5. The plan and organizational structure of lecture.

№	The basic stages of lecture and their maintenance(contents)	Type of lecture. Means of activation of students. Materials of methodical maintenance	Distribution of time
1.	Preparatory stage. Definition of a urgency of a theme, the educational purposes and motivation.	Introductory, clinical lecture with elements of problematical character.	5 %
2.	The basic stage. Teaching of a lecture material under the plan. 1. The characteristic of the basic stages of development domestic and foreign ортогнатической surgeries. 2. Known classifications of replacement of skeletal anomalies of a bite. 3. A substantiation of concept " orthodontic surgery ". 4. Classifications of different kinds оrtognatic operations. 5. The characteristic of separate stages of planning оrtognatic operations. 6. The basic kinds ortognatic operations: by Limberg, by Semenchenko, Dal Pont, Obwegeser and ect.	Clinical lecture with application of presentation: multimedia support the decision of problem situations, situational problems(tasks), thematic patients.	85 %
3.	The final stage. The resume of lecture, the general(common) conclusions. Answers to questions. The task for self-preparation of students.	The educational literature. Methodical development of faculty. The task for self-preparation.	10 %

Congenital anomalies and deformations of the dentition is a manifestation of the development of the facial and cerebral cranium. Shape and dimensions of the jaws largely depend on the individual shape and dimensions of the skull. Violation of the growth or development of the jaws leads to the development of deformation or anomalies, and this can be observed both in the process of embryogenesis, and after the birth in the period of formation of a temporary or permanent dentition. In this regard, it becomes clear what a wide range of anomalies or deformation may occur, and the severity of their symptoms is in direct dependence on the timing of. Etiology зубочелюстно-facial anomalies and deformations is extremely varied. Organo - and morphogenesis of jaws the facial skull may be disrupted as a result of hereditary effects on the embryo transferred parents diseases (endocrine and metabolic disorders in the body of the mother, infectious diseases), radiation exposure, as well as physiological and anatomical changes in the genital organs of the mother and malposition of the fetus. Early childhood development dentition may be impaired under the influence of exogenous factors (heredity, endocrine disorders, various infectious diseases, infringement of metabolism) and exogenous factors (inflammation in the areas of growth of the jaws, injury, including birth, radiation injury, mechanical pressure, bad habits, dysfunction of the masticatory apparatus, violation of the act of swallowing, nasal breathing and others).

Most of deformations in childhood and adolescence - a consequence of the disease in the period of development of the facial skull (osteomielit, rickets, TMJ arthritis), injury, malocclusion in connection with loss of teeth, early and traumatic operations about cleft lip and palate, removal of the adenoids, misuse and poor quality orthodontic treatment. Deformation of one of the jaw in the process of growth and development of the body more or less sharply is reflected in the structure of all the facial skull. On the deformation of one or both jaws speech can go only with a sharp rejection of their parameters from the conditional mean of the values that are most relevant to the rest of the departments of the facial and cerebral cranium of a particular individual. The second criterion is the availability of deformation jaw - infringement of function of chewing or speech. PATHOGENESIS In the basis of the pathogenic mechanisms of anomalies and deformations of the facial skull dentition lie oppression or partial cessation of the growth of the base and the vault of the skull and jawbones, loss of bone substance, off the chewing function or mouth opening. A significant role in the pathogenesis of play endocrine disorders in growing organism. Anomalies and deformations of the facial skull, including deformations of jaws, children and adults occur very often and in various forms, and is accompanied by pronounced aesthetic and functional disorders. Most people focus on the violation of the proportions of the face, a change of appearance. Aesthetic defect, in turn, negatively affects the emotional state of patients, makes them closed, малообщительными, suspicious. Wrong attitudes and the patient to anomalies or deformation of the person leads to the development of painful feelings foreign inferiority that has a significant impact on the whole life of the patient.

The reaction of the personality on the aesthetic defect is expressed in the development of secondary neurotic reactions, патохарактерологических and intellectual impairments, which, according to various authors, are observed in 45-50% of cases. Many clinicians have noted that these violations occur more often in women, explaining it more high lability of the female psyche. Along with the aesthetic violations and psychoemotional disorders in patients with anomalies and deformations of the facial skull there are other functional disorders that have a significant impact on the vital activity of organism. In connection with difficulties for biting and chewing food suffers function of the digestive system, which leads to the development of chronic diseases of the gastrointestinal tract. Formed a kind of vicious circle: malocclusion cause pathological changes in the nervous and the digestive systems, the respiratory system, LOR-bodies, and the relationship of these organs and systems contributes to the progression of functional deviations, until the occurrence of structural changes in the body. Some patients with dentoalveolar anomalies and deformations of the system are marked by the speech of chronic inflammation in the Airways ways and related respiratory disorders. Suffers from lack of pronunciation mainly dental and a number of other sounds a result of incorrect correlation of dentitions, the availability of open bite, deformation of the hard and soft palate, the narrowing of the nasal passages, violations of the articulation of the language.

