EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
VOLUME04 ISSUE11
39
CHILDREN WITH THIS DISEASE AND THEIR EPIDEMIOLOGY, ETIOLOGY, PREVENTION,
TREATMENT
Turayev Alimjan Baxriddinovich
Samarkand State Medical University, Uzbekistan
AB O U T ART I CL E
Key words:
Epidemiology, Etiology, Prevention,
Treatment.
Received:
06.11.2024
Accepted
: 11.11.2024
Published
: 16.11.2024
Abstract:
Congenital cleft lip, alveolar process
and cleft palate are among the most difficult
deformities of the maxillofacial region, the
number of children with such deformities is 1 per
1000 newborns and continues to grow [3, 4, 13,
18]. Treatment and rehabilitation of such patients
is an urgent problem due to abnormal facial
development and secondary deformities, speech
and chewing disorders, a long recovery period and
the need for social adaptation of the child [8].
Modern literature describes the treatment of
children with complications of cleft lip and palate,
and there is an opinion about the need for an
integrated approach [11, 19]. Children with this
disease can receive full-fledged rehabilitation and
social adaptation in specialized medical centers
[7, 14]. The aim of the work is to demonstrate the
effectiveness
of
interaction
between
orthodontists and maxillofacial surgeons on the
example of a clinical case of complex
rehabilitation of a patient with congenital cleft of
the left upper lip, alveolar process and cleft palate.
INTRODUCTION
Congenital cleft lip, alveolar process and cleft palate are among the most difficult deformities of the
maxillofacial region, the number of children with such deformities is 1 per 1000 newborns and
continues to grow [3, 4, 13, 18].
VOLUME04 ISSUE11
https://doi.org/10.55640/eijmrms-04-11-07
Pages: 39-42
EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
VOLUME04 ISSUE11
40
Treatment and rehabilitation of such patients is an urgent problem due to abnormal facial development
and secondary deformities, speech and chewing disorders, a long recovery period and the need for
social adaptation of the child [8]. Modern literature describes the treatment of children with
complications of cleft lip and palate, and there is an opinion about the need for an integrated approach
[11, 19]. Children with this disease can receive full-fledged rehabilitation and social adaptation in
specialized medical centers [7, 14]. The aim of the work is to demonstrate the effectiveness of
interaction between orthodontists and maxillofacial surgeons on the example of a clinical case of
complex rehabilitation of a patient with congenital cleft of the left upper lip, alveolar process and cleft
palate.
METHODS
Patient I was diagnosed with "congenital complete left-sided cleft of the upper lip, alveolar process and
palate" on August 5, 2003 [23]. [23]. From 15 days to 5 months, the child underwent early orthopedic
treatment according to the method of G.V. Dolgopolova in order to normalize the position of the palate.
The aim was to normalize the position of the palatine plate, large and small fragments of the maxillary
alveolar process and reduce the discrepancy between them [5]. After completion of this stage of
treatment, primary rhinoplasty was performed at the age of 5 months, and ureteroplasty at the age of
12 months [10, 15]. After surgery, the patient was examined annually by a surgeon and an orthodontist;
at the age of 8 years, during the period of tooth change, a slight narrowing of the maxillary dentition
and an abnormal location of individual teeth in the anterior maxillary region were noted The patient
was fitted with a partial 2*4 bracket system to normalize the axial position of the maxillary incisors [1,
2, 11, 16, 21]; after teeth alignment in 1.1 and 2.1, the braces were removed, and the treatment period
was 11 months. Diagnosis at the time of withdrawal: "Late tooth change, narrowing and shortening of
the dentition, abnormal position of individual teeth and absence of an alveolar process on the left upper
jaw." Subsequently, after consultation with an orthodontist and a maxillofacial surgeon, it was decided
to conduct preparatory orthodontic treatment at the age of 10 years (Fig. 3) [9, 17, 22, 25] in order to
create optimal conditions for alveolar osteogenesis. Postoperative orthodontic treatment of the patient
continued from the age of 11 using the fixed straight arc technique. At the beginning of treatment, all
permanent maxillary teeth erupted, which made it possible to justify and establish the diagnosis of
"neutral bite (molars of class I according to Engl), narrowing and shortening of the maxillary dentition,
palatal position of teeth 1.2 and 2.2, excessive fullness of the tooth 2.2 and the absence of an alveolar
process on the left side of the upper jaw." Further treatment took place in several stages: 1. Active
Orthodontic treatment stage (12/25/2014): Gemini braces were installed, CuNiTi 0.014, CuNiTi 0.016,
EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
VOLUME04 ISSUE11
41
CuNiTi 0.016*022 arches were aligned horizontally to create space, and teeth 1.2 and 2.2 were
installed.After completing the first stage with the transition to the SS 0.016*022 arc, the patient was
examined by a maxillofacial surgeon and the tactics of alveolar osteoplasty were determined.2. The
surgical stage (05.04. (2016): bone autograft from the iliac crest and Bio-Gide biodegradable membrane
were used to fill in the paraphyseal defect of the alveolar bone according to a technique developed at
the Bonum Medical Center" [6, 12, 20, 24]. An intraoperatively resected and mobilized muco-periosteal
flap was stitched to form a bed for the installation of a bone autograft. Then, a biodegradable Bio-Gide
membrane with a smooth and rough surface was applied to the soft tissues 1-2 mm from the edge of
the bone to install a bone graft. The bone autograft (excellent iliac bone) was placed on a prepared bed
and covered with a absorbable BioGide membrane with a rough surface relative to the bone,
overlapping the edge of the bone defect by 1-2 mm. The membrane was fixed under moderate pressure
during the formation of a blood clot. The space under the membrane is necessary for bone regeneration
and preservation of the blood clot. A muco-rib flap was applied to the absorbable membrane, the wound
was sealed and sutured. After surgery, the bite and proportions of the teeth returned to normal. Taking
into account the wishes of the patient and parents, it was decided to remove the bracket system, and
install non-removable retainers on the upper teeth. Aggressive orthodontic treatment and alveolar
osteoplasty took a total of 18 months. The photo shows the result of a complex rehabilitation process.
At the same time, during dynamic follow-up at the Bonhomme International International Medical
Center, the patient received all rehabilitation from specialized specialists, including a speech therapist,
ENT doctor, neurologist and pediatric dentist, up to 15 years old. When the patient was removed from
dynamic observation, an assessment of facial aesthetics was performed. A slight asymmetry of the face
was revealed due to scarring after jaw surgery, but the profile was straight. The patient and her mother
rated the appearance as satisfactory. The child's speech, according to the speech therapist, was good.
CONCLUSION
This case demonstrates the cooperation of orthodontists and maxillofacial surgeons using the latest
technologies developed at the International Medical Center (early orthognathic treatment of the author,
alveolar osteogenesis with a bio-controlled biodegradable membrane) in combination with a
traditional non-removable orthodontic device. Such an integrated approach ensures timely
rehabilitation of children with congenital cleft lip, alveolar process and cleft palate with final positive
results.
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EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
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