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"name": "Расщелина неба [волчья пасть]",
"icd_name": "Расщелина неба [волчья пасть]",
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"lead": "аномалия развития врожденного генеза, которая проявляется незаращением твердого и мягкого участков неба, в результате чего отмечается связь носовых и ротовой полостей",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У специалистов нет единого мнения по вопросу, почему рождаются дети с «волчьей пастью». Появление порока связывают с наличием одного или нескольких провоцирующих факторов:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">неполноценность половых клеток родителей: возраст за 40 лет, наследственные мутации генов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">инфекции и хронические заболевания матери: краснуха, ветряная оспа, герпес, сифилис, хламидиоз и др.;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">химическая интоксикация: алкоголем, наркотиками, курением, химикатами и пр.;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">физическое воздействие: давление околоплодных вод, перегрев тела, излучения, падения, удары в живот и т.п..</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нередко причиной возникновения «волчьей пасти» становится нарушение обмена веществ на начальных сроках беременности, когда она сопровождается нехваткой витаминов и минеральных веществ, токсикозом, недостатком кислорода, угрозой выкидыша. Спровоцировать расщелину верхнего неба у новорожденных способен прием антибиотиков, снотворных и успокоительных медицинских препаратов, лекарств от болезней щитовидной железы, опухолей, артрита. Повышают риск возникновения порока психологические факторы: стрессы, длительные переживания, отсутствие отдыха.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Принимая во внимание то, что аномалия развития формируется внутриутробно, когда происходит закладка и развитие органов и систем, ранняя диагностика волчьей пасти проводится при беременности, когда срок достигает 14-16 недель. Каждая беременная женщина при постановке на учет проходит плановое УЗИ, с помощью которого визуализируется плод и имеющиеся аномалии развития (если есть). Такое исследования периодически повторяют на протяжении всей беременности, так как не все мутации можно обнаружить на первом УЗИ.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Точная диагностика осуществляется после осмотра зева ребенка врачом уже после рождения. </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Принципы лечения пациентов с волчьей пастью</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Операции по устранению врожденных челюстно-лицевых пороков обычно проводятся поэтапно. Количество вмешательств может варьировать от 2-3 до 5-7 и даже более. Возраст проведения коррекции волчьей пасти определяется специалистами, наблюдающими ребенка с рождения, по индивидуальным показаниям, но не ранее 3-6 месяцев (обычно в более поздние сроки). Окончание лечения, включая восстановительный период, должно быть завершено к возрасту 6-7 лет.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возраст от 3 до 7 лет благоприятен для проведения дополнительных косметических операций по улучшению внешности ребенка с тем, чтобы после полной реабилитации он мог посещать общеобразовательное учебное заведение, поскольку психическое и умственное развитие детей с волчьей пастью не отличается от таковых у здоровых детей. После исправления дефекта нёба и прохождения полного курса реабилитации дети снимаются с учета по инвалидности.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечением челюстно-лицевых дефектов занимаются профилированные клиники, в которых есть все необходимые специалисты: педиатр и микропедиатр, хирург, ортодонт, педагог логопед, психолог и социальный работник. Современная пластическая медицина призвана не только помочь ребенку избавиться от внешнего дефекта, но и преодолеть последствия психической травмы от ощущения своей неполноценности для дальнейшей полноценной адаптации в обществе.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Коррекция волчьей пасти методом уранопластики</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Задачу восстановления правильной анатомической структуры мягкого и твердого неба, а также средних отделов глотки решает проведение уранопластики. Классическим вариантом уранопластики при волчьей пасти, решающим данные задачи, служит операция по методу Лимберга. Уранопластика по Лимбергу на сегодняшний день является основной методикой лечения врожденного дефекта нёба. При сочетании расщелины нёба с заячьей губой также проводится хейлопластика – операция по коррекции верхней губы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Перед проведением уранопластики осуществляется индивидуальное планирование операции, подбирается пластический материал для ликвидации дефекта расщепления нёба. Современные методы уранопластики и квалификация пластических хирургов обеспечивают восстановление полноценной анатомической структуры нёба у 92-98% пациентов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Радикальное исправление дефектов мягкого и твердого нёба подразумевает решение сложного комплекса задач: восстановление анатомически правильной непрерывности каждого слоя мягкого и твердого нёба и их размеров; устранение порочного прикрепления небно-глоточных мышц, анатомически правильное их соединение; исключение повреждения нервов, обеспечивающих сокращение этих мышц при операции; выполнение стабильного закрепления восстановленных анатомических структур, формы и функции неба.