Significant changes with deformations of jaws occur in the tissues surrounding the teeth and TMJ. The mucosa of the gum individual teeth and their groups are developing inflammatory changes with the transition to the periodontium and the emergence of further symptoms of periodontitis and a violation of the volume of the movements of the lower jaw leads to dysfunctional changes in the TMJ. All of the above testifies a huge spectrum disorders occurring in strains of dentition, significant changes of the functions of a number of organs and systems, their close interrelation and interaction. Elimination of existing anatomical changes in the development of the facial skull leads to the elimination of a number of functional disorders and to promote full psychosocial rehabilitation of patients with anomalies and deformations of the facial skull and a return to active industrial and public activities.

The diversity of functional disorders of organs and systems of organism of the patient with the deformation of the dentofacial system is indicative of the importance of purposeful complex treatment in the course of medical rehabilitation of a patient. From an organizational point of view of great importance epidemiological studies to determine how common patients with anomalies and deformations of the facial skull and dental system. Before discussing the question about the frequency of manifestation of various anomalies and deformations, it is necessary to define the concept of standards. According to many experts, involved in treatment of patients with anomalies and deformations of the facial skull and dental system, under the norm should be understood as such ratio various departments of the facial skull, form and relationship tooth alignment: •external characteristics are similar to the most common physiological varieties (aesthetic factor); •provide optimum chewing efficiency (functional factor); •have maximum resistance in the process of development and formation of the masticatory apparatus (the ontogenetic factor). In connection with this norm of the ratio of the dental arches of the upper and lower jaws in clinical practice it is assumed ортогнатический bite, as the most common. Deviations from ортогнатического bite, except its physiological varieties (direct, бипрогнатический, прогенический), which are characterized by multiple contact between the teeth-antagonists, are considered as a deformation.

CLASSIFICATION Domestic and foreign literature, there is no single classification anomalies and deformations of the facial skull and dental system. Domestic and foreign specialists most often use the classification of Энгля based on the symptom of the ratio of the first permanent large indigenous teeth of the upper and lower jaws. The disadvantage of classification is that the deformation estimate only in anterior-posterior direction within the dentition. When determining the ratio of dentitions impossible to get an idea about the structure of the facial and cerebral cranium in General and to reveal the true reason malocclusion. Introduction into clinical practice of new, more modern methods of research, especially teleroentgenography allowed to realistically evaluate the morphological abnormalities in patient with an abnormality or deformation of the facial skull. It should be noted that the same malocclusion can be caused by various morphological changes in the dental system and personal skull. Accurate record of them can be critical in developing a rational treatment plan. Proposed by various authors classification schemes anomalies of the facial skull and jaw deformities are based on embryological, pathogenetic, morphological and other signs. The variety of terms denoting deformation or abnormality difficult diagnosis and treatment planning. As a rule, the application of each of the classification schemes is limited specialty (orthodontics, orthopedy, maxillofacial surgery, embryology). Such schemes do not reflect the essence of anomalies or deformation, morphological changes in them and do not allow to make a clear plan of treatment at all stages of medical rehabilitation.

Currently, the most complete considered a

working classification of the anomalies of the facial skull, jaw and teeth, and their deformations, proposed Кalmakarov (1972) and advanced V. Bezrukov (1981) and V.I.'ko (1986). I. Abnormalities of the teeth. 1. Anomalies of the number of teeth. a) Edentulism (partial, full). b) Сверхкомплектные teeth. 2. Anomalies of the teeth (vestibular, oral, мезиальные, distal, turn teeth-axis, high or low position of the teeth, transposition). 3. Anomalies in the size and shape of the teeth. 4. Anomalies teething (premature, later, ретенция). 5. Anomalies of teeth. II. Deformations of jaws. 1. Макрогнатия (top, bottom, symmetrical, asymmetrical, different departments or the entire jaw). 2. Micrognathia (top, bottom, symmetrical, asymmetrical, different departments or the entire jaw). 3. Прогнатия (top, bottom, functional and morphological). 4. Ретрогнатия (top, bottom, functional and morphological). III. Combined deformations of jaws (symmetric multiprocessing). 1. Top micro and ретрогнатия, lower macro - and прогнатия. 2. Top macro - and прогнатия, the lower micro - and ретрогнатия. 3. The upper and lower micrognathia. 4. The upper and lower макрогнатия. IV. Combined dental anomalies and deformations of jaws. V. Combined anomalies and deformations of the facial and cerebral cranium and dentition. 1. Symmetric. a) the Oral dysostoses (syndrome treacher-Collins-Franchesketti). b) Краниостенозы (syndromes Aper, Crouzon). in) Hypertelorism I-III degree. 2. Unbalanced. a) Гемифациальная микросомия III extent syndrome Гольденхара). b) Hypertelorism I-III degree.

