МИОФУНКЦИОНАЛЬНЫЕ НАРУШЕНИЯ И ЗУБОЧЕЛЮСТНЫЕ АНОМАЛИИ КАК ФАКТОР РИСКА ВОЗНИКНОВЕНИЯ ГИПЕРТРОФИИ АДЕНОИДОВ (ОБЗОР ЛИТЕРАТУРЫ)

Введение: В данном обзорном исследовании рассматривается роль миофункциональных нарушений и зубочелюстных аномалий в развитии гипертрофии глоточной миндалины, включая ее рецидив после аденотомии. Актуальность проблемы подтверждается количественными данными: согласно систематическому обзору, распространенность зубочелюстных аномалий в мире составляет 56 %, при этом их наличие связано со снижением качества жизни, обусловленного состоянием полости рта (RR/PR = 1,15; 95 % ДИ: 1,12–1,18; 3672 участника). В исследованиях с участием детей зубочелюстные аномалии выявлены у 49,1 % детей в возрасте 8–10 лет, а ротовое дыхание статистически значимо ассоциировано с трансверсальными аномалиями прикуса (PR = 6,15; 95 % ДИ: 2,96–12,80).

Цель: анализ литературных источников о роли миофункциональных нарушений и зубочелюстных аномалий в развитии гипертрофии глоточной миндалины.

Материалы и методы: Проведен аналитический обзор публикаций, представленных в научных базах данных Google Scholar, Scopus, Web of Science, PubMed и eLIBRARY за 2019-2024 гг. Также были включены ключевые классические источники, опубликованные вне указанного периода. В итоговый обзор вошли 92 публикаций, соответствовавших предварительно заданным критериям отбора.

Результаты и обсуждение: Проанализированные данные свидетельствуют о тесной взаимосвязи гипертрофии аденоидов, нарушенного носового дыхания, ротового дыхания, миофункциональных нарушений и зубочелюстных аномалий. Гипертрофия глоточной миндалины является распространенным ЛОР-заболеванием у детей 6 лет; у часто болеющих детей она описывается в 70-90 % случаев. Ротовое или смешанное дыхание при гипертрофии аденоидов может сопровождаться артикуляционными нарушениями: дефекты речи были зарегистрированы у 81.7 % детей с нарушениями дыхания. Несмотря на то что повторные хирургические вмешательства встречаются относительно редко, в крупном ретроспективном исследовании частота ревизионной аденоидэктомии составила 0.55 %, при этом 21 % ревизионных случаев были связаны с гиперплазией трубной миндалины, а не с истинным повторным разрастанием аденоидной ткани.

Выводы: Проведенный анализ литературных данных дает основания заключить, что профилактика рецидивов после аденотомии имеет клиническое значение и должна включать междисциплинарный комплексный подход к ведению послеоперационного периода. Такой подход должен объединять оториноларингологическое наблюдение, раннюю ортодонтическую оценку, коррекцию сохраняющегося ротового дыхания и зубочелюстных аномалий, а также миофункциональную или логопедическую терапию при наличии показаний.

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