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Радикальную уранопластику предпочтительнее выполнять детям в возрасте 3-6 лет. В 3-5-летнем возрасте оперируют пациентов, имеющих несквозные расщелины нёба; с 5 до 6 лет – со сквозными одно- и двусторонними расщелинами. Осуществление радикальной уранопластики не рекомендуется у детей раннего возраста, т. к. это может вызвать задержку развития верхней челюсти. Выполнение щадящих способов уранопластики возможно до достижения ребенком возраста 2-х лет.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В дооперационном периоде детям рекомендуется ношение «плавающего» обтуратора, способствующего нормальному вскармливанию, дыханию, становлению правильной речи. Обтуратор снимают за 2 недели до проведения уранопластики.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Послеоперационный уход включает соблюдение постельного режима в течение 2-3 дней, прием только протертой пищи, обильное щелочное питье. Тщательное внимание уделяется уходу за ротовой полостью: до и после приема пищи проводятся орошения рта слабым раствором перманганата калия. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Несколько раз в день рекомендуется надувать воздушные шарики. С 14-х суток необходимо проведение специального комплекса упражнений и пальцевого массажа мягкого нёба.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">С целью предотвращения послеоперационной инфекции назначаются антибиотики на 5-7 дней, для купирования болевого синдрома - обезболивающие средства. На лице после уранопластики остается послеоперационный рубец. Выписку из стационара осуществляют на 21-28 день после операции.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В дальнейшем пациентам предстоит длительная и кропотливая работа по восстановлению полноценного небно-глоточного смыкания и подвижности нёба с помощью физиотерапевтических методик лечения.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При планировании беременности женщине рекомендуется пройти тщательное обследование для выявления имеющихся противопоказаний. Это касается инфекционных болезней, а также органной патологии, которая может оказать негативное воздействие на развитие плода.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Перед беременностью необходимо принимать фолиевую кислоту в дозировке 400 мкг, а при наступлении беременности дозу увеличить до 600 мкг.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обязательным условием является отказ от приема лекарственных средств, которые запрещены при беременности. Если же женщина нуждается в постоянном приема каких-либо препаратов, например, антигипертензивных или сахароснижающих, то врач должен подобрать оптимальные лекарственные средства и дозы во избежание негативного влияния на плод.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика также заключается в отказе от алкогольных напитков, наркотических средств и курения. Кроме того женщине следует больше уделять внимания прогулкам на свежем воздухе, избегать стрессовых ситуаций и достаточно спать.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Сложности у детей с расщеплением нёба начинаются с момента рождения, т. к. во время родов возможна аспирация околоплодной жидкости в дыхательные пути. Дыхание новорожденного с волчьей пастью затруднено, сосание невозможно, из-за чего наблюдается отставание ребенка в весе и развитии. Кормление малыша до операции осуществляют с помощью специальных ложечек, одевающихся на бутылочки.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наличие расщелины нёба нарушает нормальное функционирование верхних дыхательных и пищеварительных путей, развитие речи и слуха, а также может вызывать снижение самооценки личности ребенка. У детей, имеющих волчью пасть, изменена речь в связи с нарушением процесса правильного формирования звуков. Речевые расстройства выражаются в открытой ринолалии, обусловливающей ФФН или ОНР.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дефект нёба приводит к свободному выхождению через нос вдыхаемого воздуха, а также попаданию в нос пищи и жидкости. Жидкость через расщелину в нёбе может попасть в евстахиевы трубы и пазухи носа, что способствует развитию у таких пациентов отита и синуситов. При волчьей пасти отмечается наличие деформации прикуса и зубов, нарушающих процесс жевания пищи.</span></p>",
