9
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Г., Халманов
Б., Абдурахмонова
Л., & Олимжонова
Г. (2020).
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Г., Джурабекова
А., Исанова
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Ф. (2019).
Ботулинотерапия в комплексной реабилитации детей с дцп. Журнал
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Ж. (2021). Эффективность дуплексной
ультразвуковой исследование для определение дальнейшей тактики
хирурга при воспалительных заболеваниях мягких тканей лицевой области
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Д. (2021).
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жевательных мышц. in Library, 2
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20. извлечено от
https://inlibrary.uz/index.php/archive/article/view/14871.
IMPROVING THE PREVENTION OF INFLAMMATORY
COMPLICATIONS AFTER URANOPLASTY IN CHILDREN
Ikramov G.A., Khatamov U.A., Urinov M.M.
Tashkent state dental Institute, Uzbekistan
The problem of rehabilitation of children with congenital cleft lip and palate
continues to be relevant and complex. The very birth of a child with visible
developmental disorders is a severe social and psychological trauma for parents
and the child himself. This is especially evident in cases where rehabilitation
measures end at a later date with the development of secondary deformities.
Complete medical, psychological and social adaptation of the child, the
formation of a full-fledged personality are directly dependent on anatomical,
functional and cosmetic disorders, as well as the timeliness of the rehabilitation
measures taken.
To provide qualified assistance to this group of complex patients, multi-
stage surgical interventions and constant monitoring by an orthodontist,
pediatrician, speech therapist and other specialists are required.
The most urgent issue in solving the problem of rehabilitation of this
contingent of patients today is the creation of a concept of assistance to these
patients, because this assistance includes a number of specific organizational,
medical, technical and social aspects.
10
The most common complication after surgery is the divergence of the edges
of the wound at the border of the hard and soft palate. This is the result of
technical errors during the operation (poor removal of the vascular bundles,
incorrect, rough interlaminar osteotomy). In isolated cases, marginal or partial
necrosis of the mucoperiosteal flaps is observed due to extensive tissue trauma
or severe compression after the surgical bandage. A short, inactive palate is a
leading sign of palatopharyngeal insufficiency. For a clear pronunciation of speech
sounds, the soft palate must be mobile, long, and when speaking, it must ensure a
sufficiently complete closure of the palatopharyngeal closure. Proper planning of
the operation, taking into account the width and length of the cleft palate, reduces
the percentage of postoperative complications.
This requires further in-depth study of the features of regeneration of the
oral mucosa with congenital cleft palate in order to increase the clinical
effectiveness of soft tissue plasty and improve the course after the surgical period.
Healing after a surgical wound in conditions of deficiency of the surrounding
tissue is also an unsatisfactory result, since complications such as dehiscence of
the wound edges due to edema and hematoma or marginal necrosis due to
excessive tension are possible. In the future, there is a change in the architectonics
of the oral cavity, aesthetic and functional disorders due to the formation of
deforming scar tissue, which aggravates the further possibility of orthopedic
treatment and disrupts the implementation of such functions as chewing and
swallowing. The effectiveness of uranoplasty largely depends on the functional
and metabolic activity of the tissues of the oral cavity.
There is a need to improve existing and develop new methods of treatment
that would be highly effective and at the same time economically acceptable.
In connection with the above, complications are relevant for the practice of
pediatric surgical dentistry, and we were very interested in the data on the use of
Hexoral aerosol, which would allow isolating postoperative defects in the oral
cavity with congenital cleft palate, protecting the wound surface and optimizing
wound healing processes.
Hexoral aerosol (produced by the international pharmaceutical company
Johnson & Johnson, LLC, Russia produced by: Famar Orleans).
The antimicrobial effect of the drug "Hexoral" is associated with the
suppression of oxidative reactions of bacterial metabolism (thiamine antagonist).
The drug has a wide spectrum of antibacterial and antifungal activity, in particular
against grampositive bacteria and fungi of the genus Candida, but the drug
“Hexoral” may also have an effect in the treatment of infections caused, for
example, by Pseudomonas aeruginosa or Proteus spp.
