On the issue of surgical treatment of patients with congenital orofacial clefts combined with other organ and system comorbidities

Abstract

Relevance. Surgical treatment of patients with congenital orofacial clefts and comorbidities of other organs and systems remains a complex problem in specialized surgery, and it requires concentration of knowledge of individual characteristics and diagnosed disorders during their implementation, taking into account the sequence, volume and time of execution. Purpose. Optimize the tactics of surgical treatment of children born with orofacial clefts combined with disorders of other organs and systems, improving rehabilitation effectiveness. Material and methods. The work focuses on the results of a study of 2475 patients with congenital orofacial defects during the long-term follow-up period (1998-2022) in the Bonum Medical Center (Yekaterinburg). There were 823 cases of congenital orofacial clefts combined with disorders of other organs and systems. The disease combination groups were systematized and determined the tactics of surgical treatment of orofacial defects and the rehabilitation techniques for comorbid defects. Results. To date, out of 823 patients with orofacial clefts and comorbidities of other organs and systems, 591 (71.81%) patients are known to have received comprehensive surgical rehabilitation, part of them turned 18 years and were withdrawn from the long-term follow-up care, the rest – 232 (28.19%) continued to receive specialized care in the Bonum Center system. Of the 823 patients, 370 children needed primary cheilo-rhinoplasty, 196 people (52.97%) had surgery at the traditionally accepted time (in the first six months of the child's life), 302 children (81.62%) had surgery by the age of nine months, and 329 children (88.92%) by one year. Based on the individual indications, thirty-six children (9.73%) had surgery after one year, of which eight patients (2.16%) after two years. Of the 823 patients, 770 people needed palatoplasty (cleft repair of hard and soft palates), while in the conditions of special preparation, the operation was performed in 360 children (46.75%) by 18 months, in 483 children (62.73%) by24 months, and 588 children (76.36%) by the age of 3 years. Considering the cleft palate complexity, 102 children (13.25%) needed further treatment later due to physical condition restrictions and social reasons. Conclusion. The proposed strategy of surgical treatment of children with orofacial clefts combined with disorders of other organs and systems allows treatment of congenital orofacial malformation in the most favourable period based on the patient's physical condition.