左側完全口唇口蓋裂1女子症例の長期咬合管理結果について

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  • Results of long-term orthodontic care of a growing girl with left complete cleft lip and cleft palate: Report of a case

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左側完全口唇口蓋裂1女子症例の, 骨移植を併用した長期咬合管理結果について報告する。口唇裂初回手術を生後5か月に, また, 口蓋裂初回手術を1歳10か月に行った。4歳から咬合管理を開始した。乳歯咬合期には前歯から左側側方歯にかけて反対咬合がみられた。7歳時にリンガルアーチを用いて, 前歯反対咬合を改善した。9歳2か月に, 顎裂への新鮮自家腸骨海綿骨細片移植術を行った後, 上顎左側中切歯と犬歯を隣接させて永久歯咬合を形成した。10歳5か月から14歳0か月まで, チンリトラクターを使用した。長期咬合管理の17歳時での結果は, 1)形成した永久歯咬合は安定している, 2)鼻翼に軽度の変形がみられるが, 正貌はほぼ左右対称である, 3)側貌は, 中顔面からオトガイにかけて著明に後退している, 4)軽度の顎機能異常がある, であった。口唇口蓋裂初回手術の上顎骨への手術侵襲が大きくはなく, また, 顎裂部への新鮮自家腸骨海綿骨細片移植術を適切な時期に行ったことが, 咬合の安定に寄与したと言える。しかし, チンリトラクターの使用が, 側貌の不調和と顎機能異常をもたらした可能性が考えられる。総合的には, 良好な長期咬合管理結果が得られた。

This case report presents the results of long-term orthodontic care combined with an alveolar bone graft in a girl with left complete cleft lip and palate. Primary lip repair was done at five months of age, and palatoplasty was performed at one year ten months. Orthodontic care was started at the age of four years. Anterior crossbite and posterior crossbite on the left side were seen in the primary dentition. Anterior crossbite was improved by means of a lingual arch at seven years of age. At the age of nine years and two months, bone grafting of the alveolar cleft was performed, using autogenous particulate marrow and cancellous bone harvested from the iliac crest. The permanent teeth were then aligned orthodontically, and the upper left canine was positioned next to the upper left central incisor. A chin retractor was used from the age of ten years five months to the age of fourteen years. The long-term orthodontic care of this patient, at the age of seventeen years, was evaluated as follows : 1. The occlusion of the permanent teeth was found to have stabilized. 2. Facial asymmetry was not evident, except for a slight deformity in the left wing of the nose. 3. A retruded unbalanced facial profile was evident in the middle and lower face. 4. Slight masticatory disorders were detected. It was concluded that the primary repairs of both the cleft lip and cleft palate did not remarkably retard maxillary growth and that bone grafting in alveolar cleft was performed at the appropriate time for this patient, resulting in good alignment and stability of the permanent dentition. Chin retractor therapy may have caused about the unbalanced profile and slight masticatory disorders. Overall, good results were obtained by this long-term orthodontic care.

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