Predictive factors reducing the effectiveness of the rehabilitation process in patients with congenital orofacial clefts combined with malformations in other organs and systems

Abstract

Relevance. The successful completion of the rehabilitation process for patients with complex congenital defects, specifically those with a combination of orofacial clefts (OFC) and malformations in other organs and systems, presents a significant challenge. This challenge is pertinent not only to medical practice but also to the socio-psychological development of the child.Objective. To identify predictive factors that diminish the success of the rehabilitation process in patients with congenital OFC combined with malformations in other organs and systems by systematising and addressing these factors at various stages of specialised care.Materials and methods. An analysis of medical records was conducted for 2,475 patients with congenital orofacial clefts (OFC) over a 24-year period (1998-2022) who were under dispensary observation at the "Bonum" Center in Yekaterinburg. Among these patients, 823 (33.25%) had OFC combined with malformations in other organs and systems. A comprehensive study was conducted among these 823 individuals within the framework of dynamic observation and treatment, focusing on patients who had reached 18 years of age and were subsequently removed from dispensary observation. The study included an examination of staged treatment and discharge summaries, alongside the clinical characteristics of the restored midface area following surgical correction of OFC amidst correction for concomitant congenital malformations.Results. Among the 823 individuals surveyed, a retrospective study registered 591 (71.81%) who had completed the main stages of comprehensive specialised care amidst concomitant malformations, while the remaining 232 (28.19%) continue to receive combined rehabilitation. Within the 591 patients, a subgroup of 123 (20.81%) individuals who had reached 18 years of age, completed the full cycle of medical-social rehabilitation at the "Bonum" Center, and were removed from dispensary observation due to age, was selected and studied in detail. Questionnaires, parent interviews, and analysis of the results obtained were conducted. The study identified predictive factors reducing the effectiveness of the rehabilitation process in patients with congenital orofacial clefts (OFC) combined with malformations in other organs and systems.Conclusion. The multifaceted study conducted has facilitated the identification and systematisation of predictive factors that reduce the success of the rehabilitation process. Consequently, this enables the enhancement of comprehensive specialised treatment outcomes for this category of patients.