At a concentration of 100 mg / ml, the drug suppresses most strains of
bacteria. The development of resistance was not observed. Hexetidine has a weak
anesthetic effect on the mucous membrane.
The foregoing circumstance served as the basis for the present clinical study.
Purpose of the study: To study the state of local factors of protection of the oral
cavity and microflora in children with congenital cleft palate before and after uranoplasty
and to improve the prevention of inflammatory complications of uranoplasty.
11
Research objectives: To study the effectiveness of Hexoral aerosol in
children with congenital cleft palate after uranoplasty.
Materials and methods of research: 30 children 18 boys and 12 girls with
CCLP at the age of 3-10 years were hospitalized and followed up in the
Department of Pediatric Surgical Dentistry of the Tashkent state dental Institute.
All children with CCLP underwent uranoplasty. Cheiloplasty was performed by
him at the age of 6 months. up to 1.5 years. In each patient, the extent of the palate
defect, the condition of the muscles of the soft palate and pharynx, the size of the
palatopharyngeal passage were determined, the features of speech disorders
(twang and atriculation changes) and hearing, and the intellectual development
of the child were specified. Depending on the characteristics of postoperative
local treatment, all patients were divided into groups. The first group included 20
children who received only basic therapy: after the completion of uranoplasty, an
iodoform-gauze swab was applied to the bare surface of the hard palate. On the
fifth day, the protective plate was removed, the iodoform tampon was removed
from the surface of the mucoperiosteal flap. Daily oral cavity and wound were
irrigated with antiseptic solutions. The second group included 20 children. After
completion of uranoplasty, we apply Hexoral aerosol on the bare surface of the
hard palate, held by a protective plate. On the second day it was removed, and the
wound surface remained open. The rest of the days we treat with Hexoral aerosol.
The study of local signs shows that children with CCLP on the first day after
uranoplasty had pain in the soft palate and pharynx during swallowing and eating,
swelling of the soft tissues and bruising and hematoma of the mucous membrane
of the palate and pharynx. Particular attention was paid to the condition of the
sutures and edges of the postoperative wound, since the type and nature of
healing depends on it. As a result of the operation in the soft tissues and muscles
of the palate and pharynx, capillaries are crushed and the tissues are flooded with
blood, after which bruises, hematomas are formed, swelling of the soft tissues of
the palate and pharynx occurs, which decreases only on the sixth-seventh day of
treatment. Bruising and hematoma of the mucous membrane of the palate and
pharynx increase in the first 3 days after the operation, significantly decreasing
by the sixth day.
In patients who received traditional treatment, bruising and hematoma of
the mucous membrane of the palate and pharynx, pain in the soft palate and
pharynx during swallowing and eating persist up to the fifth day, swelling of the
soft tissues of the palate and pharynx and bad breath remain until the sixth day of
treatment.
The state of the seams and edges after the surgical wound depends not only
on the type, quality and technique of suturing, but also on the development of
inflammation in the soft tissues, which leads to suppuration of the wound.
In 10 (50%) of 20 children who received traditional therapy, the wound became
infected and on the fourth or fifth day, 50% of the sutures (along the line “A” and
in the oropharynx, where the tension of the wound edge was greater than in other
places) were in unsatisfactory condition. As a result, in 5 children by the eighth-
ninth day of treatment there was a partial divergence of the sutures. In 5 children,
12
secondary healing was observed after the surgical wound, which led to
palatopharyngeal insufficiency. The use of Hexoral significantly influenced the
dynamics of local signs of the wound process after uranoplasty. In these children,
pain in the soft palate and pharynx disappeared earlier than in the first two
groups, hematomas resolved earlier. In 2 out of 20 children who received
traditional therapy, the wound became infected on the fifth day. As a result,
secondary healing of the postoperative wound occurred in 1 child by the ninth
day of treatment.
Thus, the high efficiency of Hexoral aerosol application in children with
congenital cleft palate after uranoplasty in the early postoperative period was
noted. As can be seen from the data obtained, the drug maintains a moist
environment that promotes the fastest healing of wounds.
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