Subject: development of an algorithm for the rehabilitation of children with congenital cleft lip and palate in a region with petrochemical ecotoxicants. Objectives: optimization of the algorithm for the rehabilitation of children with congenital cleft lip and palate in the region with ecotoxicants. Methods. A retrospective analysis of the medical records of children with a diagnosis of congenital cleft lip and palate was conducted on the basis of the Republican Children's Clinical Hospital in Ufa in the department of maxillofacial surgery. In the period from January 1, 1985 on December 31, 2018 were surveyed 3463 children with congenital cleft lip and palate. Results. Children born and living in the region with the petrochemical industry have a high percentage of concomitant somatic diseases and deviations from the norm in blood tests. An algorithm was developed for the rehabilitation of children with congenital cleft lip and palate in the region with petrochemical ecotoxicants, optimized by including a toxicologist, anesthesiologist, immunologist, otorhinolaryngologist, gastroenterologist, and endocrinologist in the algorithm of consultation and treatment. The algorithm is aimed at improving the health of the child by increasing the effectiveness of prevention and treatment of somatic diseases in the preoperative period. Conclusions. The proposed algorithm for the rehabilitation of children with congenital cleft lip and palate has been developed taking into account the adverse effects on the body of emissions into the air of large petrochemical enterprises. Children with congenital cleft lip and palate, born and living in a region with petrochemical ecotoxicants, have a high percentage of somatic diseases and contraindications to surgical treatment according to accepted terms due to the presence of comorbidities and disorders in blood tests, and need additional treatment from a toxicologist, anesthesiologist and other specialists.
Objectives. A clinical case of surgical rehabilitation of a patient with palatopharyngeal insufficiency with congenital cleft palate after uranoplasty. Purpose. Description of the long-term result of surgical treatment of congenital cleft palate, the causes of complications and the rationale for the method of treatment of palatopharyngeal insufficiency. Methodology. The paper presents the results of a clinical observation of a patient aged 12 years with congenital cleft palate after uranoplasty and formed palatopharyngeal insufficiency. A child at the age of 2 years 8 months underwent sparing uranoplasty. Since the child lived in a remote area from the city, he did not have the opportunity to engage in logotherapy. On examination, the soft palate is moderately shortened, postoperative scars are not rough. Speech is vile. To select the most optimal method of treating this pathology, it was necessary to visualize the causes of palato-pharyngeal insufficiency. Results. When conducting an examination using nasopharyngoscopy, a sphincter type of closure of the palatopharyngeal ring was revealed. When pronouncing sounds, the soft palate rose slightly, but the lateral walls of the pharynx with the posterior palatine arches actively contracted, narrowing the palatopharyngeal ring. Taking into account the data obtained during nasopharyngoscopy, a surgical method for eliminating palatopharyngeal insufficiency proposed by M. Orticochea was chosen — “speech-improving surgery”, or sphincter pharyngoplasty, with suturing of the distal ends of the mobilized posterior palatine arches on the posterior pharyngeal wall. According to the control examination for 6 months, there was a significant improvement in speech function, there was no nasalization. Conclusions. Nasopharyngoendoscopy makes it possible to objectively assess the causes of palatopharyngeal insufficiency, which makes it possible to choose the most optimal method of surgical treatment. One of the methods of choice in the surgical treatment of palatopharyngeal insufficiency is the method of sphincter pharyngoplasty.
