Anisimova L.A.

State Establishment «Dnepropetrovsk Medical Academy of Health of Ukraine»

TEACHER’S TACTICS WHILE TEACHING THE INTERNS ABOUT THE TOPIC “THE CONGENITA TERATOSISS OF PERSON”

As we know, the congenital nonclosures of overhead lip and sky belong to the most widespread and heavy pathology of maxillofacial area. They compose more than 30 % of all congenita pathologies. Anatomic anomalies at these treatises are accompanied by considerable functional disorders of breathing, violation of eating, swallowing [1, 2, 3, 5].

The main purposes of congenital nonclosures: inefficient reception of medicament preparations in the first months of pregnancy, especially on 5 - 11 weeks of pregnancy is a period of forming of overhead lip and sky, self-treatment. The considerable role in the origin of nonclosures is played by harmful habits of the parents (taking drugs, smoking). Also a multifetation, teratosis of uterus, tumor of uterus, early abortions and so on.

A considerable role is played by the mental condition of future mother, age of parents, possible pathological heredity is also should be counted (ununion of lip and sky can be passed, both on a dominant and on recession sign). The mechanism of forming of the plural congenital teratosiss for patients with the cleft of overhead lip and sky stipulates system character of dysplasia of connecting tissue and violation of process of migration of mesenchyma on the stage of embryonic fetation [1,2,5,7].

That is why we are teachers of the higher school on the practical reading with doctors interns - stomatologies, doctors - therapists of the domestic profile, must pay the special attention to this question.

First of all it is necessary to pay attention to the fact, that one of the most substantial factors for valuable development of new-born is the natural feeding.

The rational quality and quantitative feeding of the child substantially affects on his physical and neuropsychic development, in particular assists of prevention in the delay of forming of motive and speech skills [2, 6, 8].

At the practice classes and seminars we accent attention on reasons of origin of congenital pathology, features of birth defects of person. Also we pay attention to complex of local and general changes which have place at these birth defects.

It should be noted that the special difficulties a child tests at the act of suction in the first days of life. The new-born embraces the nipple of breast of mother and a part of the circle near the nipple; thus a lower jaw and a tongue go down.

Due to motions of the tongue and lower jaw following one by another, negative pressure is created in the cavity of the mouth. At the cleft of overhead lip of pressurizing at enthrallment of nipple does not appear and that is why the act of suction has difficulty or becomes not possible.

Such children's suction is accompanied by the considerable functional and physical loading, frequent choking are possible, hit of food in the cavity of nose and her axsufflation. The violation of the natural rearing results in the lowered feeding and reduction of proteins and vitamins getting into organism.

The gagging of decomposing food pieces got in the cavity of nose during a meal, can be a result of disorder of gastric intestinal highway. The Ununion of overhead lip and sky causes violation of the nasal breathing: a clearing process breaks and moistening of respirable air, is violated in respiratory tracts also get the decomposing food pieces.

A child wreaked by permanent malnutrition, in these terms, is especially predispositioned to inflammatory to the diseases of over head respiratory tracts and pneumonias.

For children with the cleft of overhead lip and sky external stigma of embryogenesis, the congenital teratosiss of heart and buds have system character [1,2,5,7].

Their prevalence for children with this pathology determines the necessity of participation of the doctor - cardiologist and urologist for an preparation and pre-operation preparation of children with the cleft of overhead lip and sky. Everything told above can be a result of heavy complications threatening to the life of the child.

The questions of a care after the children with congenital pathology of maxillofacial area, in particular, rearing, terms of operative intervention, postoperative rehabilitation are important in an identical measure for the doctors of family profile - dentists, pediatricians and therapists.

The medical workers of maternity hospitals, district pediatricians, doctors of a family profile do not always pay much attention to the questions of rearing new-born with the congenita ununions of overhead lip and sky. The feeding of such children often becomes insufficient at once after their birth. It is necessary to medical workers to attach a maximum of efforts in order to explain to the mother all the necessity of the natural rearing, to teach her how to put a child to the breast, to strain off thoracal milk with the purpose of maintenance of natural lactation.

A mother must be convinced in that, that her pectoral milk is vitally needed and can not be not replaceable. Only it will provide a harmonious physical and neuropsychic development to the child, will promote stability to the unfavorable factors of environment, will prepare him to surgical interferences that he will need to relive.

The deformation of the face appears in the excalation of tissues of overhead lip (muscular layer), excalation of bone tissue of supramaxilla on the side of defeat (it is especially expressed at the outward edge of the pear-shaped opening). The deformation of the nose (flattening and prolapsus of tag of nose, displacement of backside and outside grounds of wing of nose) is marked also. The defect of alveolar sprout and sky appears in the report of two not compatible in a norm cavities - mouth and nasal [6, 7, 8].

The consultation with a surgeon - dentist is extremely important. Joint skilled examination of specialists will help to define all the heaviness of congenital pathologists, to set a presence or absence of other congenital teratosis, to estimate the common state of new-born. As a result of joint consultation an individual feeding will be appointed to the child, and conversation with a mother will quiet her, will infuse a faith in the favorable end of operation.

Beginning from the 16 th century in life and in practical medicine in cases of congenital ununions of overhead lip and sky were used a term as "harelip" and "wolfish mouth", which it is possible to hear from the mouths of inhabitants till present tense, that it is very sad, from the mouths of medical workers. It is a powerful par therapeutic factor which assist a development of secondary hypogalactia of mother, and can bring to her complete stopping in a maternity hospital.

In this period, the most difficult for a young mother, co-ordination in the actions of neonatologist and surgeon - dentist of in-patient department is very important. They must attach a maximum of efforts, to convince the mother in a viability of child (if there is not other vices threatening to life of child); to tell about possibility and terms of removal of birth defects surgically. Such conversation will calm a mother down and will help to save the secretion of milk for her.

Used literature:

1. Volodatskiy M.P.Description of concomitant teratosiss for children with the congenita teratosiss of person and jaws, morbidity, death rate, risk//M.P.Volodatskiy, P.I.Tchumakov, A.V.Balandina,Z.A.Rekova, I.V.Pavlenko/ Vesnik of new medical technologies. 2009. - Т. XVI, №4 - P.195.

2. Davidov B.N. Congenita and inherited pathology of head, persons and necks for children: actual questions of complex treatment.М. : МГСМУ, 2006. – 68p.

3. Bezrukov V.M, Rabuhina N.A. Deformations of viscerocranium. М.: Medical news agency, 2005. - 304с.

4. Рабухина Н.А. Rehabilitation of patients with congenita deformations of krats – fanial area// Н.А. Рабухина, Н.М. Хелминская, В.П. Ипполитов, А.Г. Шамсудинов/ Manual for doctors. – М., 2005. – 7p.

5. Volodatskiy M.P. Clinical and embryological parallels of congenita teratosiss of face // of M.P.Volodatskiy, V.M. Volodatskiy.Stavropol. 2004. – 80p.

6. Davidov B.N. Rehabilitation of children with cleft lip and palate at the dentist, pediatric, therapist// Davidov B.N, Gavrilova O.A, Maksimova V.V. – Tver: Riotgma, 1999. – P. 5-7; 104p.

7. Frolova L.E. The treatment of the cleft lip / L.E Frolova. – 1967. Tashkent: MedUzUSSR. – 146p.

8. Frolova L.E. The features of feeding of children of 1 year of age with congenita nonclosures of upper lip and sky [medical recomendations] – 1973. – Odessa. – P. 3-11.