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.
Aim. To search for genetic markers of oral lichen planus development and recurrence risk based on the study of polymorphic variants of tumor necrosis factor α (TNFα rs1800630, rs1800629, rs361525) and interleukin-18 (IL-18 rs187238) genes in patients from the Volga-Ural region of Russia.Methods. Standard methods of molecular genetic analysis were used in the study. Deoxyribonucleic acid was isolated from peripheral blood lymphocytes by deproteinization with phenol and chloroform. Genotyping of studied polymorphic loci was performed by real time polymerase chain reaction using TaqMan-competing probes. In order to identify the association of polymorphic loci in different models (additive, dominant, recessive, overdominant) the method of logistic regression was used.Results.. Statistical analysis using logistic regression revealed that polymorphic locus rs187238 in IL-18 gene is associated with the risk of lichen planus development in a recessive model (p=0.042). In addition, the association of a polymorphic locus rs187238 in IL-18 gene with the recurrence risk was described: rs187238*C/C genotype is a genetic marker of increased risk of oral lichen planus recurrence (p=0.01). Analysis of the association of polymorphic loci rs1800630, rs1800629, rs361525 in tumor necrosis factor α gene with the disease severity and the recurrence risk did not reveal any statistically significant results.Conclusion. The study results confirm the cytokine genes contribution to the oral lichen planus development and disease reccurrence.
Objectives. A clinical case of elimination of a rare congenital pathology in a patient with a median isolated cleft lip. Congenital cleft lip is not only a functional malformation in which the structure and function of the orbicular muscle of the mouth is impaired, but also located in an aesthetically significant place that cannot be hidden from the eyes of others. Sucking disorders and aesthetic dissatisfaction are important factors for surgical intervention as soon as possible in order to avoid problems with the social adaptation of the child and his parents in society. Medical care for congenital cleft lip should be timely, highly qualified and accessible to all children in the regions, regardless of the social and financial situation of the family. Reconstructive plastic surgery of the upper lip is the only way to eliminate a congenital cleft, which affects the quality of life, social adaptation and psychological atmosphere in the family. Cheilorhinoplasty is performed at different age periods depending on the type of defect, and the technique of operations for each type of congenital facial defect has its own characteristics. In the literature, we did not find data on the frequency of the birth of children with an isolated median cleft of the upper lip, since this is a rather rare form of congenital cleft.
Purpose. Description of the stages and basic principles of cheilorhinoplasty to restore the aesthetics and functionality of the orbicular muscle of the mouth in a rare form of congenital isolated median cleft of the upper lip.
Methodology. The paper presents the results of a clinical observation of a 5-year-old patient with congenital isolated median cleft lip and the basic principles of cheilorhinoplasty.
Conclusions. There are many types of congenital cleft lip, but adhering to the basic principles above will improve the aesthetic outcome of any upper lip reconstruction technique.
Objectives. Children who find themselves in a difficult life situation are one of the neediest social groups who need help both from the state and from specialists in various fields. To improve and improve the quality of medical dental care for this social group of children, it is necessary to evaluate the effectiveness of the developed complex of therapeutic and preventive measures, taking into account the specific situation in social institutions for orphans and children left without parental care.
Purpose. To evaluate the effectiveness of the developed complex for the prevention and treatment of major dental diseases in orphans and children in a difficult life situation with the use of photodynamic therapy and herbal medicine.
Methodology. The article presents clinical and laboratory data after the implementation of the developed complex of therapeutic and preventive measures using photodynamic therapy and herbal medicine in orphans and children in difficult life situations in the age groups of 6–7 years, 11–13 years and 14–16 years. The dynamics of the dental and hygienic status, some physicochemical, biochemical, immunological parameters of the oral fluid and the periodontopathogenic microbiota of the periodontal sulcus are presented.