Subject. Study of the results and complications of uranoplasty in children with congenital cleft lip and /or palate in the first year after surgical treatment. The goal is to determine the frequency of surgical and speech complications after uranoplasty in children with congenital cleft lip and/or palate in regions with a petrochemical industry and without industrial ecotoxicants. Methodology. After the uranoplasty, 80 children with various forms of cleft palate were examined at the Republican Children's Clinical Hospital. Comprehensive examination included the use of clinical (examination, palpation, percussion ― assessment of surgical status) and functional (electromyography, rheography, magnetic resonance imaging, nasopharyngoendoscopy, speech therapy speech assessment using a sound identification system) research methods. Results. Children with congenital cleft lip and/or palate born and living in regions with petrochemical ecotoxicants more often (37.5 %) have complications after uranoplasty than children from regions without petrochemical ecotoxicants (18.8 %). They have a higher prevalence of palatopharyngeal insufficiency, the frequency of fistulas of the soft and hard palate, and the need for secondary surgical intervention, more often they experience difficulties in restoring speech functions. Conclusions. Due to the presence of somatic diseases and disorders in blood counts at the preoperative stage, more pronounced postoperative complications are noted in the group of children with congenital cleft lip and/or palate from regions with the petrochemical industry, which indicates a violation of their reparative regeneration after uranoplasty. This is the rationale for the development and application of a method for the prevention of postoperative complications, which will be included in the rehabilitation algorithm to improve the physiological and speech functions of children after uranoplasty in a region with a petrochemical industry.
Subject. Dental examination and identification of the features of the dental status of children with congenital cleft lip and palate, born and living in the region with industrial ecotoxicants. Objectives. To study the dental morbidity in children with congenital cleft lip and palate living in a region with industrial ecotoxicants, compare the data with a group of children with congenital cleft lip and palate from an ecologically safe region. Methods. The article presents the results of a dental examination of 195 children with congenital cleft lip and palate, including 108 children aged 3 years, 87 children aged 6 years. Children were divided into two groups depending on the place of birth and residence: 113 children were born and lived in regions with a developed petrochemical industry, 82 children from relatively ecologically safe regions. In the examined children, the prevalence and intensity of dental caries, malformations of hard dental tissues, periodontal diseases, dentoalveolar anomalies, and the hygienic state of the oral cavity were assessed. To determine the intensity of dental caries in children of 3 years old, the index "KPU" was used, in children of 6 years old - the index "KPU+kp". The hygienic state of the oral cavity was assessed by the Fedorov-Volodkina index (1968), the periodontal condition in children of 6 years old was assessed by the KPI index (Leus P.A., 1988). Results. Our data indicate that children from regions with the petrochemical industry have higher rates of dental caries intensity in the age groups of 3 and 6 years, there is a decrease in the resistance of the tooth enamel, and periodontal diseases are more common. Conclusions. The results of the study made it possible to obtain clinical and dental data characterizing the negative impact of industrial petrochemical ecotoxicants on the condition of the dentition in children with congenital cleft lip and palate, which is the rationale for the development of methods for optimizing and increasing the effectiveness of therapeutic and prophylactic measures in this group of patients.
Study of the determination of the polymorphic variants -1298A> C and -677C> T of the gene of methylenetetrahydrofolatereductase (MTHFR) in predicting the congenital pathology of the maxillofacial area. Objectives. To study the role of polymorphisms -1298A> C and -677C> T of the MTHFR folate cycle gene in the formation in patients with congenital pathology of the maxillofacial area. Methods. We analyzed the frequency distribution of genotypes and alleles according to polymorphism 1298 A> C of the MTHFR gene. We also analyzed the frequency distribution of genotypes and alleles according to polymorphism 677C> T of the MTHFR gene in a group of patients (n = 37) with congenital pathology of the maxillofacial area and control group (n = 46). Results. Genetic marker of the disease congenital pathology of the maxillofacial area is the genotype of the SS polymorphic locus 1298 A> C of the MTHFR gene. Its frequency was 13.6% against 2% in the control. In the calculation of odds ratios index following values were obtained: OR-7,32; CI95% -1.51-48.51. The results confirm the predictive value of a mutant CC genotype -1298A>C MTHFR gene as a risk of congenital disease pathology maxillofacial area. There was no statistically significant differences between patients and the control group for the distribution of frequencies of genotypes and alleles of the locus 677 C> T of the MTHFR gene. Conclusions. Genetic marker of congenital pathology of the maxillofacial area is the genotype of the SS polymorphic locus 1298 A> C of the MTHFR gene. The obtained data can be used, to predict a congenital pathology of the maxillofacial area with the purpose of treatment and prevention.
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