Журнал «Здоровье ребенка» 5 (65) 2015
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The silhouette-lift for the treatment of congenital unilateral lower lip palsy in сhild
Авторы: Samoylenko G.E.
Donetsk National Medical University named after M.Gorkiy (Surgery №2 and urology department, Kramatorsk, Ukraine)
Рубрики: Педиатрия/Неонатология
Разделы: Справочник специалиста
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The study of the facial nerve and facial muscles pathology has significant relevance to the functional, aesthetic and psychological points of view. Were are many reasons and facial paralysis can be classified according to the etiology of congenital and acquired. One variety of such conditions, described as Congenital Unilateral Lower Lip Paralysis, appears as a congenital anomaly Asymmetric Crying Facies (ACF).
Patients with facial paralysis is often perceived by others from a position of alienation and face social discrimination, especially in children's groups. The effectiveness of these methods depends on the cause of mimic and functional deficits and remain of the modern medicine unsolved problem.
The aim of this work was an attempt to improve the cosmetic results of the facial expressions use to static correction in children with minimally invasive suspending Silhouette Lift threads technology.
Material and Methods: We present case of the 3 years old child with congenital facial asymmetry treatment. Disease was manifested during crying or smiling. She was born from the uncomplicated childbirth. Mother’s pregnancy pathology and drug therapy in the antenatal period were observed. Cosmetic defect is detected by parents in the first days after birth and without the positive dynamics in the coming months.
On examination: the child's face symmetrically alone. The right corner of his mouth moves downward and outward during the smiling and crying, while the left corner of the stationary. Additional eye movements there, complete closure of the eyelids, naso-labial folds of equal depth, symmetrical facial forehead is not broken. At other organs and systems objective study aren’t features although laboratory tests noted chronic herpes virus infection. Other parameters are in the normal range. On those data base use to get the inspection diagnose - ACF. After the Needle Stimulation electroneuromyography was shown a partial Depressor angulis oris (mDAO) muscle, m. Depressor labii inferioris and m. Mentalis denervation, with the muscle denervation lack of the excitability and conduction of nerve VII normal values. The mDAO hypoplasia signs: interference pattern during the mourning consisted of short-term reduced number of motor potentials of low amplitude; response to stimulation of the facial nerve was also a low amplitude and a simplified structure.
We used a minimally invasive method of the filament static "hanging" with technology Silhouette-lift. The essence of this method consists in that, in the temporal hair growth zone, and chin areas carried up to 0.5 cm incisions, respectively, through which the fabric faces 20G needle was introduced for one tapered thread Silhouette-lift to the mouth’s angle, with access to the lower lip. After the facial tissues cones tension and their movement in a fixed position thread’s end were sutured to the temporal fascia, and the periosteum of the mandible through polypropylen mesh..
This fixing enhances seat and allows, if necessary in the future to increase yarn tension and fixed there to tissues. The lower bearing face principle implies that the thread should provide an anchor in the midline of the lower lip. If the lock point made in nasolabial folds, then in the partition wall and the lower lip central portion, the thread is displaceable to the movable side of the face without interfering with its function. Perhaps were is aesthetically negative factor may be visualization retractions of the skin on the cheek for passage of the thread axis. At the same time, the mandibular angle fixing of a lip zone is too stable, which ensures the symmetry face of the child.
Conclusion: The use to minimally invasive "suspensory" Silhouette-Lift technology considered by us as a gentle, reversible, psychologically less traumatic, and, in fact outpatient treatment option. The ACF disease comprehensive treatment improves to the face symmetry and some functional aspects with minimal risk and the short postoperative period. Were is important method that the corresponds to the patient’s parents wishes. Method was shown for the satisfactory result achievement.
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