日本人片側性口唇口蓋裂患者における5-Year-01d Indexを用いた咬合評価 [in Japanese] Assessment of the Dental Arch Relationship using the 5-Year-Old Index in Japanese Patients with Unilateral Cleft Lip and Palate [in Japanese]
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片側性口唇口蓋裂患者の咬合評価方法として,歯列模型をもとに5段階に評価する方法が多く用いられている.本研究では東京大学医学部附属病院(東大病院)顎口腔外科・歯科矯正歯科に来院した患者について,5-Year-Old Indexによる評価を行い,その有用性を検討するとともに,咬合状態を調査した.また,言語成績についても検討を加えた.<BR>評価には,完全片側性口唇口蓋裂患者31名の乳歯列後期の歯列模型を用いた.口唇・口蓋形成術は,東大病院のほか,13の施設で行われていた.このうち当科と同じく口唇形成をMillard+小三角弁法で行い,口蓋形成をpushback法で行った症例(M-P症例群)は22名で,M-P症例群のうち口唇・口蓋形成術ともに当科で行った症例(当科症例群)は8名であった.評価者内・評価者問の評価一致度は,重み付きカッパー値を用い検討した.<BR>評価者内,評価者問一致度は,すべて良好であった.全症例の平均スコアは3.23で,M-P症例群では3.36,当科症例群では3.00であった.グループ分布では,"良い"咬合(グループ1,2)を示した割合は,全症例で16.1%,M-P症例群で13.6%,当科症例群で37.5%であった.また,"悪い"咬合(グループ4,5)を示した割合は,全症例で32.3%,M-P症例群で36.4%,当科症例群で25.0%であった.言語成績では,異常構音が全症例の36.0%,M-P症例群の26.3%,当科症例群の12.5%でみられ,鼻咽腔閉鎖機能不全は,全症例の4.0%にみられたが,M-P症例群,当科症例群ではみられなかった.<BR>評価一致度の検討結果から,5-Year-Old Indexは信頼性の高い方法であることが確かめられた.また評価結果は,これまでの当科におけるGoslon Yardstickを用いた結果に比べ良かったものの,諸外国の報告に比べると,"悪い"咬合をもつ割合が多かった.しかし,結果の解釈には,外貌,言語成績人種差などを考慮する必要があると思われた.
The five categories rating based on dental models has been used in many assessments of dental arch relationships in patients with unilateral cleft lip and palate (UCLP). This study was performed using the 5-Year-Old Index in the Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital (UTH). In this study, the usefulness of the index was examined and dental arch relationships in deciduous dentition in patients with UCLP were evaluated. An evaluation of speech was also carried out.<BR>Dental models in late deciduous dentition of 31 patients with complete UCLP were used in this study. The average age was 6 years 0 month and primary surgeries were performed in 13 hospitals. The modified Millard's method with small triangular flap was used for lip closure and the pushback operation was performed for palate closure in 22 patients (M-P group). Eight out of 22 patients were treated in UTH (UTH group). Intra- and inter-examiner agreements were evaluated using the weighted kappa statistics. Speech evaluation was performed on 25 out of 31 patients using clinical records.<BR>Intra- and inter-examiner agreements were high indicating good reliability. The average score was 3.23 in all 31 patients, and 3.36 and 3.00 in the M-P group and in the UTH group respectively. Good dental arch relationships (Group 1 and 2) were found in 16.1% of all patients, in 13.6% of the M-P group and in 37.5% of the UTH group. Poor relationships (Group 4 and 5) were found in 32.3% of all patients, in 36.4% of the M-P group and in 25.0% of the UTH group. Articulation disorder was found in 36.0% of all patients, in 26.3% of the M-P group and in 12.5% of the UTH group. Velopharyngeal insufficiency was found in 4.0% of all patients but was not found in both the M-P and UTH groups.<BR>The 5-Year-Old Index seemed to be a reliable method for the evaluation of dental arch relationships in patients with UCLP. Average dental arch relationships revealed in this study were slightly better than those of our previous studies using the Goslon Yardstick. On the other hand, when compared with other reports from foreign institutions, the proportion of patients with poor dental arch relationship was larger. However, facial appearance, speech ability and racial difference should be taken into consideration when interpreting the results of this study.
- Journal of Japanese Cleft Palate Association
Journal of Japanese Cleft Palate Association 32(1), 34-42, 2007
Japanese Cleft Palate Association