employee
Ufa, Ufa, Russian Federation
Ufa, Ufa, Russian Federation
Astrakhan, Astrakhan, Russian Federation
employee
Ufa, Russian Federation
graduate student from 01.01.2018 until now
Ufa, Ufa, Russian Federation
Ufa, Ufa, Russian Federation
student
Ufa, Ufa, Russian Federation
Ufa, Russian Federation
Ufa, Ufa, Russian Federation
Objectives. A clinical case of surgical rehabilitation of a patient with palatopharyngeal insufficiency with congenital cleft palate after uranoplasty. Purpose. Description of the long-term result of surgical treatment of congenital cleft palate, the causes of complications and the rationale for the method of treatment of palatopharyngeal insufficiency. Methodology. The paper presents the results of a clinical observation of a patient aged 12 years with congenital cleft palate after uranoplasty and formed palatopharyngeal insufficiency. A child at the age of 2 years 8 months underwent sparing uranoplasty. Since the child lived in a remote area from the city, he did not have the opportunity to engage in logotherapy. On examination, the soft palate is moderately shortened, postoperative scars are not rough. Speech is vile. To select the most optimal method of treating this pathology, it was necessary to visualize the causes of palato-pharyngeal insufficiency. Results. When conducting an examination using nasopharyngoscopy, a sphincter type of closure of the palatopharyngeal ring was revealed. When pronouncing sounds, the soft palate rose slightly, but the lateral walls of the pharynx with the posterior palatine arches actively contracted, narrowing the palatopharyngeal ring. Taking into account the data obtained during nasopharyngoscopy, a surgical method for eliminating palatopharyngeal insufficiency proposed by M. Orticochea was chosen — “speech-improving surgery”, or sphincter pharyngoplasty, with suturing of the distal ends of the mobilized posterior palatine arches on the posterior pharyngeal wall. According to the control examination for 6 months, there was a significant improvement in speech function, there was no nasalization. Conclusions. Nasopharyngoendoscopy makes it possible to objectively assess the causes of palatopharyngeal insufficiency, which makes it possible to choose the most optimal method of surgical treatment. One of the methods of choice in the surgical treatment of palatopharyngeal insufficiency is the method of sphincter pharyngoplasty.
congenital cleft palate, uranoplasty, palatopharyngeal insufficiency, sphincter pharyngoplasty, nasopharyngoscopy
1. Bazina I.G., Lopatin A.V., Mkrtumyan E.S., Vasil'eva E.P. Ispol'zovanie tubulirovannogo loskuta zadney stenki glotki u pacientov s nebno-glotochnoy nedostatochnost'yu posle uranoplastiki. Detskaya hirurgiya. 2017;21(6):306-310. [I.G. Bazina, A.V. Lopatin, E.S. Mkrtumyan, E.P. Vasil'eva. The use of a tubulated flap of the posterior pharyngeal wall in patients with palatopharyngeal insufficiency after uranoplasty. Children's surgery. 2017;21(6):306-310. (In Russ.)]. DOI: 10.18821/1560-9510-2017-21-6-306-310
2. Gvozdeva L.M., Danilova M.A., Aleksandrova L.I. Ocenka prognosticheskih faktorov, vliyayuschih na kachestvo zhizni detey s vrozhdennoy rasschelinoy guby i neba. Stomatologiya. 2020;99(3):57-59. [L.M. Gvozdeva, M.A. Danilova, L.I. Aleksandrova. Assessment of prognostic factors affecting the quality of life of children with congenital cleft lip and palate. Dentistry. 2020;99(3):57-59. (In Russ.)]. DOI: 10.17116/stomat20209903157
3. Gonchakova S.G., Gonchakov G.V. Hirurgicheskoe lechenie detey s ostatochnymi defektami neba posle uranoplastiki. Kremlevskaya medicina. Klinicheskiy vestnik. 2016;3:59-63. [S.G. Gonchakova, G.V. Gonchakov. Surgical treatment of children with residual palate defects after uranoplasty. Kremlin medicine. Clinical Bulletin. 2016;3:59-63. (In Russ.)]. http://kremlin-medicine.ru/index.php/km/article/view/981