During formation of diagnosis, in addition to reflecting the morphological characteristics of anomalies or deformation listed in the classification, it is advisable to specify the ratio of dental rows and view bite (прогеническое, прогнатическое, ортогнатическое ratio dentition; deep, outdoor, cross bite). Anomalies and deformations of the facial and cerebral cranium are characterized by size in three mutually perpendicular planes, therefore, in formulating the diagnosis, you must specify which dimensions mostly violated (sagittal, transversal, vertical). The use of this classification scheme allows to provide continuity in the work of specialists (orthodontists, orthopaedic surgeons, maxillofacial surgeons, neurosurgeons, speech therapists) in medical rehabilitation of patients with anomalies and deformations of the facial skull and dental system. THE CLINICAL PICTURE OF For all of these types of anomalies and deformations of the facial skull and tooth-jaw system, patients typically complain of aesthetic defect - violation of the right proportions of the face due to underdevelopment or excessive development of the various departments of the facial skull and functional disorders associated with defective откусыванием and chewing, wrong and indistinct pronunciation of a number of sounds, violation of breathing, articulation. Special attention should be paid to the fact that the isolated strains can only take place in the period of growth and development of the facial and cerebral cranium. Over the age of 16 years, when the growth and development of brain skull and upper jaws are completed, there is a formation of a combined jaw deformities and abnormalities of the facial skull. The clinical picture in patients with upper прогнатией or макрогнатией characterized as a violation of the proportions of the midface: middle third of the face shortened compared with the bottom, the width of its more; upper lip is forward, slightly elevated. Nasolabial angle of either increases or decreases. Creases ironed out. This deformation is observed прогнатическое ratio of dental rows. Sagittal gap between Central teeth of the upper and lower jaws can have different values, depending on the degree of deformation. Bite can be deep, deep traumatic when the front group of the lower teeth rests on the mucous membrane of the hard palate, and open. The dimensions of the arch of the upper jaw broken in трансверсальной and sagittal planes. In most cases, reduced the width of the top of the dentition on the level of the first premolars and increases the length of the anterior upper jaw, the front teeth protruding. In a state of physiological rest upper lip does not close the teeth on the upper jaw. In some cases the teeth of the upper jaw protruding from under the upper lip two thirds of the height of the crown or even more. When you smile upper lip, shifting upwards, revealing and mucosa, alveolar bone of the upper jaw. The clinical picture in the bottom erythropoietic or ретрогнатии characterized by decrease in the size of the lower areas of the face in the sagittal plane and vertical dimensions of the lower zone of the face, as a rule, increased. The lower jaw is underdeveloped, decreased in size or shifted backwards with preservation of normal parameters. Most patients with this type of deformation chin Department of the face is cut back, губоподбородочный angle is not pronounced губоподбородочная furrow smoothed the soft tissues of the chin area shifted backwards towards the lower lip. Cervical-mental corner poorly expressed, the distance between the chin and the hyoid bone is reduced.

