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Medical rehabilitation of children with congenital facial malformations


Author: Ion Lupan
Degree:doctor habilitat of medicine
Speciality: 14.00.21 - Stomatology
Year:2004
Scientific adviser: Pavel Godoroja
doctor habilitat în ştiinţe medicale, profesor universitar, Academia de ştiinţe Româno-Americane
Institution:
Scientific council:

Status

The thesis was presented on the 29 September, 2004
Approved by NCAA on the 23 December, 2004

Abstract

Adobe PDF document – 0.36 Mb / in romanian

Keywords

congenital malformations of the face, epidemiology of malformations of the face, cleft lip, cleft palate, clefte lip and palate, oblique facial cleft, syndrome p. robin, syndrome van der woude, primary lip plasty, primary palate plasty, logopedique rehabilitation, ortodontic rehabilitation

Summary

The purpose of this study is to increase the efficacy on rendering a specialized medical aid to children with congenital malformations of the face (CMF). Their incidence in Moldova was 1,01: 1000 live-borns in the period 1987-2000. The highest incidence was noted in the southern and central regions of the republic (1,06). The increase of incidence up to 0,32 :1000 live-borns in comparation with the period 1960- 1974. The incidence of separate cleft lip (CL) increased only 0,03 and incidence of cleft lip and palate (CLP) increased 0,12 and the incidence of cleft palate (CP) increased 0,16 per 1000 live-borns, that rezulted in the change of the ratio between the certain form of lip and palate clefts (CL:CLP:CP) from 1,4:1,4:1 to 1:1,3:1,2. This means the increase of the abnormality severity. We elaborated the scheme of an early rehabilitation in complex treatment of children with unilateral CLP.

Cheiloplasty was performed under the techniques of D.Millard; C.Tenisson, Л. Обухова. Values of filtrum height index (FHI) were used to chose an individual technique. Uranoplasty was performed in two stages: I - velofaringoplasty was made at the age of 10-12 months; II - was performed zix months later, at the age of 16-24 months.

The treatment results were evaluated by the character of postoperative wound healing, restorstion of the anatomical shape and mobility of the soft palate, duration of logopedic training, quality of the restored speech, the influence of the operation on the maxilla growth (biometric measurements on plaster models, teleradiograophy, orthopantomography) etc.

The tactics of primary surgical treatment of under school children and adolescents with CLP is proposed. P. Robin syndrome was noted in 24 children. The clinical picture showed three forms of gravity and three variants of measures to control the uper respiratory airways were developed. Van der Woude syndrome was revealed in 14 children who were divided into thre groups depending on the localization of fistulas and the tactics of surgical treatment was proposed. In the treatment of five children with oblique facial cleft the nasal-orbital form technique was used with the flap on the peduncle from nasal-labial fold preceding epithelisation. In the treatment of children at age of 11-12 years the upper lip and nose malformations who undervent Millard‘s cheiloplasty depending on the severity of malformation (mild, moderate, marked) a new modification of the operation with the use of a flap cut in the nasal aperture to extend the columella and to eliminate the distorsion of nasal septum. Thus, on the basis of our data and thase of the other specialized clinics we developed the scheme of medical rehabilitation in the complex tratment of children with CMF.