Украинский журнал хирургии 2 (21) 2013

In structure of congenital developmental anomalies of an congenital unilateral cleft of an upper lip and the palate is one of the most widespread and is high on the list on weight among anatomic and functional infringements [2, 7, 18].

Manifestation in an oral cavity at patients are connected with variety densmaxilla anomalies (anomalies of teeth, tooth alignments, jaws, a bite, soft fabrics), causing a pathology of a bite [1]. Early orthodontic treatment is directed on normalization of the form of an alveolar shoot of the top jaw and improvement of conditions of carrying out cheilo- and uranoplasty. However it completely does not eliminate anatomic and functional infringements in the maxillofacial area, caused by the given developmental anomaly and aggravated with growth of the child, especially in the period of change of a milk teeth on constants [15, 17, 21].

Patients with congenital unilateral cleft of an upper lip and the palate need long and difficult treatment at the ortodont, the maxillofacial surgeon, the stomatologist-therapist, paradontolog, demand the special approach in prosthetics [2, 3, 13]. In the literature there is contradictory data about morphological infringements at IUCLP at level alveolodental arches and all obverse department of a skull [9, 12, 14, 20, 23].

At 46–100 % of patients about congenital maxillary deformations, anomalyan arrangement of teeth, infringement of a bite [10].

Typical deformations of the top jaw are described at germs and fruits of various age terms with congenital cleft of an upper lip and the palate. There are they early, in 8 weeks, and quickly enough progress. The bone of the top jaw at a 24-week fruit on the party of a crevice is less, than on the healthy party on 8 % also is displaced behind. And these terms influence of dysfunction of muscles slightly as in 7–8 weeks there is a bookmark and a differentiation of face muscles. At a germ the structure of average department of the person, a formed nose, an upper lip, the top jaw are deformed all. However the common opinion about an original cause and the mechanism of occurrence of deformations during the period perinatal ontogenesis is not present [11].

Considering it, throughout many years in the leading centres methods of treatment an congenital unilateral cleft of an upper lip and the palate are constantly improved. Last decade the tendency of carrying out of operation cheilo- and uranoplasty in early terms is distinctly traced [4, 8]. Advantage of the operations spent to early terms of disease, possibility as timely consecutive restoration of normal anatomo-topographical and functional mutual relations off tissues of maxillofacial area, and formation of functional systems of an organism is. However in overwhelming majority of cases at children with a through crevice of a lip and the palate at early age of operation it is not spent because of development in them intercurrent diseases (frequent catarrhal diseases, anemia, a rickets, etc.).

The question of restoration of the anatomic form of an upper lip and the palate [16]. However is now full enough developed, redistribution of functional loadings, cicatricial change in a zone of operative intervention quite often leads to considerable secondary deformations densmaxilla systems [19].

Character of postoperative changes and their influence on growth, development and formation densmaxilla systems at patients with congenital cleft of an upper lip, an alveolar shoot and the palate have the features. Usually meet combination the deformations which treatment is labour-consuming and demands an individual approach [6, 20]. According to M.S. Syplakovoy, M.A. Dovbish, E.S. Keroz (1996), for children with through upper lips and the palate in the period of a replaceable and constant bite are characteristic; the closed arch of the upper jaw; a neutral parity of the first constants molar teeth at half of patients; displacement of an average line aside, opposite to defect; high frequency of return and deep incisors over lappings; unilateral buccal a cross bite in every third case.

On the party not cleft the palate of the central top cutter, close position of cutters on upper jaw, frequent absence of a constant lateral cutter is marked palatal cutting a canine [6].

The important place in the occurrence mechanism before operation and after operation secondary deformations of the split upper jaw occupies defect of a bone fabric along the edges of a cleft and first of all defect of a bone basal department of an alveolar shoot [10]. The cleft alveolar shoot after restoration of integrity of a lips-cheek-muscular ring under the influence of muscular draught is closed. Fragments of the upper jaw displace to the centre, the form of an alveolar shoot improves, decrease deformation a bone skeleton of a nose. In 12–18 months after cheiloplasty the ends of alveolar shoots densely adjoin to each other, and in case of them not elaboration hidden micrognathiais shown by infringement progeniuses. Formation or return overlapping of cutters and a canine on the crevice party, or deformation bite as false progeniuses.