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"lead": "аномалия развития врожденного генеза, которая проявляется незаращением твердого и мягкого участков неба, в результате чего отмечается связь носовых и ротовой полостей",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У специалистов нет единого мнения по вопросу, почему рождаются дети с «волчьей пастью». Появление порока связывают с наличием одного или нескольких провоцирующих факторов:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">неполноценность половых клеток родителей: возраст за 40 лет, наследственные мутации генов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">инфекции и хронические заболевания матери: краснуха, ветряная оспа, герпес, сифилис, хламидиоз и др.;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">химическая интоксикация: алкоголем, наркотиками, курением, химикатами и пр.;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">физическое воздействие: давление околоплодных вод, перегрев тела, излучения, падения, удары в живот и т.п..</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нередко причиной возникновения «волчьей пасти» становится нарушение обмена веществ на начальных сроках беременности, когда она сопровождается нехваткой витаминов и минеральных веществ, токсикозом, недостатком кислорода, угрозой выкидыша. Спровоцировать расщелину верхнего неба у новорожденных способен прием антибиотиков, снотворных и успокоительных медицинских препаратов, лекарств от болезней щитовидной железы, опухолей, артрита. Повышают риск возникновения порока психологические факторы: стрессы, длительные переживания, отсутствие отдыха.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Принимая во внимание то, что аномалия развития формируется внутриутробно, когда происходит закладка и развитие органов и систем, ранняя диагностика волчьей пасти проводится при беременности, когда срок достигает 14-16 недель. Каждая беременная женщина при постановке на учет проходит плановое УЗИ, с помощью которого визуализируется плод и имеющиеся аномалии развития (если есть). Такое исследования периодически повторяют на протяжении всей беременности, так как не все мутации можно обнаружить на первом УЗИ.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Точная диагностика осуществляется после осмотра зева ребенка врачом уже после рождения. </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Принципы лечения пациентов с волчьей пастью</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Операции по устранению врожденных челюстно-лицевых пороков обычно проводятся поэтапно. Количество вмешательств может варьировать от 2-3 до 5-7 и даже более. Возраст проведения коррекции волчьей пасти определяется специалистами, наблюдающими ребенка с рождения, по индивидуальным показаниям, но не ранее 3-6 месяцев (обычно в более поздние сроки). Окончание лечения, включая восстановительный период, должно быть завершено к возрасту 6-7 лет.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возраст от 3 до 7 лет благоприятен для проведения дополнительных косметических операций по улучшению внешности ребенка с тем, чтобы после полной реабилитации он мог посещать общеобразовательное учебное заведение, поскольку психическое и умственное развитие детей с волчьей пастью не отличается от таковых у здоровых детей. После исправления дефекта нёба и прохождения полного курса реабилитации дети снимаются с учета по инвалидности.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечением челюстно-лицевых дефектов занимаются профилированные клиники, в которых есть все необходимые специалисты: педиатр и микропедиатр, хирург, ортодонт, педагог логопед, психолог и социальный работник. Современная пластическая медицина призвана не только помочь ребенку избавиться от внешнего дефекта, но и преодолеть последствия психической травмы от ощущения своей неполноценности для дальнейшей полноценной адаптации в обществе.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Коррекция волчьей пасти методом уранопластики</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Задачу восстановления правильной анатомической структуры мягкого и твердого неба, а также средних отделов глотки решает проведение уранопластики. Классическим вариантом уранопластики при волчьей пасти, решающим данные задачи, служит операция по методу Лимберга. Уранопластика по Лимбергу на сегодняшний день является основной методикой лечения врожденного дефекта нёба. При сочетании расщелины нёба с заячьей губой также проводится хейлопластика – операция по коррекции верхней губы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Перед проведением уранопластики осуществляется индивидуальное планирование операции, подбирается пластический материал для ликвидации дефекта расщепления нёба. Современные методы уранопластики и квалификация пластических хирургов обеспечивают восстановление полноценной анатомической структуры нёба у 92-98% пациентов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Радикальное исправление дефектов мягкого и твердого нёба подразумевает решение сложного комплекса задач: восстановление анатомически правильной непрерывности каждого слоя мягкого и твердого нёба и их размеров; устранение порочного прикрепления небно-глоточных мышц, анатомически правильное их соединение; исключение повреждения нервов, обеспечивающих сокращение этих мышц при операции; выполнение стабильного закрепления восстановленных анатомических структур, формы и функции неба.