CHANGES IN THE CYTOKINE PROFILE OF SYNOVIAL FLUID OF THE TEMPOROMANDIBULAR JOINT IN PATIENTS WITH FRACTURES OF THE LOWER JAW HEAD

Abstract

Despite significant achievements in recent years, in particular the development of minimally invasive approaches, surgical techniques, methods of fixation and drug prevention of complications, TMJ dysfunction in patients with condylar head fractures (CHFs) remains quite common and exceeds this indicator in comparison with condylar base and neck fractures almost in 3 times. One of the promising areas of prevention of internal disorders is the study of their pathogenesis at the level of molecular mechanisms of regulation, in order to find ways of effective influence on these mechanisms. The aim of the study was to determine the content of chemokines VEGF, TNFα, MIP-1b (CCL4), FGF4 in the synovial fluid of TMJ in patients with CHFs in the early and late post-traumatic period depending on the severity and nature of trauma. The study included 28 patients with 39 CHFs (8 women, 20 men, mean age 35.3±15 years). Synovial fluid was collected under general anesthesia before open reduction and internal fixation of mandible head and during the second operation (removal of fixators) and proteins content of synovial fluid samples was determined in the supernatants by solid-phase enzyme-linked immunosorbent assay (ELISA). Research results. It was found that in the early post-traumatic period, in patients with CHFs with the arthroscopic signs of acute traumatic arthritis increase level of pro-inflammatory cytokines TNFa, MIP-1b (CCL4), VEGF and FGF4. In 4 months after osteosynthesis, in most patients, cytokine levels decrease by an average of 70.5±24.6 %, which was a sign of normalization of the functional state of the damaged joint; however, in some patients (15 % for CCL4 and VEGF, 30 % for TNFa and up to 50 % for FGF4), an increase in cytokine levels was noted, which can be considered as a sign adaptive and compensatory mechanisms failed and creates prerequisites for the chronicity of inflammatory processes and the development of degenerative changes with the formation of osteoarthritis. Also was found statistically significant relationship between the content of pro-inflammatory cytokines TNFa and CCL4 in synovial fluid, which could be essential during diagnosing molecular disorders of the regulation of biological processes and predicting the occurrence of internal disorders and inflammatory processes in patients with CHFs.