Some patients губоподбородочный angle and губоподбородочная furrow, on the contrary, are pronounced and stand out much. Chin Department looks like a short while maintaining its normal settings. The lower lip is deployed forward, the mucous membrane of the red portion of the rests on the cutting surface of the upper teeth. Cervical-mental corner expressed well, and the distance between the chin and the hyoid bone is only slightly shorter. All the patients with the lower micro - or ретрогнатией notes прогнатическое ratio of dental rows with different values of the sagittal gap between the Central incisors of the upper and lower jaws, which depends on the degree of deformation. Прогнатическое ratio teeth accompanied by a deep, deep traumatic or open bite. In patients with the lower micro - or ретрогнатией had been a violation of трансверсальных and sagittal size of the dentition of the lower jaw, which is reflected in the narrowing it at the level of the first premolars and shortening of the length of its anterior. Many patients are detected crowding of teeth on the lower jaw, vestibular slope of the front teeth and a shift upward in relation to the occlusal plane. In patients with upper micro - or ретрогнатией flattened and drops in the middle third of the face. This is especially apparent when comparing the most protruding points in the forehead, upper jaw and chin. Relief cheek and infraorbital areas symmetrically rounded and flattened. The base of the cartilage of the Department of drops in nose, nasal passages narrowed due to a decrease грушевидного holes. Nasal breathing is difficult. On the border of transition bone Department of the nose cartilage is determined by crook. Upper lip, especially its base drops in. Nasolabial angle less than 90 degrees. Nasolabial folds pronounced deep. The lower lip, despite the correct dimensions of the lower jaw, covers the upper. Chin receded. Patients with this type of deformation is observed прогеническое ratio of dental rows. This is accompanied by the formation of прогенического or open bite, the severity of which depends on the degree of deformation. At the top ретрогнатии, as a rule, the sizes of teeth on the upper jaw in трансверсальной and sagittal planes not differ from the normal. In patients with upper микрогнатией identified ретенция and дистопия teeth, their overcrowding, the narrowing of the dentition of the upper jaw. Arch palate sharply marked, deep, is called Gothic.

In patients with upper микрогнатией after Heiloo - and уранопластики about cleft lip and palate, above all, marked a shift of bone skeleton nose in a healthy way. Cartilage Department of the nose also shifted in a healthy way, nose wing on the side of the cleft deformed, flattened. Septum of the nose is shortened. Base грушевидного holes on the side of the cleft primary is undeveloped, flattened, drops in. Entrance in the lower nasal passage on the side of the cleft is lower in comparison with the healthy side. Bone and cartilaginous septum crooked nose, nasal turbinates on the side of the cleft are hypertrophied. All patients with clefts broken nasal breathing. The upper lip is shortened, flattened, the scar is deformed. The mobility of it is somewhat limited due to scar deformation and the presence of scar adhesions on the upper vault of atrium of mouth cavity. Nasolabial angle less than 90 degrees. The top set of teeth greatly deformed in a zone of the cleft may be missing teeth. The upper vault of the vestibule of mouth shallow due to scarring of tissues after previously held Heiloo - and уранопластики. The mucous membrane of the hard and soft palate scar changed, soft palate sedentary, abridged. Often patients of this group is defined by the residual defects the hard palate and ротоносовое fistula in the region of upper arch of vestibule of mouth. In patients with lower macro - or прогнатией a deformation of the lower third of the face due to its protrusion forward. This creates the impression that upper lip drops in. Nasolabial folds pronounced deep. The lower lip covers the upper. Chin receded. At the bottom макрогнатии body size and branches of the lower jaw increased. In patients with lower прогнатией marked increase in the mandibular angle (OK 127 degrees).

DIAGNOSTICS For examination of patients with abnormalities of the facial and cerebral cranium and deformations of the dentition of importance is the study of the history of life, illness and operations, family history, family history. Peculiarities of clinical examination of patients with anomalies and deformations of the facial skull are detailed analysis of the local status, the study of photos of the person in different projections, jaw models, chest x-ray of the skull and dental system. In a survey of patients special attention should be given to the clarification of complaints, assess their significance in light of the objective analysis of functional and aesthetic violations. Study local status is recommended in the following sequence: 1) to assess the position of the head; 2) to analyze the the contours of the face in the full face and profile, determine its proportions, symmetry; 3) to find out the ratio of dentitions, their shape, size, relationship teeth of the upper and lower jaws, and position of teeth, periodontal status; 4) assess the state of the nasal cavity, nasal breathing function; 5) find out nature and scope of the movements of the lower jaw; 6) determine the dimensions of the language, its position, articulation, character speech disorders; 7) to consider the peculiarities of structure and function of the hard and soft palate; 8) assess the state of the salivary glands and jaw and facial muscles, functional state of the cranial the nerves. Study local status should be strictly sequential, it is more expedient from the top down. Analyzing the state of the patient's head, be aware that for many years the patient chose an optimal its layout, anomaly or deformation of the least visible to others. Can be observed bending of the cervical spine, forced position of the lower jaw, tilt the head with the rotation axis with asymmetrical deformations. In this regard, conducting the clinical examination, you must constantly monitor the proper position of the patient's head in space. Originally exploring the contours of the face in three mutually perpendicular projections taking into account its symmetry, the proportionality of the upper, middle and lower zones. It should be noted that the absolute symmetry of different departments of the person is not found, and minor deviations cannot be a basis for surgical intervention. Dividing a person on the field of conventional lines vertically and horizontally, carry out the detailed analysis of symmetric plots, defining deformed departments.

