ENDONASAL OSTEOPLASTY OF THE MEDIAN PALATAL SUTURE IN CHILDREN WITH NASAL SEPTAL DEVIATION AT ABNORMAL DEVELOPMENT OF THE UPPER JAW

Abstract

Relevance of the problem. The nasal septum deviated (NSD) is the source of the atypical vertical biomechanical thrust of the gothic arch of the palatine bone. At the same time, the greater the depth of the dome of the Gothic palate, the coarser becomes its thickness. These phenomena contribute to the occurrence of recurrent dental-jaw anomalies in 40% of cases after their orthodontic treatment. Therefore, solving the problems of reducing the bone resistance of the mid-sagittal palatine suture and eliminating its vertical thrust as a preliminary stage of surgical correction is one of the urgent problems in the daily practice of rhinologists and orthodontists. Aim of the study. Endonasal osteoplasty of the median palatal suture through the elimination of pathological vertical traction in children with a curvature of the NSD with abnormal development of the upper jaw (ADUJ). Material and methods. The study included 146 children diagnosed with NSD with ADUJ (main group). In children from 5 to 12 years old (n = 38), endonasal removal of the nasal crest (crestotomy) was performed, and in children over 13 years old (n = 108) - endonasal removal of the nasal crest and partial thinning of the median palatal suture (crestosuturotomy) during sparing septoplasty preserving the growth zones of the septum cartilage. The control group of the components of retrospectively studied case histories of 62 patients with NSD in ADUJ obtained the results of directly complex rhinological and orthodontic treatment methods. Results. The use of new methods of endonasal osteoplasty of the middle palatal suture in children of the main group helped to obtain positive results that were not registered in the control group: straightening the curved nasal septum while maintaining its vertical and sagittal length; the weakening of the bone resistance of the hard palate and the prevention of recurrence of dental-jaw anomalies after their orthodontic treatment; accelerating the rate of decrease in the height of the Gothic palate, the protraction of the upper jaw and the synchronous expansion of the upper jaw, including the nasal cavity, allowing to restore full nasal breathing; preservation of the growth zone of the cartilage of the nasal septum, normalization of the growth and development of the nasal septum; restoration of aesthetics of the face and the full integration of children in society. Findings. Endonasal osteoplasty of the median palatal suture in children with NSD with ADUJ helps to eliminate a number of drawbacks of traditional rhinological and orthodontic measures and is recommended for widespread use.