MODERN CONCEPTION OF TREATING PURULENT INFLAMMATORY DISEASES OF FACE AND NECK IN PATIENTS WITH DIABETES MELLITUS

Abstract

The issue of surgical treatment of purulent infection in people suffering from diabetes mellitus is becoming increasingly important that can be explained by a significant growth of diabetes worldwide. The combination of diabetes mellitus and surgical infection forms a closed vicious circle, in which the infection negatively affects metabolic processes, increasing insulin insufficiency and acidosis, while metabolic and microcirculation disorders worsen the course of reparative processes in the lesion. A lack of insulin in patients with diabetes mellitus results in the disorganization of carbohydrate metabolism that is manifested by hyperglycemia, glycosuria, a decrease in the content of glycogen in tissues and, first of all, in the liver. Liver dysfunction, in turn, leads to water-salt and protein metabolisms changes. The impairment of protein metabolism is manifested in a decrease in its synthesis and an increase in its breakdown. As a result, the formation of glucose from amino acids becomes more intensive. The accumulation of ketone bodies and acetone under an almost complete inability to synthesize fats leads to ketoacidosis.
 The goal of this work is to analyze the treatment outcomes of patients with diabetes mellitus who had various purulent and inflammatory diseases of the maxillofacial area. The treatment of purulent wounds in the patients with diabetes mellitus requires the participation of an endocrinologist to control criteria, which can objectively reflect the course of the wound healing including cytological examination of wound impressions, morphological examination of wound tissues, determination of indicators of tissue homeostasis in the lesion. The use of the methods described above, as well as the scope and direction of therapy in each specific case should be based on the teach approach to this comorbidity.
 Noteworthy, the course of purulent and inflammatory diseases of the maxillofacial area under diabetes mellitus is peculiar and atypical, often leading to the development of formidable complications and even death. Effective treatment of foci of inflammation under decompensated diabetes is a hard task. Special attention should be paid to the study of the etiopathogenetic mechanisms of the development of purulent-inflammatory diseases of the maxillofacial area in patients with diabetes mellitus and to the development of new treatment algorithms. Close cooperation of maxillofacial surgeons and endocrinologists will help preserve life quality and life expectance of the patients with diabetes mellitus.