Analysis of bone-reconstructive surgery aimed at normalization of occlusal relationships of the jaws at the final stages of rehabilitation treatment of children with congenital cleft lips and palate (Literature review)

BACKGROUND: The completion of medical rehabilitation of children aged 1618 years with congenital cleft lips and palate is often impossible without surgical correction of occlusal relationships of the jaws and improvement of facial aesthetics. At the same time, the main efforts of the specialists engaged in the treatment of children with orofacial clefts are aimed at correcting local plastic operations of the upper lip, nose, oral cavity, and orthodontic, using non-removable arc equipment, correction of disturbed occlusion. AIM: Our aim is to study and analyze the problems of final bone reconstructive operations in patients with HRGN. MATERIALS AND METHODS: The article presents a review of the literature on this topic, based on 61 sources. The literature was searched by keywords in the databases such as PubMed, ScienceDirect, E-library, and Google Scholar from 1938 to 2020. The data on the treatment of children with combined maxillofacial anomalies and deformities with cleft lips and palate, who underwent reconstructive bone operations on the jaws in order to normalize their occlusal relationships, were analyzed. RESULTS: In order to achieve good morphofunctional and aesthetic results, as well as early socialization of patients with VRGN at the final stages of rehabilitation, complex hardware and surgical treatment are necessary. The indication for reconstructive operations on the jaws in patients is the face disorder and disharmony of the face, which cannot be corrected by orthodontic treatment. The operations should be based on careful planning, including CT modeling, the use of sparing techniques, including various modifications of Le Faure I osteotomy on the upper jaw, and retromolar sagittal osteotomy of the jaw and, according to indications, genioplasty on the lower jaw. CONCLUSIONS: Two-jaw orthognatic bone reconstructive operations on the jaws to restore the correct bite have recently been used in the complex medical rehabilitation of patients, especially in adolescents with VGN. At the same time, there are a number of unresolved issues of orthodontic and surgical treatment that require further study. There is a strong need for a clear understanding of the age of planning and timing of such operations considering the stage of completion of skeletal growth. The criteria for the patients readiness for surgery for multiple occlusive contacts also need to be evaluated. It is of paramount importance to determine the order of performing corrective operations on the soft tissues of the face and oral cavity. Hence there is a necessity to develop new methods of reconstructive operations on the jaws.

Determination of occlusal connections in patients with congenital cleft lip and palate before and after their orthopedic rehabilitation

The aim of this study was to define and analyze the reproducibility of occlusal relationships according to the results of occlusogram in jaw closure using quantitative analysis of occlusion in adult patients with congenital cleft lip and palate before and after their prosthesis with different versions of dentures and types of their constructive features. Materials and methods. The study was conducted on 37 patients with congenital cleft lip and palate, 11 (29.73 %) of whom had right-sided clefts, 11 (29.73 %) – left-sided and 15 (40.54 %) – bilateral. The number of occlusal contact points was measured for all patients before the treatment and after the orthopaedic rehabilitation. Research results. Significant differences were found between the number of occlusal contact points before (unusually small number) and after orthopaedic treatment (significant increase), regardless of the type of cleft (p<0.001). Such conditions in the oral cavity significantly complicate the tactics of orthopaedic rehabilitation, which affects the need to find more complex options for combinations of fixed and removable orthopaedic structures. Conclusion. Based on the conditions and objectives of this study, the application of the basic principles of a multidisciplinary approach determine the possibility of rehabilitation of such patients by orthopedic methods by making different versions of orthopedic structures. Adequate and high-quality prosthesis for defects and deformations of the teeth rows and occlusion in patients with CCLP leads to improved occlusal relationships and increase in the number of occlusal contact points.

Feeding Plate of an Eight-day-old Patient Having Veau Type III Cleft Lip and Palate

Congenital Cleft lip and palate is a craniofacial defect which results into difficulty in feeding because of the communication between the oral and nasal cavities. Feeding plate restores the gap between the oral and nasal cavities and helps in feeding and reduces the chances of airway problems, regurgitations. This clinical report describes a design and method of fabricating a feeding plate in an 8-day old neonate with a cleft lip and palate.

