planning surgical interventions allows you to create three-dimensional models of the patient’s anatomy based on computed tomography (CT) or magnetic resonance imaging (MRI) data. This allows the surgeon to assess the complexity of the operation in advance and choose the most appropriate methods and techniques.

3D modeling helps to visualize changes in anatomy and predict the outcome of the intervention, which significantly increases the accuracy of operations and reduces the risks of complications.

3D printing technology is used to create customized surgical templates that help the surgeon perform operations with high precision. Templates can be made based on preoperative models, which allows precise positioning of implants and osteosynthesis.

3D printing also allows the production of customized implants that are ideally suited in shape and size to the patient’s anatomy. This is especially important in complex injuries, when a high degree of individualization is required.

Virtual reality allows surgeons to train on three-dimensional models, and augmented reality can be used during surgery to display critical information directly in the surgeon’s field of view, which increases the safety of the intervention. The use of biocompatible materials to create implants and fixing structures is becoming the standard in maxillofacial surgery. Titanium, polymers and composite materials have high strength and corrosion resistance, which makes them ideal for use in human conditions.

Modern biomaterials also have properties that promote tissue regeneration. Some of them can secrete growth factors that accelerate tissue healing and repair. The development of new synthetic materials such as hydroxyapatite and tricalcium phosphate, which mimic the structure and functions of natural bone tissue, makes it possible to effectively compensate for bone defects. These substitutes have good osseointe-gration and promote the formation of new bone tissue.

The use of autografts and allografts, as well as materials based on collagen and other organic compounds, improves the results of reconstruction, allowing to achieve a full restoration of anatomical integrity.

Laser surgery is increasingly being used in maxillofacial surgery. Lasers can minimize injuries to sur- rounding tissues, reducing healing time and reducing the risk of infections. They are used for resection of soft tissues, removal of tumors and correction of scars. In addition, lasers can be used to stimulate tissue healing and repair, as they increase blood supply and activate cellular processes.

Stem cells represent a promising direction in the field of regenerative medicine and tissue repair. Their use in the reconstruction of the maxillofacial region can help in the treatment of complex defects, as well as in stimulating the regeneration of bone and soft tissue tissue. Stem cells can be obtained from a variety of sources, including adipose tissue, bone marrow, and teeth. They are able to differentiate into different cell types, which makes them ideal for repairing damaged tissues.

Injections of growth factors such as platelet concentrate (PC) and morphogenetic proteins (MGP) can significantly improve the healing process. These substances contribute to the activation of cellular processes, which increases the rate of tissue repair and their functional properties. The use of biological factors and regenerative approaches opens up new horizons for the treatment of complex injuries that were previously considered incurable.

Modern technologies allow you to create individual treatment plans that take into account the characteristics of each patient. The personalized approach includes the use of data on the patient’s health status, lifestyle and preferences, which increases satisfaction with treatment and improves results. The use of mobile applications and online platforms to monitor the patient’s condition and his interaction with doctors allows for more thorough monitoring of the recovery process, ensuring early detection of possible complications.

Modern technologies and materials have significantly changed the approach to rehabilitation of patients after injuries to the maxillofacial region [18]. Innovative methods of diagnosis, treatment and tissue repair allow us to achieve better results in restoring the functionality and aesthetics of the face. The use of 3D printing, biomaterials, laser technologies and regenerative medicine opens up new horizons in maxillofacial surgery, improving the quality of life of patients and their psychological state. An interdisciplinary approach and individualization of treatment become the basis for successful rehabilitation, which allows each patient to receive the most effective and safe treatment.

DISCUSSION

Treatment and rehabilitation of patients with acquired maxillofacial defects is one of the most urgent medical and social problems of modern dentistry. Large-scale and comprehensive rehabilitation measures are important in the system of specialized dental care, since OCD is often accompanied by serious aesthetic and functional disorders, which, in turn, limit the patient’s vital activity, lead to his inability to adapt to the social environment and cause deep socio-psy-chological problems. causes problems. Rehabilitation of patients with acquired defects of the upper jaw, which cause serious violations of vital functions such as breathing, swallowing, vocalization, speech and chewing, is especially difficult. To date, there is no clear concept of managing this category of patients by different specialists in joint activities [19].

The main attention of Russian specialists who conducted scientific research in this direction was focused on aspects of the problem related to surgery, however, clinical and organizational issues related to further orthopedic rehabilitation have been little studied. Also, little attention is paid to the organization of joint work of maxillofacial surgeons and dentists, their consistent and phased participation in rehabilitation activities, stages of examination and treatment.

One of the biggest problems of the orthopedic dental care system for patients with injuries of the maxillofacial region is the lack of an integrated approach to their rehabilitation. This problem has been identified on the basis of sociological research and expert opinion, and it is of great importance. An analysis of the available literature has shown that there is a shortage of information on the issues of comprehensive rehabilitation of such patients [20].

