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Vol 9, No 3 (2021)

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Original Study Article

The use of intraoperative neurophysiological monitoring in dorsal resection of hemivertebrae

Vissarionov S.V., Syundyukov A.R., Nikolaev N.S., Kuzmina V.A., Kornyakov P.N., Maksimov M.N., Mikhailova I.V.

Abstract

BACKGROUND: Congenital disorders of vertebrae formation are a common pathology in children. Intraoperative neurophysiological monitoring is a mandatory procedure, although it may not be effective enough due to the immature neural structures and the use of inhalation anesthetics in young children.

AIM: To study aims to investigate the characteristic features of intraoperative neurophysiological monitoring in children with a congenital deformity of the spine during dorsal resection of the hemivertebrae.

MATERIALS AND METHODS: 42 patients aged 1–17 years with a congenital deformity of the spine underwent 46 resections of the abnormal vertebra from an isolated dorsal approach (egg-shell technique). Intraoperative neurophysiological monitoring at the stages of the operation included a muscle relaxant test (TOF), transcranial electrical stimulation of the motor cortex (TCeMEP), control of the approach to the nerve (N. Proxy), correct placement of the pedicle screw (Screw Integrity), and EMG recording of the electromyogram. The accuracy of the screw placement was assessed by the Gerzbien method, and the presence of neurological disorders was tested by the Frenkel scale. The effect of inhalation anesthetic (sevoran) on motor evoked potentials was monitored by regulating its delivery, and the dependence on the age of patients was evaluated.

RESULTS: The average age of patients was 7.7 ± 4.5 years, and the TOF value was 80.5 ± 17%. In 41 patients, the N. Proxy test was unremarkable, while in one patient, the 8–12 mA value did not require a change in the trajectory of the screws. From the beginning of sevoran and intraoperatively, motor evoked potentials from all tested muscles were recorded in 54.8% of patients; in children over 8 years old, this was observed in 92.8%, in children under 8 years old — in 35.7% of cases in their age groups. In other patients, motor evoked potentials were most often not recorded from the muscles of the thigh and lower leg after sevoran administration. In children over 8 years old in 7.2%, under 8 years old — in 83.3% of patients; Interestingly, in 7.2% of patients who are under 8 years of age, motor evoked potentials were not initially recorded from any muscle. Withdrawal of sevorane in 30.9% of patients allowed intraoperative motor evoked potentials to be obtained from all tested muscles in 100% of cases. For adequate management of anesthesia, 5 patients (50%) 1–4 years old and one patient 6 years old (5.6%) did not receive sevoran, and motor evoked potentials were recorded from the abdominal muscles. This allowed to assess the conduction only at the thoracic level and are required increased vigilance of surgeons when carrying out any corrective manipulations.

CONCLUSIONS: Intraoperative neurophysiological monitoring with dorsal hemivertebra resection is an effective method that allows controlling the neurological complications during manipulations on the spine.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):267-276
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Selected aspects of proximal femoral epiphysis fixation in children with early stages of slipped capital femoral epiphysis

Barsukov D.B., Bortulev P.I., Baskov V.E., Pozdnikin I.Y., Murashko T.V., Baskaeva T.V.

Abstract

BACKGROUND: Epiphyseodesis of the femoral head in the early stages of slipped capital femoral epiphysis using auto-, allografts, and synthetic implant may result in deformities of the femur leading cam-type femoroacetabular impingement and dysfunction of the gluteal muscles. Most surgeons refused this intervention and favor in situ fixation of the epiphysis with modern metal instrumentation and, in particular, cannulated screws with proximal threading. However, the number of screws that provide stable fixation and how to reduce their negative effect on the enchondral growth of the femur remain controversial.

AIM: To improve the results of surgical treatment in children with early stages of slipped capital femoral epiphysis.

MATERIALS AND METHODS: The radiological results of surgical treatment of 40 patients (80 affected joints) aged from 11 to 14 years with slipped capital femoral epiphysis of stage 1 in one joint and stage 2 in the other joint were analyzed. 20 children were divided into two groups. In each group, the epiphysis was fixed with a 7.0 mm cannulated screw. In the first group, the screw head was held on the cortical layer. In the second group, the screw head was held 5–10 millimeters away from the cortical layer. Long-term results were evaluated at the age of 17–18 years when no signs of enchondral and ecchondral growth of the proximal femur were noted. The obtained data were subjected to statistical analysis.