Median facial cleft syndrome: A case report

Congenital Cleft Lip and Palate is a common birth defect with an incidence of 1 in 600 to 800 live births. This defect usually affects either the left, right or in some cases both sides of the lip and is called a Tessier Type 3 cleft. Clefting of the face in the midline is exceedingly rare and such a case of a Median Facial Cleft Syndrome is being reported which occurs in nearly 1 in 1,000,000 live births. This was first described by Bechard in 1823 and can be sporadic or part of an inherited syndrome. The child had a median cleft of the upper lip, nose, and palate of a severe, complete variety, with absent philtrum of the upper lip, premaxilla, columella, nasal septum and vomer.

SOMATIC DISEASES IN CHILDREN WITH CONGENITAL LIP AND PALATE IN A REGION WITH INDUSTRIAL PETROCHEMICAL ECOTOXICANTS

Monitoring of congenital malformations and concomitant somatic diseases in children is one of the important indicators of the causal influence of environmental factors on the health of the population. From the moment of birth, a child with congenital cleft lip and palate differs significantly from healthy peers not only externally, but also morpho-functional features of the structure of the primary section of the digestive and respiratory systems and often has a greater number of previous diseases in the history. Purpose: To determine the structure and frequency of somatic morbidity in children with congenital cleft lip and palate in regions with petrochemical ecotoxicants. Materials and methods: During the study, 3463 children from birth to 16 years old with congenital cleft lip were treated and monitored at the Department of Maxillofacial Surgery at the Republican Children's Clinical Hospital, Ufa for the period from January 1, 1985 to December 31, 2019 and / or sky. The diagnosis of concomitant systemic pathology was recorded based on the findings of the district pediatricians, ENT doctor, gastroenterologist, immunologist, allergist, rheumatologist from outpatient and inpatient records of the examined patients. Conclusion. In the course of our study, a direct relationship was noted between the level of environmental pollution by ecotoxicants and the frequency of concomitant somatic diseases in children with congenital cleft lip and palate. This must be taken into account in the pre- and postoperative algorithm for the rehabilitation of children with congenital cleft lip and palate with the involvement of pediatricians to improve the general somatic state of children when planning reconstructive surgery.

FREQUENCY AND RISK FACTORS AFFECTING THE BIRTH RATE OF CHILDREN WITH CONGENITAL CLEFT LIP AND PALATE IN THE SOUTHERN REGION OF KYRGYZSTAN.

The aim of the study is to examine the incidence and factors of congenital cleft lip and palate in the southern region of the Kyrgyz Republic, according to the form of clefts and according to the classification of MMDI, as well as their rehabilitation. We studied in detail the case histories of 2116 patients treated in the maxillofacial surgery department of Osh Interregional United Clinical Hospital according to the age and sex, as well as the form of congenital cleft lip and palate. Moreover, a questionnaire was administered to parents of children with CCLP for risk factors during pregnancy. A retrospective study of medical history revealed, among congenital anomalies, clefts of the soft, hard palate, alveolar process and upper lip prevailed - (combined) 891 (42,3%) Congenital cleft of soft, hard palate - 586 (27,7%), then isolated congenital cleft of the maxilla - 415 (19,6%), congenital cleft of the soft palate only 10,5% - 224 children were followed. The results of the questionnaire revealed that the parents of children born with CCLP were influenced by various unfavorable factors in the period of formation of the facial section of the fetus. The survey revealed that the relatives had CCLP, which accounted for 12.9% of all newborns, indicating a rather high role of hereditary predisposition. In addition to the hereditary genetic factor, an important role is played by infectious diseases suffered during the first trimester. It is noted that 12.8% of the children born with CCLP had infectious diseases. The mothers independently took drugs during pregnancy (antibiotics, salicylates, sulfonamides without a doctor's prescription), 17.6% of women were anemic during pregnancy, and 16.3% had severe toxemia. Along with this, it was found that the smallest number of women suffered mental trauma in the first trimester of pregnancy 0.4% of the mothers of children born with CCLP. Further, we registered patients with CCLP in the special software ONYX CEPH-3 from 01.01.2015 to the present, where we enter detailed information about patients with CCLP pathology. It creates convenience for parents both informationally and economically, as well as directly for the doctor in terms of dynamic observation of the functional and aesthetic condition and development of the child. In order to further develop programs to prevent the prevalence of congenital pathology, improve the quality of comprehensive treatment method, as well as medical and social rehabilitation of such patients and work with families of children with CCLP, we have developed a single program ONYX CEPH3 providing dispensary and rehabilitation of children.