Egorov R. Evaluation of the effectiveness of veloplasty depending on the procedure of operation and the condition of muscles of the soft palate.

The urgency of the problem lies not only in the increasing frequency of birth of infants with incompleteness and severity of this defect, but also difficulties in choosing the optimal Methods of surgical and complex treatment, and in connection with this - inappropriate results of treatment. However, the success of surgical treatment is determined not only by the surgical intervention according to the protocol, but also by the different state of the soft palatal muscles, which in turn determine the functional results of the operation. In the surgical treatment of congenital malformations of hard and soft palate, besides the basic techniques, we have applied our own developed modifications to existing ones. The following methods are as follows: consists in changing the line of incisions of the palatine scars, in order to prevent the trauma of one of the zones of growth of the upper jaw. Used to prevent the development of postoperative defects at the boundary of hard and soft palate, and the technique of surgical intervention using two additional triangular shards at the boundary of hard and soft palate has been developed. Used an additional palatine flap formed from the posterior part of the solid palate and thrown over 180°. Of the 63 patients operated on the proposed methods, 3 postoperative defects were formed, which is 4.7%. Comparing the results with the basic techniques where success was 89%, we obtained 95.3% of the high anatomical result, due to the use of modifications of the basic techniques. As it was noted, one of the key elements in veloplasty is - retrotransposiation. Therefore, during the operation, all patients were given this stage. The modifications of the standard technique of veloplasty showed the greatest increase, using Z plastics at the boundary of the soft and soft palate and using an additional flap from the back of the hard palate, the growth was 23 and 21 mm, respectively. The expression level of myogenin and myostatin mRNA indicates a clear link between disorders of the anatomical structure of the muscular complex, depending on the type of transplantation and the age of the child. The rational and clinically validated use of the developed complex of therapeutic measures and the application of modified techniques allows for higher functional and anatomical results, which leads to a reduction in the timing of rehabilitation.