RESULTS: The fixation of the epiphysis was stable in all 80 joints. The shape of epimetaphysis in the joints of stage 2 did not change in most patients by the end of femoral growth. However, the correction recorded in 32.5% of cases was more often observed in children of the second group. The shape of epimetaphysis in all 40 joints with stage 1 of the disease remained normal. The mean length of the epimetaphysis was greater in the second group than in the first group by the end of growth regardless of the stage of the pathologic process during surgery.

CONCLUSIONS: The considered method of proximal femoral epiphysis fixation, which excludes the compressive effect of a cannulated screw with proximal threading on the epiphyseal growth cartilage, provides reliable epiphysis retention in the early stages of slipped capital femoral epiphysis. It has a less negative effect on the enchondral growth of the femoral component of the joint.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):277-286
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How to prevent graft resorption or breakage in shelf acetabuloplasty for Perthes disease with hinge abduction – A modified Staheli technique successful in 31 hips in midterm results

Abol Oyoun N., Khaled M., Mohamed Elbaseet H., Hafez Ibrahim A.

Abstract

BACKGROUND: Shelf acetabuloplasty covers the hip and allows remodeling in hips with Legg-Calvé-Perthes disease and hinge abduction. Graft resorption or breakage is a bad complication that necessitate another surgical procedure.

AIM: Our report evaluates a modified Staheli technique for graft resorption or breakage.

MATERIALS AND METHODS: Case series study of 31 hips (29 patients) with mean age at operation was 8.1 (range 6-14 years). Duration of complaint ranged between one year and up to three years with the mean duration 1.52 ± 0.76 years. The different parameters evaluating the hip as: Tönnis angle, Sharp angle, center-edge angle, and acetabular coverage percentage were measured. For unilateral cases only, medial joint space ratio and epiphyseal height ratio were evaluated.

RESULTS: The mean postoperative follow-up was 47.8 ± 9.8 months. All studied joints had Catterall type IV, Salter-Thompson classification type B. Seven joints were in Fragmentation stage whereas 24 joints were in re-ossification stage. Based on Lateral Pillar classification; only two joints were classified as B/C and 29 joints were classified as C. Final follow up internal rotation, abduction, center-edge angle, and acetabular coverage percentage were found to be significantly higher. In contrast, Tönnis angle and Sharp’s angle were significantly decreased. For unilateral cases, it was found that medial joint space ratio and epiphyseal height ratio were significantly decreased. None of the hips had resorbed or broken graft till final follow up.

CONCLUSIONS: This modified Staheli technique prevent graft resorption or breakage. Shelf provides a good acetabular coverage for the deformed aspherical head with Legg-Calvé-Perthes disease and hinge abduction to improve hip clinical and radiological outcome.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):287-296
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First metatarsal elevation after subtalar arthroeresis in children with flatfeet

Sapogovskiy A.V., Boyko A.E., Rubtsov A.V., Rubtsova N.O.

Abstract

BACKGROUND: Arthroereisis of the subtalar joint is a common surgical option for children with flat feet. Along with all the advantages of arthroereisis of the subtalar joint, the indications for surgery, the optimal age for surgical treatment, as well as secondary deformities of the forefoot that occur after treatment are debatable.

AIM: The aim of this study was to analyze the frequency and degree of I metatarsal elevation after arthroereisis of the subtalar joint in children.

MATERIALS AND METHODS: The study group included 106 patients / 202 feet who were treated at H. Turner National Medical Research Center for the period from 2015 to 2019. The average age was 11 years (8; 13). Arthroereisis of the subtalar joint was performed in two variants: arthroereisis with a locking screw in the calcaneus — 44 patients / 83 feet and arthroereisis with a locking screw in the talus — 62 patients / 119 feet. An analysis was made of the incidence of I metatarsal elevation after arthroereisis of the subtalar joint. The relationship between the degree of elevation of the first metatarsal bone and the main clinical and radiological characteristics of the feet at different times after surgical treatment was analyzed.

RESULTS: The frequency of elevation of the I metatarsal bone with the use of a calcaneal locking screw was 20.7%, and with the use of a talar locking screw, the frequency is 51.6%. Clinical manifestations of elevation of the I metatarsal bone took place when the amount of elevation was more than 65% of the size of the head of the I metatarsal bone. At a period of 2–3 years after the operation, elevation of the I metatarsal bone were noted in 15.9%. A statistically significant correlation (Spearman coefficient) was noted between the degree of elevation of the I metatarsal bone and the following parameters: anteroposterior Meary angle (–0.360), lateral Kite angle (–0.367), lateral Meary angle (–0.378), foot arch angle (0.344), tibio-talar angle (–0.351), Friedland’s index (0.402).