4. Danilova M.A., Aleksandrova L.I. Kachestvo zhizni detey s vrozhdennoy rasschelinoy guby i neba. Stomatologiya detskogo vozrasta i profilaktika. 2018;17(3):54-57. [M.A. Danilova, L.I. Alexandrova. Quality of life in children with congenital cleft lip and palate. Pediatric dentistry and prevention. 2018;17(3):54-57. (In Russ.)]. https://www.elibrary.ru/item.asp?id=36347137
5. Mamedov A.A., Dudnik O.V., Zavgorodnyaya E.A. Mezhdisciplinarnyy podhod lecheniya detey s rasschelinoy guby i neba, oslozhnennoy nebno–glotochnoy nedostatochnost'yu. Znanie. 2019;4;1(68):50-59. [A.A. Mamedov, O.V. Dudnik, E.A. Zavgorodnyaya. Interdisciplinary approach to the treatment of children with cleft lip and palate complicated by palatopharyngeal insufficiency. Knowledge. 2019;4;1(68):50-59. (In Russ.)]. https://elibrary.ru/item.asp?id=37336477
6. Mamedov A.A., Ivoylov A.Yu., Goncharova O.V., Obuhova N.V., Stebeleva Yu.V., Yanovskiy V.V., Parshikova S.A. Ocenka rezul'tatov issledovaniya rechi detey posle uranoplastiki. Voprosy prakticheskoy pediatrii. 2022;17(2):47-54. [A.A. Mamedov, A.Yu. Ivoilov, O.V. Goncharova, N.V. Obukhova, Yu.V. Stebeleva, V.V. Yanovsky, S.A. Parshikova. Evaluation of the results of the study of children's speech after uranoplasty. Questions of practical pediatrics. 2022;17(2):47-54. (In Russ.)]. DOI: 10.20953/1817-7646-2022-2-47-54
7. Mustafaev M.Sh., Vissarionov V.A., Tarchokova E.M., Dyshekova S.A. Osnovy kompleksnoy reabilitacii bol'nyh s rechevymi narusheniyami posle uranoplastiki. Medicinskiy alfavit. 2020;3:40-42. [M.Sh. Mustafaev, V.A. Vissarionov, E.M. Tarchokova, S.A. Dyshekova. Fundamentals of complex rehabilitation of patients with speech disorders after uranoplasty. Medical alphabet. 2020;3:40-42. (In Russ.)]. DOI: 10.33667/2078-5631-2020-3-40-42
8. Rogozhina Yu.S., Blohina S.I., Bimbas E.S. Hirurgicheskaya taktika ustraneniya slozhnyh variantov vrozhdennoy rasscheliny neba. 2020;16(1):121-126. [Yu.S. Rogozhina, S.I. Blokhina, E.S. Bimbas. Surgical tactics for the elimination of complex variants of congenital cleft palate. 2020;16(1):121-126. (In Russ.)]. DOI: 10.18481/2077-7566-20-16-1-121-126
9. Tokarev P.V., Shulaev A.V., Saleev R.A., Tokareva L.V., Gaysina L.A. Primenenie rechevogo pasporta v reabilitacii detey s vrozhdennymi chelyustno–licevymi porokami razvitiya. Problemy stomatologii. 2019;15(2):79-83. [P.V. Tokarev, A.V. Shulaev, R.A. Saleev, L.V. Tokareva, L.A. Gaysina. The use of a speech passport in the rehabilitation of children with congenital maxillofacial malformations. Actual problems in dentistry. 2019;15(2):79-83. (In Russ.)]. DOI: 10.18481/2077-7566-2019-15-2-79-83
10. Fomenko I.V., Filimonova E.V., Kasatkina A.L., Kraevskaya N.S. Analiz rezul'tatov kompleksnogo lecheniya detey s vrozhdennoy odnostoronney rasschelinoy verhney guby i neba v zavisimosti ot metoda plastiki defekta neba. Klinicheskaya stomatologiya. 2016;1(77):16-21. [I.V. Fomenko, E.V. Filimonova, A.L. Kasatkina, N.S. Kraevskaya. Analysis of the results of complex treatment of children with congenital unilateral cleft lip and palate, depending on the method of plasty of the palate defect. Clinical dentistry. 2016;1(77):16-21. (In Russ.)]. https://elibrary.ru/item.asp?id=25718060
11. Chuykin S.V., Davletshin N.A., Kuchuk K.N., Chuykin O.S., Grin' E.A., Muratov A.M. Analiz rezul'tatov i oslozhneniy uranoplastiki u detey s vrozhdennoy rasschelinoy guby i neba. Problemy stomatologii. 2020;16(1):133-138. [S.V. Chuikin, N.A. Davletshin, K.N. Kuchuk, O.S. Chuikin, E.A. Grin, A.M. Muratov. Analysis of the results and complications of uranoplasty in children with congenital cleft lip and palate. Actual problems in dentistry. 2020;16(1):133-138. (In Russ.)]. https://www.elibrary.ru/item.asp?id=42817262.
12. Chuykin S.V., Snetkova T.V., Chuykin O.S., Kuchuk K.N., Murzina A.N., Bilak A.G., Chuykin G.L. Posleoperacionnaya reabilitaciya detey s vrozhdennoy rasschelinoy neba. Ural'skiy medicinskiy zhurnal. 2020;9(192):123-127. [S.V. Chuikin, T.V. Snetkova, O.S. Chuikin, K.N. Kuchuk, A.N. Murzina, A.G. Bilak, G.L. Chuikin. Postoperative rehabilitation of children with congenital cleft palate. Ural Medical Journal. 2020;9(192):123-127. (In Russ.)]. DOI: 10.25694/URMJ.2020.09.25