CLINICAL ASPECTS OF ORTHODONTIC TREATMENT DEPENDING ON THE RESULTS OF PRIMARY SURGICAL INTERVENTIONS IN CHILDREN WITH CONGENITAL CLEFT LIP AND PALATE

Abstract

Treatment and rehabilitation of children with congenital cleft lip and palate (CLP) requires adherence to clear protocol terms. The COVID-19 pandemic and full-scale Russian military aggression had multiple consequences for the health care system. Purpose: analysis of the impact of primary surgical interventions on clinical aspects of orthodontic treatment of children with congenital unilateral cleft lip and palate (UCLP) during the period of mixed occlusive, taking into account extreme conditions. Materials and methods. The subject of the analysis is data on the number of visits by children's patients to dentists of the Surgical Dentistry and Maxillofacial Surgery of Pediatric Age Department of the MNE Children’s Clinical Hospital No. 7 in Kyiv in the period from March 2018 to March 2023. At the stage of orthodontic treatment of 137 patients aged 4.5 to 14.5 years with UCLP, removable and non-removable orthodontic appliances were used. The impact of primary surgical interventions on orthodontic treatment was analyzed. Results and Discussion. Attendance rates for treatment of injuries, neoplasms, and congenital malformations of the maxillofacial area as a percentage of total visits during the war impact period were similar to those during the COVID-19 pandemic impact period. The more aggressive the technique and volume of surgical interventions, the more tissue scarring and the likelihood of occurrence of upper jaw deformities. Peculiarities of orthodontic treatment of children with unilateral nonunion in mixed occlusive are physiological changes in teeth, conditions for fixation of appliances, impossibility of placing supporting elements on temporary teeth due to existing resorption of their roots, difficulties in high-quality oral hygiene, high intensity of caries and frequent diseases of periodontal tissues, acute respiratory and diseases of the ENT organs. The reduction in hospitalization of patients did not have an impact on surgical outcomes, despite the COVID-19 quarantine and the impact of the war. When developing programs to prevent the development of CLP and related anomalies, the multifaceted influence of factors caused by extreme conditions on the course and pregnancy results should be taken into account. Conclusions. The effectiveness of the complex rehabilitation of children with UCLP are determined by timely and methodically correct treatment by a team of specialists, the sequence of actions and the method of primary surgical interventions, the type of cleft, the degree of severity of morphological and functional disorders of the maxillofacial area, the presence of concomitant diseases. The epidemic and the war outlined a number of problems in the provision of dental care, which affected the attendance of clinics, resulted in a violation of the treatment plan, phasing and timing of planned operations that must be taken into account when conducting orthodontic treatment.