CONCLUSIONS: Incidence of the first metatarsal bone elevation reaches 51% of the in patients in the immediate follow-up period after performing arthroereisis of the subtalar joint. Elevation of the first metatarsal bone developed dorsal bunion with an elevation value of more than 65%. The degree of elevation of the first metatarsal bone has a positive correlation with the degree of planovalgus deformity correction. Elevation of the first metatarsal bone tends to decrease up to 15% in the long-term follow-up after surgical treatment.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):297-306
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Predictors of polytrauma outcomes in the early period in children

Shabaldin N.A., Golovkin S.I., Shabaldin A.V.

Abstract

BACKGROUND: The problem of anti-shock measures and stabilization of the general condition of the affected children with polytrauma at the stage of intensive care is an extremely urgent issue in pediatric traumatology. Various aspects, such as determining the most sensitive prognostic scale for assessing the severity of polytrauma, clinical and laboratory predictors of changes in the vector of development of the course of traumatic disease in the direction of thanatogenic orientation, remain actively discussed among clinicians.

АIM: The aim of the study is to analyse the dynamics of changes in the indicators of internal homeostasis in children with polytrauma, indicating a favorable or thanatogenic direction of the course of the traumatic disease.

MATERIALS AND METHODS: A retrospective analysis of the medical records of 49 patients diagnosed with polytrauma was performed. All patients were divided into two groups: the survivors’ group comprised 41 patients, and the deceased group consisted of 8 patients.

All patients were examined for total blood count (Er, Tr, Ht, Hb, le, ESR), acid-base state (pH, SBC, BE), blood biochemical parameters (creatinine, urea, ALT, AST, K, Na, Ca), and C-reactive protein. The tests were performed daily during the first 10 days of the acute phase of the injury. The severity of the injury was determined by the NISS and pediatric trauma score scales, and in the case of a traumatic brain injury, the Glasgow coma scale was used.

A logistic step-by-step regression analysis was performed to identify predictors of polytrauma outcomes. The statical significance was considered at p < 0.05.

RESULTS: The step-by-step logistic regression revealed significant predictors that determined the unfavorable outcome of polytrauma (death), already on the second day. They were the NISS score, the level of CRP, Hb, Er, Na, and creatinine. At the same time, the statistical significance in the dynamics of changes in red blood parameters (Er, Hb), blood ionic composition (Na, K), humoral activity (Le, ESR, CRP) remained up to 10 days, i.e., during the period of possible complications of the traumatic disease. Our data offered the possibility to derive an equation for calculating the risk of failure of compensatory mechanisms in polytrauma.

CONCLUSIONS: The course of traumatic disease in children with polytrauma is characterized by morpho-functional changes in many organ systems. Predictors of failure of compensatory-adaptive mechanisms in response to polytrauma can be determined already in the early post-shock period.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):307-316
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Exchange of experience

Sternal fractures in children

Skryabin E.G., Naumov S.V., Zotov P.B., Akselrov M.A.

Abstract

BACKGROUND: Sternal fractures are a rare nosological form of injuries in children. The injuries of the sternum often are accompanied by fractures of the long bones of the skeleton or thoracic vertebrae. Isolated fractures of the sternum in children are rarely diagnosed. The medical information on pediatric sternum injuries is limited by a small number of scientific publications.

AIM: Our aim is to study the peculiarities of traumagenesis, clinic, diagnostics, treatment of sternal fractures in children.

MATERIALS AND METHODS: Clinical material for the served as experience in providing traumatology assistance to 8 children who received sternal fractures. The average age of the injured children was 11.5 years. 87.5% of the victims were boys. In all patients, sternal fractures had been diagnosed along with other damage to the musculoskeletal system. During the survey, traditional diagnostic methods for emergency traumatology were used.