Results. The use of the developed complex for the prevention and treatment of dental diseases using photodynamic therapy and a phytopreparation in a socially vulnerable group of children showed high efficiency: oral hygiene improved in all age groups from a poor to a satisfactory level, the indicator of cured temporary and permanent teeth increased (component "P") in the structure of KPU in children 6 years of age more than 0.5 times, in adolescents more than 2.7 times. In the mixed saliva, the pH increased, the levels of pro- and anti-inflammatory cytokines normalized, the content of lipid peroxidation products sharply decreased against the background of an increase in the activity of the main antioxidant defense enzymes, and the amount of periodontopathogenic microbiota in the periodontal sulcus decreased.
Conclusions. The program for the comprehensive prevention and treatment of major dental diseases in orphans and children in difficult life situations leads to a decrease in the intensity of dental caries and periodontal disease, and a significant decrease in cases of tooth loss.
Relevance. Diabetes mellitus is one of the most complex metabolic chronic diseases. Severe forms of type I diabetes mellitus are more common in children and adolescents, and its prevalence is increasing in many countries. Type I diabetes mellitus in children and adolescents remains an essential health issue in many countries despite the achieved scientific and practical results and progress in diabetology. Therefore, its early detection in children is still relevant and is associated with the early diagnosis of endocrinolog ical pathologies. Materials and methods. The study searched the publications in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), Medline (www.elibrary.ru, www.ncbi.nlm.nih.gov/pubmed) by the specific keywords. Results. In children with diabetes mellitus, vascular changes in periodontal tissues appear earlier than in other organs. On oral examination of children with diabetes mellitus, 50% of cases reveal periodontal lesions, and the lesions are often in the areas of the lower molars. If not treated, the following perio-dontitis signs are present in diabetic children: bleeding of the gingival papillae and the bright red colour of the gingival margin. There may be bulging of granulations from pathological gingival pockets. In most patients with type I diabetes mellitus, cytology of the periodontal pockets and gingival sulci demonstrated inflammatory cytologic responses, changes in the stratified squamous epithelium, and mixed bacterial microflora with leukocytes and erythrocytes. Conclusion. The study of type I diabetes mellitus impact on pathological changes in the oral cavity of children and the development of therapeutic and preventive measures is a relevant issue in pediatric dentistry, which justifies the need to continue research in this area.
The paper presents the results of a clinical observation of a 6-year-old female patient, who was admitted to the department of maxillofacial surgery of a multidisciplinary hospital under the compulsory health insurance system with a rare disease of the bone tissue of the lower jaw – desmoplastic fibroma. Desmoplastic fibroma of bone tissue (aggressive fibromatosis, desmoid fibroma) is a rare, locally aggressive, benign tumor localized in bone tissue, it is a mesenchymal fibroproliferative tumor with locally destructive growth, accounting for less than 0.03% of all human tumors. According to the literature, desmoplastic fibroma has a recurrence rate of 37% to 72%, resection of the affected bone is the preferred therapy, and, ideally, resection should be a single resection block. Wide excision is the method of choice for treating operable desmoid tumors in children. The article presents a dynamic observation within 1 year after surgical treatment. The article presents the clinical, radiological and computed tomographic picture of the disease and the results of instrumental and histological examination of a rare oncostomatological pathology. Purpose: clinical, radiological, 3D computed tomography observation of a child with desmoplastic fibroma of the lower jaw. Materials and methods: the results of a clinical examination, instrumental methods of X-ray diagnostics, stages of surgical treatment, a histological report and photographs of the patient's appearance are presented. Conclusion: Given the high regenerative capacity of bone tissue in children, it is necessary to perform surgical treatment of benign neoplasms by the type of marginal resection, that is, by the organ-preserving type, and to conduct dispensary observation of the patient during the first year.
A special place in the pathogenesis of recurrent aphthous stomatitis is occupied by the state of local immunity, which can affect the clinical course and prognosis of chronic diseases of the oral mucosa. The inflammatory process in recurrent aphthous stomatitis is initiated by stimulation of keratinocytes of the oral mucosa by a currently unknown antigen, which leads to stimulation of T-lymphocytes and the release of cytokines and various interleukins.
