[Treatment of bilateral cleft lip].

UNLABELLED: Complexity of treatment of children for congenital bilateral clefts is caused by anatomical and functional impairments of the middle zone of the face present in it: splitting of the upper lip and alveolar process in 3 parts, protrusion of the intermaxillary bone, lack or hypoplasia of muscular fibers in the central portion of the lip, shortening of columella, flattering of the nose wings. THE AIM OF THE PAPER: improvement of the methods of surgical treatment of patients for congenital bilateral clefts of the upper lip to obtain higher esthetic and functional results. 62 infants aged 3-9 months with congenital bilateral clefts of the upper lip and associated nose deformation were operated. 37 children were followed up from 2 to 10 years and their long-term results were obtained. Comparative analysis of the long- term results of the patient has shown that deformation of the spitted upper lip with significantly protruded permaxilla does not allow to completely eliminate the present anatomical and functional disorders of the upper lip and nose and thus significantly reduce the efficiently of surgical treatment. Presurgical orthodontic treatment directed to subsiding of intermaxillary bone and reduction of the width of the cleft is indicated to such patients. Surgical restoration of anatomical form of the upper lip and of the function of the circular muscle of the mouth, formation of vestibule of the mouth, correction of the nose deformation allow considerably improve appearance of the patients, contribute to more proper further development of the middle portion of the face and decrease probability for secondary deformation to arise.

[Chondroblast proliferative activity study in forming big alar cartilage].

Study was performed of chondroblast proliferative activity peculiarities on early stages of big alar cartilage forming. The reaction with monoclonal antibodies towards proliferating cell nuclear antigen in alar cartilage of human embryo and newly born infant rat testified to 2 cartilage growth types - appositional and interstitial. Cells proliferative activity did not depend upon their location on inner or outer side of nasal cartilaginous plate thereby not conforming existent in the literature opinion about the presence of special zones of cartilaginous tissue primary new formation in human nasal cartilage on early stages of its ontogeny.

[Philtrum formation in congenital cleft of upper lip].

Philtrum (labial groove) has aesthetic importance and governs individual features of human face. There are discussed the ways of philtrum reconstruction described in domestic and foreign literature. The main principles of the upper lip central part formation in one-sided congenital clefts are set out. Method of orbicularis oris muscle myoplasty by putting in the asymmetric stitches on deep and surface layers lets to reconstruct the philtrum and its column on the cleft side. Such philtrum reconstruction was performed in 90 cases of primary and secondary cheiloplasty in female patients with congenital one-sided clefts of the upper lips. Long-term results of 58 primary and 14 correcting operations on the upper lips were followed in the time period from 1 to 5 years. Good aesthetic results were achieved in 86.21 and 92.86% of the cases, respectively.

[Secondary early osteoplasty of the maxillary alveolar process in the combined treatment of patients with bilateral congenital clefts of the upper lip and palate]. / Vtorichnaia ranniaia kostnaia plastika al'veoliarnogo otrostka verkhnei cheliusti v kompleksnom lechenii bol'nykh s dvustoronnimi vrozhdennymi rasshchelinami verkhnei guby i neba.

Gnathometric and roentgenocephalometric studies helped reveal the pathogenesis of abnormal maxillary growth in children with bilateral clefts of the upper lip and palate. In order to improve the results of treatment of such patients, the authors propose a method of secondary early osteoplasty of the alveolar process, which may be carried out simultaneously with uranoplasty or separately. Thirty-six patients were operated on using this technique. Complete repair of the alveolar process was attained in 58.3%, partial in 30.6% patients.

[Primary rhinocheiloplasty in bilateral incomplete clefts of the upper lip]. / Pervichnaia rinokheiloplastika pri dvustoronnykh nepolnykh rasshchelinakh verkhnei guby.

Anthropometric examinations of 31 patients with bilateral incomplete clefts of the upper lip revealed an excessive elongation of the lateral fragments and reduced height of the central part of cleft lip. Two methods of primary rhinocheiloplasty are suggested, depending on the degree of prolabium underdevelopment, both of them permitting levelling of the height of the fragments and repair of anatomically correct shape of the upper lip and nose. Preparation and connection of the stumps of the oral orbicular muscle during the operation are conductive to recovery of the function of the upper lip, which is confirmed by electromyography data.

[Primary upper cheiloplasty in congenital bilateral clefts]. / Pervichnaia plastika verkhnei guby pri vrozhdennykh dvustoronnikh rasshchelinakh.

Anthropometric and electromyographic analysis of the treatment results in 104 patients operated on according to Limberg's, Le Mezourier's, Manchester's techniques, or making use of primary rhinocheiloplasty and rhinocheilognathoplasty has shown the deformations typical of every one of these methods. The author describes a modification of primary rhinocheiloplasty, that helps avoid the characteristic postoperative deformations and improve the anatomic and functional results of treatment of patients with bilateral clefts of the upper lip. Late results were followed up for 4 years.