Patients with injuries to the maxillofacial region suffer not only from violations of vital functions (chewing, speech), but also from aesthetic defects. As a result, they develop deep mental problems. The above-mentioned patients go through several stages of adaptation to new living conditions: from physical and aesthetic adaptation to life with a prosthesis, to accepting their new and unusual situation. This circumstance increases the urgency of the problem of returning patients belonging to this category to everyday life, and also raises the question of the need to organize comprehensive rehabilitation of such patients. In this regard, both the dentist and the maxillofacial surgeon have a great responsibility[21].

An important task of the adaptation process is the problem of survival, combining the capabilities of an individual organism with the potential of the natural and social environment. Social adaptation is a person’s ability to live in harmony with a changing social environment. It has two forms – active and passive. An active individual tries to influence the social environment in order to change it, while a passive individual is indifferent to the relationship with it.

Patients with injuries to the maxillofacial region have relatively deep psychological problems, and these processes are accompanied by conditions such as depressed mood, depersonalization, and avoidance of communication. The importance of communication between an orthopedic dentist and a patient in an inpatient setting is explained by the fact that during the conversation, he, as an expert, explains the possibility of restoring lost functions and appearance, outlines the perspective of relationships, and also clarifies the question of the timing of treatment. prosthetics of the face and jaw area. Thanks to this, several important tasks are solved: the volume of work is planned, the patient is given hope for the future thanks to information about the prospects of recovery from injury and, thus, psychological support is provided.

From an organizational point of view, this process is of particular importance. The interaction between institutions and dental organizations performing surgical interventions in the maxillofacial region is ensured by an examination (interview with the patient) conducted by an orthopedic dentist. This can be done in several ways: an orthopedic dentist can be on staff as an official employee of a surgical center (dispensary) or act as an “invited” consultant.

The second stage of rehabilitation is directly related to orthopedic treatment. At the stage after surgery, based on the condition of the person, as well as the level of readiness of the prosthesis for prosthetics. The patient is then sent to a dental facility, where he is examined by an orthopedic dentist, who provided him with consulting support from the very beginning.

At the stage aimed at restoring lost functions, prosthetics of the maxillofacial region is performed, and it is during this period that the role of psychological support for the dentist increases immeasurably. Prosthetics, on the one hand, restores the integrity of the lost limbs and, in addition, the functions associated with it, on the other hand, living conditions with a prosthesis cause new sensations. An orthopedic dentist should help the 108 | Cardiometry | Issue 33. November 2024

patient adapt to a new situation through conversation, persuasion, examples and recommendations. One of the effective methods of this process can be the preparation of an individual work plan designed to monitor the dynamics of the patient’s condition. For these purposes, a diary can be used to assess the condition of a patient with a maxillofacial prosthesis. At each visit to the patient, the orthopedic dentist evaluates and registers the patient’s condition in such a diary based on the appropriate scale. The rating system is based on scores from one to eight on each scale. The mental picture and its dynamics are evaluated according to the following principle: the lower the score on each scale, the more positive the mental state of the patient is.

At the third stage, in cooperation with medical and social experts (rehabilitation specialists) and professional psychologists, it is necessary to take measures to adapt a patient with facial and jaw defects to new professional conditions. For this purpose, the patient is given a conclusion (prognosis) and recommendations from an orthopedic dentist for consideration at the third stage of rehabilitation.

CONCLUSIONS

Comprehensive rehabilitation of patients after injuries to the maxillofacial region is a complex and multifunctional process that requires coordinated efforts of various specialists such as maxillofacial surgeons, dentists, plastic surgeons and orthodontists. Effective rehabilitation of patients requires close cooperation between various medical specialists. Teamwork provides a holistic approach to treatment, which is especially important in complex injuries when both bone structures and soft tissues are damaged.

The reconstruction of soft tissues and bones is a key element in the rehabilitation process, contributing to the restoration of chewing function, normal bite and facial aesthetics. Surgical intervention based on modern methods can significantly improve the results of treatment and the quality of life of patients.

The use of digital technologies such as 3D modeling and printing, as well as the use of biomaterials and regenerative medicine, open up new horizons in reconstructive surgery. These technologies make it possible to plan operations more accurately, create customized solutions for each patient and accelerate the healing process.

Personalized treatment, taking into account the characteristics of each patient, allows you to achieve the best results. Individual rehabilitation plans based on a thorough assessment of the patient’s condition and needs contribute to faster recovery and increased satisfaction from treatment.

The restoration of facial functions and aesthetics after injuries to the maxillofacial region has a positive effect on the psychological state of patients, contributes to their social adaptation and return to normal life. The importance of an integrated approach to rehabilitation is confirmed by improving not only the physical condition, but also the psycho-emotional well-being of patients.

The research of new technologies and methods in the field of rehabilitation of the maxillofacial region continues to be relevant. The need for more in-depth and systematic research to improve diagnostic, treatment and rehabilitation methods underscores the importance of this field of medicine.

In general, comprehensive rehabilitation of patients after injuries to the maxillofacial region requires the integration of various areas of medicine and innovative approaches, which ultimately leads to more effective results and improved quality of life for patients.