Cytokines are the main nonspecific humoral factor of immunity, providing the initiation and development of an inflammatory response during the development of a protective immune response. A huge number of works are devoted to the study of cytokine status in recurrent aphthous stomatitis, which plays one of the key roles in the pathogenesis of the disease. However, most of the studies were conducted in patients over the age of 18, in addition, the results obtained are contradictory. This determined the purpose of this study – to assess the cytokine status of oral fluid in children with recurrent aphthous stomatitis. The study examined 70 children who were divided into 2 groups. The main group consisted of 45 children aged 7 to 14 years, patients with recurrent aphthous stomatitis, during the relapse of the disease. The main group was divided into 2 subgroups: A – 20 children with the duration of recurrent aphthous stomatitis up to 5 years, group B – 25 children with the duration of recurrent aphthous stomatitis more than 5 years. All patients in the main group had concomitant diseases, in most cases, diseases of the gastrointestinal tract. The control group consisted of 25 practically healthy children without recurrent aphthous stomatitis. In children with recurrent aphthous stomatitis in the oral fluid, a significant increase in the concentration of the anti-inflammatory cytokine TNF-α and a decrease in the concentration of IL-10, an imbalance in the level of IL-2 depending on the duration of the disease, as evidenced by a pronounced inflammatory process of the oral mucosa with epithelial destruction.
Between the blood and the organs, between the blood and tissues there are special barriers (blood-tissue barriers), which represent the multilevel security system of the organism, aimed at providing general and local homeostasis. The protective function of organs and tissues that are protected by blood-tissue barriers is realized by the changes of the permeability barrier for certain substances and is quantitatively estimated by the permeability coefficient (PC). In-depth studies of the functioning of blood-tissue barriers in lichen planus of the oral mucosa (LP OM) are relevant today. But they have not been conducted yet. In this study were involved 191 patients with various forms of lichen planus of the oral mucosa ( typical — 43 patients, exudative — hyperemic — 43 people, erosive-ulcerative — 47 patients, hyperkeratotic — 24 people, atypical — 28 patients, bullous — 6 people) a violation of a permeability condition of the blood-tissue barriers for some mineral elements (zinc, copper, iron, magnesium), which is of importance in the pathogenesis of the disease was found. This manifests itself in multidirectional changes in mineral composition of blood serum and oral fluid, which correlate to the severity of the clinical course of the disease. Thus, the definition of pathogenetic importance of the detected changes will allow solving the issue of a possible correction of the mineral content, resulting in a deficit, by assigning mineral supplements. The expected effects can be a relief of the clinical course of the process, a more rapid healing of erosions and ulcers in the mouth, improvement of the general condition of patients and improving their quality of life.
Importance ― study of microscopic imprints of the wound surface of purulent wounds in inflammatory diseases of the maxillofacial region in children.
Objectives ― cytological research of microscopic imprints of purulent wounds in inflammatory diseases of the maxillofacial region in children
Methods. The study included 60 children from 5 to 16 years old who were treated for abscesses and phlegmon of the maxillofacial area. Patients were divided independently into 2 groups. The main group included 30 children. For their treatment we used ointment with Furacilin, Lidocaine and Dibunolum. The control group included 30 patients. For their treatment used ointment Levomecol. To compare the effectiveness of the healing of purulent wounds in the main and control groups, we studied cytology of microscopic imprints of purulent wounds at 3, 7 and 10 days.
Results. A microscopic examination of the imprints of the wound surface of the control group on the 3 day revealed a predominantly inflammatory type of cytogram, on day 5, the type of cytorgamy was replaced by inflammatory-regenerative, which persisted on the 7th day of the study. Microflora was represented in small quantities. In the main group, in the study of microscopic imprints on the 3ed day, inflammatory-regenerative type of cytogram was also observed. On the 7th, the cytogram shifted to the regenerative type. Cell infiltrate was poor, containing macrophages and lymphocytes. Seeding by microorganisms was not observed.
Conclusions. Thus, based on the morphological studies of microscopic imprints of the wound surface, we recommend the use of ointment with Furacilin, Lidocaine and Dibunolum for the complex treatment of abscesses and phlegmon of the maxillofacial region. Since the ointment reduces the time of wound healing and reduces bacterial contamination of the wound.
