Relevance. Craniofacial microsomia is a collective definition combining congenital pathologies of organs developing from the first and second branchial arches. However, the affiliation of various congenital pathologies to this disease remains controversial. For this reason, there are no standardized indications for the timing and methods of treatment. Materials and methods. This paper analyzes the results of examinations conducted from 2011 to 2021in 89 children and adolescents from 1 to 18 years with craniofacial microsomia. Results. Patient groups were allocated according to the pathology severity and their age, and were offered various treatments depending on the phenotype variant. Conclusions. Based on international and our experience and considering the anatomical and functional changes in children and adolescents with craniofacial microsomia, creating a scheme for developing a customized multidisciplinary algorithm to treat these patients becomes relevant.
Syndromes of I and II gill arches called maxillofacial dysostoses are accompanied by damage of temporomandibular joint (TMJ). Craniofacial microsomia is one of the of maxillofacial dysostoses. This syndrome has a number of features associated with clinical manifestations which should be taken into account at steps of the diagnosis and treatment of such patients. The degree of mandibular hypoplasia in this pathology can vary from 0 to 3, and it is inversely proportional to the integrity of the articular disc on the side of the lesion. An increased mechanical load on a healthy joint leads to its dysfunction and dislocation of the articular disc at the healthy side. In addition to hypoplasia of bone structures, craniofacial microsomia is accompanied by subatrophy of masticatory muscles and that in couple leads to malocclusion and myodynamic imbalance. Before drawing up a treatment plan it is necessary to study the state of the TMJ on both sides using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). The approach to treatment should be individual, combined, staged, based on the severity of the symptom complex.
Ultrasound examination of the skin was performed on 63 women, using a 10–22 MHz high frequency linear transducer on the scanning surface in B-mode and Color Doppler Imaging (CDI) mode with the scanning depth of 7 mm, as well as a 6–18 MHz transducer in B-mode with the scanning depth of 15 mm. The thickness of the dermis was measured between the epidermis and the subcutaneous adipose tissue in the middle and lower third of the face at standard points. To determine the border between the dermis and hypodermis, we used the subdermal vascular plexus as an additional anatomical landmark, which was well visualized in the CDI mode. Comparison of three or more groups of independent quantitative parameters was carried out using ANOVA (Analysis of Variance) for looking for dependencies in the data obtained by determining the significance of differences in means. The level of significance was presented according to F. Fisher’s criterion. As a result of the analysis of variance, a significance level was 0.15, based on which it was concluded that there is no difference in measuring the thickness of the dermis with 6–18 MHz and 10–22 MHz high frequency transducers. The optimal scanning depth for measuring the skin thickness is 7–15 mm. Evaluation of the skin microcirculation should be carried out in the Doppler mode at a pulse recurrence frequency of less than 1 kHz.
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