RESULTS: The leading mechanism of injury, i.e., falling from a height of 2 meters and more were found in 62.5% of victims. In all clinical observations, fractures were localized at the level of the body of the sternum. All the children, besides sternal fractures, had uncomplicated fractures of the vertebral bodies. A total of 30 bodies of the vertebrae were compressed. Most often (in 16.75% of cases), the ThV vertebra was compressed. The reliable symptoms of sternal fractures in patients were difficult and painful breathing, local swelling of soft tissues, soreness of the sternum during palpation, and amplification of the pain in the fracture area during pressure applied on half of the chest. Compliance with the strict bed mode on the roller-reclinator under the area of the compreated vertebrae and the exclusion of the axial load on the spine was a favorable fact sufficient and led to pain disappearance in 3–7 days. In all cases, the sternum fractures did not require any surgery. Fractures of the bodies of the vertebrae in 7 children were also treated conservatively. The Corsets “Orlett” was used for immobilization, ensuring a reliable degree of fixation. The average hospital stay amounted to 16. The duration of the hospital stay was influenced by the accompanying bone-articular damage to the skeleton. The evaluation of the long-term results was performed in 4 children. The results were interpreted as good.

CONCLUSIONS: When applying for emergency traumatology assistance to children with chest injury and spine, it is necessary to purposefully explore the state of the sternum.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):317-325
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Сase report

Clinical and genetic characteristics of rare variants of acromelic skeletal dysplasias caused by mutations in the FBN1 gene

Markova T.V., Kenis V.M., Melchenko E.V., Nagornova T.S., Murtazina A.F., Dadali E.L.

Abstract

BACKGROUND: Geleophysic dysplasia and acromicric dysplasia are rare hereditary diseases characterized by dwarfism and dysplastic skeletal features. In the literature, only a few cases of geleophysic dysplasia and acromicric dysplasia caused by mutations in the FBN1 gene are described.

CLINICAL CASES: A description of the clinical and genetic characteristics of three female patients with acromelic dysplasias caused by three types of missense mutations in the FBN1 gene is presented. In two patients, on the basis of clinical manifestations and radiographic examination, acromicric dysplasia, and in one patient — geleophysic dysplasia were diagnosed. It was shown that all identified mutations were localized in exons of the FBN1 gene encoding the amino acid sequence of the fifth domain, which has homology with transforming growth factor-beta.

DISCUSSION: We have analyzed the clinical and genetic correlations to confirm the previously stated hypothesis about the occurrence of a severe phenotype of geleophysic dysplasia in patients with the c.5206T> C mutation. This mutation is characterized by the replacement of cysteine by arginine in the position of the polypeptide chain leading to moderate clinical manifestations of acromicric dysplasia in patients with the c.5284 G> A (p. Gly1762Ser). It was shown that the previously undescribed substitution c.5177G> A (p.Gly1726Asp and another previously described mutation in this codon resulted in the replacement of glutamine with valine. This mutation causes the appearance of a less pronounced phenotype of AD.

CONCLUSIONS: Based on the results of the examination of three Russian patients and analysis of clinical and radiographic parameters described in the literature, we reported that mutations in the FBN1 gene disrupted the amino acid sequence of the fifth like transforming growth factor-beta domain of fibrillin type 1. Importantly, these mutations are responsible for the occurrence of geleophysic dysplasia and acromicric dysplasia. However, the most severe clinical manifestations were observed in patients with mutations leading to the substitution of cysteine for arginine at the position of the polypeptide chain 1736. This may lead to affecting the transforming growth factor-beta signaling pathway.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):327-337
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Benign fibrous histiocytoma of the femur: A rare pediatric case report

Abdellaoui H., Tazi Charqui M., Balde F., Atarraf K., My Abderrahmane A.

Abstract

BACKGROUND: Benign fibrous histiocytoma is known to be a frequent skin tumor but its occurrence in bone remains very rare especially in pediatric population. This entity is a subject of interest also because histologically it can mimic other fibrohistiocytic lesions of bone such as non-ossifying fibroma.

CLINICAL CASE: An 11-year-old patient admitted with swelling of the right thigh and intermittent pain. Radiological evaluation shows cystic lesion of the femur with a soap-bubble and a border of condensation. Histopathological examination of the biopsy sample established the diagnosis of benign fibrous histiocytoma. The patient underwent complete curettage of the lesion with bone graft. There is no recurrence 16 months after surgery.

DISCUSSION: Benign fibrous histiocytoma is a rare bone tumor especially in children. Histologically it can mimic non-ossifying fibroma. Thus clinical and radiological features are important to differentiate these tumors in order to choose adequate treatment.

