SCARS OF THE MAXILLOFACIAL REGION IN CHILDREN (CLINICAL AND LABORATORY ASSESSMENT AND PRP THERAPY)

Abstract

Actuality. According to various authors, hypertrophic scars are formed in 30% of cases after facial operations, in 35% causes of velopharyngeal insufficiency (VPI) are deforming scars in the soft palate area. Among the many known methods of regenerative therapy, the most effective is the introduction of platelet-rich plasma (PRP).
Materials and methods. Performed examination and treatment of 11 children aged 4 to 17 years, including 6 children with hypertrophic scars after primary cheilorhynoplasty and 5 children with soft palate scarring after veloplasty. Clinical and laboratory examination of the scars was performed on a modified Vancouver scale, the results of Doppler ultrasound, MRI on the 8th and 15th day of application of PRP therapy.
Results and Discussion. The analysis of the indicators revealed that before the plasma injection the scar values ranged from 10 to 13 points. According to Doppler imag-ing, tissue density in the scar area was hyperechogenic in 67% of cases, hypoechogenic in 33%. The mean linear size of the scar in mm was 9.4x3.01 (the area of the scar was 28.29mm²), the blood flow in the scars was not visu-alized, and in tangent tissues in 100% of cases, single loci of blood flow were recorded. 8 days after the first session of plasmotherapy, the total score of scar indicators was in the range from 8 to 10. The analysis of Doppler results showed a slight decrease in the linear size of the scar due to the thickness (by 0.5 mm), the average linear dimen-sions were equal to 9.4 × 2.51 mm. (the area of the scar was 23.59mm²); the enhancement of blood flow in the tangent tissues due to a slight increase in blood flow loci was visualized. After the second PRP session, all patients had an average score of 9. According to the results of Doppler ultrasound, the linear dimensions of the scar de-creased mainly due to thickness and amounted to 6.27x2.00 mm (area of the scar 12.54mm²). In 50% of cases, increased blood flow in the tangent tissues due to an increase in blood flow loci and the number of vessels. In 5 patients after veloplasty, clinically, mild mobility of the soft palate, ischemic mucous membrane was found. All children were diagnosed with a hyperintense signal (HU 438 ± 21.12) of scar tissue in the area of the muscu-lar aponeurosis of the soft palate, irregularly shaped with clear borders. After the first injection of PRP on 7th day, all children had a partial recovery of the color of the soft palate over the scar. MRI revealed a decrease in signal intensity to HU=352±15.71, scar borders became un-clear. The second injection of PRP into the scar tissue was performed after 7-8 days. Clinical and speech-therapy examination showed no significant change com-pared to the effect after the first injection. The signal in-tensity after the second injection was within HU=348±22.14, indicating statistical inaccuracy between them.
Conclusions. There was a positive result of the use of in-jectable form of PRP therapy in hypertrophic scars of the skin and soft palate. The structure of scar tissue after PRP in the skin scar undergoes slight changes mainly due to the reduction of its thickness, the increase of blood flow loci and the number of vessels in the tissues. According to the received clinical, speech-therapy, MRI data, one in-jection of PRP is sufficient to reduce scar tissue density in children with VPI.