DIAGNOSIS AND TREATMENT OF JAWS AND ORAL ORGANS IN PATIENTS WITH SPASTIC CEREBRAL PALSY

It is known that chronic diseases (CD), including pathologies of the respiratory system (RS) and central nervous system (CNS), significantly increase the number of growth disorders of the maxillofacial system (MFS) [2, 4, 13]. In cerebral palsy (CP), isolated and combined forms of pathology are often encountered [4, 13, 20]. Authors assert that dysfunction of the orbicularis oris muscle, which closes the oral cavity (OC), and the presence of airway obstruction in the form of adenoid growths, hypertrophy of the palatine and pharyngeal tonsils, and the harmful habit of mouth breathing often lead to systemic changes in the body as a whole [1, 3, 5, 9]. Systemic changes accompanying nasal obstruction include pulmonary heart disease [7, 10, 16]. According to several authors, mouth breathing (MB) disrupts the act of swallowing, during which muscles attached to the lower jaw (LJ) and hyoid bone pull the LJ backward, leading to the development of a prognathic (distal) bite. In normal swallowing, this does not occur as dental rows are tightly closed and held in the correct position due to tight interocclusal contacts of antagonizing teeth [3, 8]. Additionally, the balance of external and internal forces acting on the upper jaw (UJ) is disrupted, hindering its growth, and additional pressure from the buccal muscles exacerbates the constriction of dental rows (DR) in the lateral sections. As a result, narrowing of the UJ DR occurs, the lateral group of teeth is set transversely, and the absence of lip closure reinforces the MB habit, closing the "vicious circle" of MFS pathology pathogenesis [18, 20]. It is also established that motor defect in CP is disabling not only due to the insufficiency or absence of certain skills but also due to impaired functions of movement, speech, and psyche [11, 15, 17]. Children with CP differ from healthy peers; their teeth wear down, the anterior group is easily traumatized, many teeth are removed, leading to bite anomalies, bruxism, periodontal tissue pathologies [2, 13], and others. Considering the above, studying the structure, frequency, and mechanisms of MFS pathology formation in children and adolescents with CP is relevant for developing methods of early diagnosis and effective treatment.