CONCLUSIONS: Benign fibrous histiocytoma is probably underestimated in pediatric population. This diagnosis should be considered in any child or teenager who presents with a non-ossifying fibroma accompanied by unexplainable pain or a rapid growing.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):339-344
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Closure of large lumbosacral defect using a combined method of bilateral bipedicle flap with lateral releasing incision and Integra® dermal regeneration template

Yap P., Mat Saad A., Wan Sulaiman W., Mat Johar S., Mohamad Shah N.

Abstract

BACKGROUND: Myelomeningocele is one of the most complex congenital malformations of the central nervous system. It is one of the most common types of spina bifida which involves a failure of neural tube closure. Reconstruction surgery for myelomeningocele had always been challenging for plastic and neurosurgeons.

CLINICAL CASE: We report a case of a new-born with lumbosacral myelomeningocele who received treatment in the Hospital Universiti Sains Malaysia. The myelomeningocele was repaired by the neurosurgery team and subsequently, the child was left with huge lumbosacral skin defect. The large defect was successfully covered by using a combined method of bilateral bipedicle flap with lateral releasing incision and remaining lumbosacral and secondary defect resurfaced using Integra® dermal regeneration template (DRT). We used ACTICOAT interfaced negative pressure wound therapy (NPWT) as our main dressing in preparing the wound bed for autologous epidermal graft. The result of our closure technique provides tension free closure.

DISCUSSION: We incorporated bilateral bipedicle fasciocutaneous flap technique together with DRT for closure of the lumbosacral defect. The bilateral bipedicle flap with lateral releasing incision served to reduce tension on the skin at bilateral lumbar region. The DRT downsized the lumbosacral defect and NPWT dressing provided an optimal sterile environment in giving time for neodermis generation. The remaining secondary defect were also resurfaced utilizing DRT and autologous skin grafting.

CONCLUSIONS: The outcome of surgery demonstrated that the combined use of bilateral bipedicle fasciocutaneous flap with lateral releasing incision and DRT with delayed skin grafting is safe, effective and provide long term stable and supple scar for large, exposed dura defect.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):345-351
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Review

Surgical treatment of children with extensive bone defects (Literature review)

Shabunin A.S., Asadulaev M.S., Vissarionov S.V., Fedyuk A.M., Rybinskikh T.S., Makarov A.Y., Pushkarev D.A., Sogoyan M.V., Maevskaia E.N., Fomina N.B.

Abstract

BACKGROUND: Reconstruction of extensive defects to bone tissue is one of the important problems of orthopedics and traumatology. Especially in acuteis, the problem is associated with the restoration of bone tissue in conditions of its deficiency in pediatric patients.

AIM: The aim of the study is to analyze modern methods of surgical treatment in children with extensive bone tissue injuries based on the published literature.

MATERIALS AND METHODS: Our report presents a review of the literature of methods of surgical treatment of extensive bone defects. The literature search was carried out in several databases such as PubMed, ScienceDirect, E-library, GoogleScholar for the period from 2005 to 2020, using the keywords given below. As a result of the search, 105 foreign and 37 domestic sources were found. After exclusion, 56 articles were analyzed, all presented works were published in the last 15 years.

RESULTS: The gold standard for replacing bone defects is still the use of autografts, including the use of technologies on a vascular pedicle. Various types of xenografts and allografts of bone tissue are increasingly being replaced by various kinds of synthetic implants.

CONCLUSIONS: To date, there is no single generally accepted standard for the surgical treatment of extensive bone defects. The option of surgical treatment of extensive bone tissue defects using tissue-engineered bone implants with axial blood supply seems to be extremely interesting and promising.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):353-366
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The influence of the TBX6 gene on the development of congenital spinal deformities in children

Khalchitsky S.E., Vissarionov S.V., Kokushin D.N., Muldiiarov V.P., Khusainov N.O.

Abstract

BACKGROUND: Congenital deformities of the spine are a group of serious congenital defects of the vertebrae, which can manifest themselves in the clinical picture as an isolated pathology of the axial musculoskeletal system, and are associated with congenital defects of internal organs and other systems. Recently, the TBX6 gene has been identified as the genetic cause of congenital scoliosis in about 11% of cases. This subtype of scoliosis is classified as TBX6-associated congenital scoliosis. The TBX6-associated congenital scoliosis phenotype is characterized by butterfly-shaped vertebrae and hemivertebrae in the lower thoracic and lumbar regions without pronounced malformations of the spinal cord.