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Радикальную уранопластику предпочтительнее выполнять детям в возрасте 3-6 лет. В 3-5-летнем возрасте оперируют пациентов, имеющих несквозные расщелины нёба; с 5 до 6 лет – со сквозными одно- и двусторонними расщелинами. Осуществление радикальной уранопластики не рекомендуется у детей раннего возраста, т. к. это может вызвать задержку развития верхней челюсти. Выполнение щадящих способов уранопластики возможно до достижения ребенком возраста 2-х лет.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В дооперационном периоде детям рекомендуется ношение «плавающего» обтуратора, способствующего нормальному вскармливанию, дыханию, становлению правильной речи. Обтуратор снимают за 2 недели до проведения уранопластики.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Послеоперационный уход включает соблюдение постельного режима в течение 2-3 дней, прием только протертой пищи, обильное щелочное питье. Тщательное внимание уделяется уходу за ротовой полостью: до и после приема пищи проводятся орошения рта слабым раствором перманганата калия. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Несколько раз в день рекомендуется надувать воздушные шарики. С 14-х суток необходимо проведение специального комплекса упражнений и пальцевого массажа мягкого нёба.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">С целью предотвращения послеоперационной инфекции назначаются антибиотики на 5-7 дней, для купирования болевого синдрома - обезболивающие средства. На лице после уранопластики остается послеоперационный рубец. Выписку из стационара осуществляют на 21-28 день после операции.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В дальнейшем пациентам предстоит длительная и кропотливая работа по восстановлению полноценного небно-глоточного смыкания и подвижности нёба с помощью физиотерапевтических методик лечения.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При планировании беременности женщине рекомендуется пройти тщательное обследование для выявления имеющихся противопоказаний. Это касается инфекционных болезней, а также органной патологии, которая может оказать негативное воздействие на развитие плода.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Перед беременностью необходимо принимать фолиевую кислоту в дозировке 400 мкг, а при наступлении беременности дозу увеличить до 600 мкг.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обязательным условием является отказ от приема лекарственных средств, которые запрещены при беременности. Если же женщина нуждается в постоянном приема каких-либо препаратов, например, антигипертензивных или сахароснижающих, то врач должен подобрать оптимальные лекарственные средства и дозы во избежание негативного влияния на плод.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика также заключается в отказе от алкогольных напитков, наркотических средств и курения. Кроме того женщине следует больше уделять внимания прогулкам на свежем воздухе, избегать стрессовых ситуаций и достаточно спать.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Сложности у детей с расщеплением нёба начинаются с момента рождения, т. к. во время родов возможна аспирация околоплодной жидкости в дыхательные пути. Дыхание новорожденного с волчьей пастью затруднено, сосание невозможно, из-за чего наблюдается отставание ребенка в весе и развитии. Кормление малыша до операции осуществляют с помощью специальных ложечек, одевающихся на бутылочки.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наличие расщелины нёба нарушает нормальное функционирование верхних дыхательных и пищеварительных путей, развитие речи и слуха, а также может вызывать снижение самооценки личности ребенка. У детей, имеющих волчью пасть, изменена речь в связи с нарушением процесса правильного формирования звуков. Речевые расстройства выражаются в открытой ринолалии, обусловливающей ФФН или ОНР.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дефект нёба приводит к свободному выхождению через нос вдыхаемого воздуха, а также попаданию в нос пищи и жидкости. Жидкость через расщелину в нёбе может попасть в евстахиевы трубы и пазухи носа, что способствует развитию у таких пациентов отита и синуситов. При волчьей пасти отмечается наличие деформации прикуса и зубов, нарушающих процесс жевания пищи.</span></p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 50,
"published": 1,
"parent": null,
"block_rubric": 180,
"standards": []
}
]
}