意識障害患児の口腔自傷の3例 Three Cases of Oral Self-mutilation in Comatose Patients

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千葉県こども病院集中治療室で加療中であった3名の意識障害患児における下唇と舌にみられた自己咬傷の治療を行った。<BR>第1症例は15歳の男児で糖尿病性ケトアシドーシスから昏睡状態になり,反射的にまた不随意運動により下唇を噛んだことから潰瘍を形成していた。即時重合レジンを用い上顎臼歯咬合面で咬合を挙上し,口蓋を覆うスプリントを作製した。作業用模型から装置をとり易くするためリリーフワックスを使用し,装着時に粘膜組織調整材(ハイドロキャスト®)でそのスペースを満たした。装置の前方には小孔をあけ細い鋼線をつけ,誤嚥防止のためそれを口腔外に出した。スプリントは患児の口腔の不随意な筋活動が消失するまで37日間使用した。<BR>第2症例は6歳の水頭症の女児で重度の肺炎に罹患し,経鼻挿管下で治療を受けていた。患児の舌は浮腫のため腫脹し,潰瘍を認めた。バイトブロック様の可撤性装置をレジンで作製し,歯列の片側に装着することで前歯部の開口を得た。6日後には潰瘍は治癒し,浮腫も消失していたため装置を除去した。<BR>第3症例は心嚢切開術を受けた5歳の男児で,舌に浮腫と潰瘍を認めた。この症例でもバイトブロック様の装置を使った。19日後,傷が治癒したため装置を除去した。<BR>意識障害患児の舌,口唇に自傷行動による傷ができた際,その状態を把握し適切な装置を作製,装着することで歯を保存し,咬傷を治癒に導くことができる。

Three comatose patients admitted to the intensive care unit of Chiba Children's Hospital were referred to the division of dentistry for treatment of self-inflicted laceration of the lower lip and the tongue.<BR>Case 1. a 15-year-old boy fell into coma due to diabetic keto-acidosis and had a considerable ulceration in the lower lip, owing to chewing it uncontrollably. In order to improve the uncontrolled jaw movement and the ulceration we used a removable acrylic dental appliance, prepared with coldcuring acrylic resin. The splint was instituted to covere the surface of the hard palate and involved the occlusal surface of the maxillary molars. Furthermore, the additional small amount of resin on the occlusal surfaces of the splint made it possible to obtain 4 mm-open bite between the interincisal space. Relief wax was placed on the dentition of the working model to facilitate removal of the dental appliance, and the space was filled with tissue treatment material (Hydro-Cast®) when the appliance was applied in the patient's mouth. To make sure he avoided swallowing by mistake, a small hole was made in the anterior portion of the appliance, and a suitable length of fine stainless steel wire was attached between the hole and the extra oral fixed place. The appliance was removed 37 days later when the normal muscular activity was restored.<BR>Case 2. a 6-year-old girl with hydrocephalus was affected with severe pneumonia and treated with nasotracheal intubation. Her tongue was edematouly swollen with severe ulcers due to her chewing it during periods of unconsciousness. A removable acrylic dental appliance similar to a bite-block was prepared on one side of the dental arch. After 6 days, the ulcer was mostly cured.<BR>Case 3. a 3-year-old boy who was in schok due to cardiac tanponade was affected by serious edema and ulceration on the tongue. A bite-block-like appliance was used such as in the previous case. After 19 days, the appliance could be removed, because the wound healed with disappearance of the self-mutilation.<BR>These results led to the following conclusions: When a wound occurs in the tongue or lip by selfinflicted behavior in comatose patients, the wound can particularly heal well by using a suitable dental appliance without sacrificial tooth extraction.

収録刊行物

  • 小児歯科学雑誌

    小児歯科学雑誌 36(4), 696-701, 1998-09-25

    The Japanese Society of Pediatric Dentistry

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各種コード

  • NII論文ID(NAID)
    10013868952
  • NII書誌ID(NCID)
    AN00116228
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    05831199
  • データ提供元
    CJP書誌  J-STAGE 
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