Examining anatomical education midface (eye socket, nose, the upper jaw, cheek bones), evaluate the symmetry and proportionality taking into account the overall shape of the face. Study the function слезоотводящих ways, the nature of nasal breathing, a form of bone and cartilage departments nose, their location in relation to other departments of the person. When analyzing the lower zone of the person's emphasis on the position and nature of the closure of the upper and lower lips, peculiarities of the structure of the nasolabial folds, the severity of the chin of the lower jaw. The functional alone upper and lower lips in a state of closing or between them can be diastasis to 3.5 mm. With the active smile upper lip, rising, can expose the mucous membrane of the alveolar bone of the upper jaw is not more than 2 mm from dentogingival region. The increase of these parameters may indicate either about the shortening of the upper lip, or excessive development of the upper jaw in the vertical. When estimating the proportions of the face in profile great importance to have data on the situation of the Foundation of the cartilage of the Department of the nose. The correct profile entity characterized by the location on one line three main points (the outermost point of the forehead, the base of the partitions and the outermost point of the chin). With aesthetic positions it is important to assess the situation of bone and cartilage of the Department of the nose, nasolabial and подбородочно-cervical angles, the severity of подбородочно-labial folds. Pay special attention to the shape and dimensions of the corners of the lower jaw, the shape of the ears. Assessing the state of TMJ, analyze the volume and the nature of the movements of the lower jaw. During the inspection of the oral cavity pay attention to the ratio of dentitions, the shape of dental arches, and position of teeth, their shape and size. Examine the state of the mucous membranes of the oral cavity, evaluate the shape of the sky, the function of the soft palate and the tongue. After a full clinical examination of patients with an abnormality or deformation of the facial skull and dental system and proceed to the objective assessment of the status of soft tissues, bone skeleton face and dentition using additional methods: •study the diagnostic jaw models; •x-ray examination; •analysis of the photographs of the person of the patient in direct and lateral projections; •functional examinations (EMG, EEG, реополярография, ринопневмометрия, фоторегистрация movements of the lower jaw). For each patient it is advisable to make two pairs of plaster models of the jaws. One of them is used for the planning of surgical treatment, another for the measurement. On models determine the size of the teeth and the angle of inclination, the width of the dental arch, deep into the sky, the length of the anterior segment of the dental arches, as well as the form of the dentition, symmetry of right and left half. Measuring the width of dentitions in the field of the first small molars and the first large indigenous teeth is performed by the method of pona, and the length of the anterior segment of the dental arch - method Коркхауза. The study of relationship dentition carried out in three planes after fixing the plaster models of the position of the Central occlusion in окклюдаторе.

In the scheme of x-ray examination of patients with anomalies and deformations of the facial skull and dental system include телерентгенографию in direct and lateral projections, orthopantomograph, radiography in полуаксиальной projection tomography TMJ open and a closed mouth, зонографию, panoramic radiograph. Краниометрическое x-ray study in three projections (direct, side and полуаксиальная) is widely applied in orthodontics and oral and maxillofacial surgery. It should be noted that data телерентгенографического studies are characterized by significant variability, and depend on the gender, age, ethnic peculiarities and distinctive features of the structure of the facial and cerebral cranium. In addition, the results are significantly influenced by the technical shooting conditions, errors in its conduct as well as subjective errors in the markup and the dimension of the linear and angular indicators on телерентгенограммах. The main advantages of teleroentgenography are: wide possibility of in vivo analysis of the main parameters of the facial and cerebral cranium in different projections, the determination of the exact localization of deformation, the assessment of the nature of the violations and registration of their changes during the growth and treatment. When decrypting телерентгенограмм in direct and lateral projections use certain benchmarks to measure the number of linear and angular parameters. A detailed study of linear and angular sizes of the parameters on the телерентгенограммах in direct and lateral projections lets you receive digital data and on their basis to conduct the analysis of mutual layout of departments of the facial skull, as well as the soft tissues of the face. You can set the position of the top jaws in relation to the base of the skull, the position of the lower jaw in relation to the base of the skull, their location in relation to each other and to the base of the skull, the sizes of the bases of the upper and lower jaws, localization dental series with respect to bases of the jaw, to determine the identity of the dimensions the right and left halves of the person or their non-compliance. On полуаксиальных pictures and ортопантомограммах assess the condition of the paranasal sinuses. About the state of the TMJ is judged according to the opt, tomography in the open and closed mouth, зонографии. The structure of bone tissue of jaws, alveolar process of the study on the enlarged panoramic radiographs or sighting of the intraoral radiographs.