Not formation and deformation of a tooth alignment, an alveolar shoot and a body of the upper jaw, and also an abnormal arrangement of teeth and bite infringement were aggravated after elimination of congenital defects in maxillofacial area at the expense of surgical actions. In the domestic and foreign literature there are individual works the conditions of department devoted to studying alveolar arches of the upper jaw of children with an congenital unilateral cleft of an upper lip and the palate and influences on them of pressure of a lip after the spent operative intervention.

Material and Methods

At all initially addressed children with an congenital unilateral cleft of an upper lip and the palate removed moulds from the upper jaw, cast control models. On control models spent anthropometrical measurement. Initial parameters of the upper jaw compared with those, received before cheiloplasty. At all children for an estimation of dynamics of position of fragments of the upper jaw and with of defect removed moulds in 2 weeks after cheiloplasty and before veloplasty.

The anthropometry was spent on reference points Sillman. On model of a jaw at children with teeth of the milk and mixed bite of a point are located as follows: A — points between the central cutters, and other points are located on the right (R) and at the left (L); B — points behind the second teeth; C — behind the third; D — behind the fourth; E — behind the fifth teeth; F — behind a crest of an alveolar shoot of the upper jaw.

At statistical processing of the sizes of models of the upper jaw and at comparison of matrixes of indexes of asymmetry of skulls (An S.V., 1993) absence of authentic distinction between boys and girls that has allowed us to unite parameters of these groups is revealed.

Following measurements have been spent:

— In transversal direction:

a) relative width of the upper jaw — distance between V IV III teeth F (R) and F (L); E (R) and E (L); D (R) and D (L); C (R) and C (L);

b) Width of alveolar defect.

— In sagittal direction:

a) length of the upper jaw points E, D, C and A, equal to length of the perpendicular lowered from these points on isometric line Х, on line F (R)-F (L) (fig. 1);

b) length of the big fragment;

c) length of a small fragment;

d) length of a forward piece of a tooth arch in relation to mesial to edge of a small fragment;

e) corner of a deviation of the big fragment from median lines.

The given measurements sagittal have grouped directions both from a crevice, and from the opposite (healthy) party. Statistical processing of the received material spent by means of methods of mathematical statistics on the personal computer c operative system Windows 7 with use of a standard package for statistical processing Excel 2010 and criterion of Student.

Results and Discussion

Congenital unilateral cleft upper lip and the palate concern to difficult developmental anomalies which it is primary, from the first hours of life of the child anatomic and functional infringements of the vital systems of an organism of the newborn accompany. After a birth when the dens-maxillary system becomes a part important intensive formed functional system, coordination miodynamic balance has the expressed deforming influence [16].

Anthropometry of models of the upper jaw at newborn children with congenital unilateral cleft upper lip and the palate have shown that the relative length of the big fragment essentially does not differ from indicators of healthy children. But at sick children the length of a small fragment of the top jaw on a projection of III tooth is truncated on 20 %. By 6–8 months of life of the child before cheiloplasty the length of the upper jaw on sagitalyon the healthy party rather to the initial increases by 41.9–27.5 % which on 10 % exceeds indicators of healthy children. The length of a small fragment of the upper jaw on 13 % remains less indicators of norm. At newborn children with congenital unilateral cleft upper lip and the palate the cross-section sizes of the upper jaw in comparison with norm are wider. In 6–8 months the Measured parameter at the same children in relation to the initial increase on the average by 19 %. The width of a crevice within an alveolar shoot and a hard palate grows on 22,1 % of its initial size.

Corner a deviation of the big fragment from the central line studied on program Image J Launcher. A corner a deviation of the big fragment was more than after cheiloplasty.

Conclusions

The analysis of morphological researches has shown that, at children with congenital unilateral cleft upper lip and the palate infringement miodynamicthe balance, beginning in antenatal the period, proceeds and in postnatal the period and it is shown not development alveolar and palatal shoots, an inclination of a palatal shoot with a nasal partition in the healthy party and change of a steepness of a slope of palatal shoots and early complex orthodontic treatment before and after cheiloplasty promote early restoration of anatomic infringements of strongly developed top jaw and a lip (normalization of length, a steepness of a slope of palatal plates) and correction of position of a nasal partition.