AIM: Our aim is to study and evaluate data from foreign and domestic scientific publications devoted to the study of the candidate gene for congenital scoliosis TBX6.

MATERIALS AND METHODS: The following databases of scientific publications such as PubMed, Cochrane Library, Web of Science, SCOPUS, MEDLINE, e-Library, Cyberleninka were used to write this review. The inclusion criteria were systematic reviews, meta-analyses, multicenter studies, controlled cohort studies, uncontrolled cohort studies of patients with congenital spinal deformities. The exclusion criteria were clinical cases, observations, conference proceedings, congenital scoliosis in genetic syndromes, congenital scoliosis associated with defects of the nervous system.

RESULTS: In order to achieve this goal, 70 scientific publications were studied relating to the data analysis of the candidate gene for congenital scoliosis TBX6. Among 49 publications that were identified, 2 were domestics, and the rest were foreign publications. These studies provided information on the molecular analysis of genes that cause congenital spinal deformities in humans and animals.

CONCLUSIONS: An analysis of the published research work on this topic indicates the presence of a significant effect of mutations in the TBX6 gene, leading to the appearance of congenital scoliosis.

Advances in elucidating the genetic contribution to the development of congenital spinal deformities and the molecular etiology of clinical phenotypes may uncover the opportunities for further refinement of the classification of signs of congenital scoliosis in accordance with the underlying genetic etiology.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):367-376
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Analysis of bone-reconstructive surgery aimed at normalization of occlusal relationships of the jaws at the final stages of rehabilitation treatment of children with congenital cleft lips and palate (Literature review)

Semenov M.G., Botsarova S.A., Stepanova Y.V.

Abstract

BACKGROUND: The completion of medical rehabilitation of children aged 16–18 years with congenital cleft lips and palate is often impossible without surgical correction of occlusal relationships of the jaws and improvement of facial aesthetics. At the same time, the main efforts of the specialists engaged in the treatment of children with orofacial clefts are aimed at correcting local plastic operations of the upper lip, nose, oral cavity, and orthodontic, using non-removable arc equipment, correction of disturbed occlusion.

AIM: Our aim is to study and analyze the problems of final bone reconstructive operations in patients with HRGN.

MATERIALS AND METHODS: The article presents a review of the literature on this topic, based on 61 sources. The literature was searched by keywords in the databases such as PubMed, ScienceDirect, E-library, and Google Scholar from 1938 to 2020. The data on the treatment of children with combined maxillofacial anomalies and deformities with cleft lips and palate, who underwent reconstructive bone operations on the jaws in order to normalize their occlusal relationships, were analyzed.

RESULTS: In order to achieve good morphofunctional and aesthetic results, as well as early socialization of patients with VRGN at the final stages of rehabilitation, complex hardware and surgical treatment are necessary. The indication for reconstructive operations on the jaws in patients is the face disorder and disharmony of the face, which cannot be corrected by orthodontic treatment. The operations should be based on careful planning, including CT modeling, the use of sparing techniques, including various modifications of Le Faure I osteotomy on the upper jaw, and retromolar sagittal osteotomy of the jaw and, according to indications, genioplasty on the lower jaw.

CONCLUSIONS: Two-jaw orthognatic bone reconstructive operations on the jaws to restore the correct bite have recently been used in the complex medical rehabilitation of patients, especially in adolescents with VGN. At the same time, there are a number of unresolved issues of orthodontic and surgical treatment that require further study. There is a strong need for a clear understanding of the age of planning and timing of such operations considering the stage of completion of skeletal growth. The criteria for the patient’s readiness for surgery for multiple occlusive contacts also need to be evaluated. It is of paramount importance to determine the order of performing corrective operations on the soft tissues of the face and oral cavity. Hence there is a necessity to develop new methods of reconstructive operations on the jaws.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):377-387
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Obituaries

Lynn Taylor Staheli (1933 - 2021) - in memory of the outstanding pediatric orthopedic surgeon of our time

Abstract

Lynn Taylor Staheli is Professor Emeritus at the University of Washington, a distinguished pediatric orthopedic surgeon, author of numerous studies and books, and a major contributor to the development of pediatric orthopedics.

Professor Staheli was a founding editor of the Journal of Pediatric Orthopaedics and founder of Global HELP. In recent years he has been active in the promotion of modern approaches in pediatric orthopedics.

Lynn Taylor Staheli passed away on August 9, 2021. He was 87 years old.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(3):388-389
pages 388-389 views

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