Improving specialized medical care and rehabilitation for children with congenal developmental malformations of the maxillofacial area in the Republic of Tajikistan

Purpose of the study. Study of increasing the effectiveness and continuity of complex treatment and rehabilitation of children with congenital malformations of the maxillofacial region in the Republic of Tajikistan.

Materials and methods of the study: there were both the results of direct observation of patients with a congenital malformation of the maxillofacial region (CMMD), carried out over a period of 5 years from 2015 to 2020, and data from a retrospective copying of information from medical records covering the period from 2010 to 2015 . The subject of the study was the health status of children with congenital defects of the maxillofacial region. The subjects of the study were children aged 1 to 17 years. The main outcome characteristic recorded for each observation unit was the presence of congenital malformations of the maxillofacial region.

The work used a complex of adequate research methods, which included retrospective analysis, clinical and laboratory research, statistical and sociological study, and mathematical simulation.

The study was conducted at the Department of Pediatric Maxillofacial Surgery of the State Institution National Medical Center “Shifobakhsh” of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Specially prepared observation cards were used as research materials, and in the case of retrospective collection of material, registration forms of the state statistical observation of the State Institution “RCMS MZiSZN RT”, including 003 - “Medical record of an inpatient”, 020 - “Statistical record of a 24- hour patient leaving the hospital” stay.

Research results and discussion. The principle of surgical treatment for congenital clefts of the upper lip/and or palate is: early age from 3 months, restoration of the anatomical and functional integrity of the defect using techniques that allow the correction of all deformities using local tissues (wing of the nose, end of the nose, myodynamic balance , the correct shape of the Cupid’s line) with a cleft in the primary stage.

Compliance with consistency contributes to the achievement of both a physiologically functioning organ and a satisfactory aesthetic result close to the norm. The technique used for surgery on the upper lip is performed using the Vissarionovna-Kozin sliding flap according to Millard. Taking into account the type of cleft palate, the supply of local tissues, the width of its base, concomitant diseases, the somatic condition of the child’s ENT organs, palate plastic surgery begins at 10 months. Simultaneous plastic surgery of the hard and soft palate is used according to the gentle Kotov-Muratov method, modified in that with asymmetrical clefts and a shortened soft palate, in the lower third of the soft palate, opposing triangular figures (asymmetrical, symmetrical) are moved.

Conclusions. It has been proven that full-fledged medical and social adaptation can be ensured only if continuity and phasing of treatment are observed. Taking into account the clinical and anatomical forms of defects, environmental factors, the use of our own methods of examination and treatment, a protocol for complex treatment of children with congenital pathology of the maxillofacial region has been developed, which has reduced postoperative complications.

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