sano yoshimi

Cleft lip and palate (CLP) is the most frequent cleft malformation seen in the maxillofacial region and morphological changes have been observed when evaluating treatment. However, few studies have reported regarding changes in oral function in affected patients. We investigated changes in physiological characteristics of sucking function along with perioral muscle activity and sucking pressure in infants with CLP.Twelve infants with unilateral CLP underwent a cheiloplasty procedure at the center of the cleft lip and palate at Fujita Health University Hospital. Measurements were performed before, and 1 week and 3 months after the cheiloplasty. Electromyogram (EMG) findings from the bilateral temporal (L-R, TM) and masseter (L-R, MM) muscles, as well as the orbicularis oris (OM) of the healthy side and the suprahyoid (SM) muscles were recorded. Values for sucking pressure and EMG findings obtained from healthy infants at the age of 3 months were used as a control.We found that both sucking cycle time and negative pressure duration during sucking were significantly longer following the operation. Activities on both sides of the TM, OM, and for total muscle were significantly increased after the operation, while sucking pressure was also significantly increased at 3 months. A comparison of CLP infants at 3 months after the cheiloplasty with the control group showed that SM activity was significantly decreased in the former.In conclusion, the duration of negative pressure in a sucking cycle increased following cheiloplasty procedures, which seemed to be effective for formation of negative intraoral pressure. However, EMG activity of the SM in the CLP remained low after the cheiloplasty, indicating that tongue movement during sucking was weaker than that in full-term normal infants.

先天性エプーリスとは、新生児に稀に見られる先天的に発生した良性の限局的小腫瘤の臨床病省である。哺乳障害や乳前歯の萠出障害がみられることもあるため、治療法としては全身もしくは局所麻酔下で歯胚に注意しながら、茎部の組織を含めて切除するのが一般的である。今回我々は上顎左側前歯部の先天性エプーリスと診断した女児に対し、約5ヵ月半の経過観察を行い、白然に消失した症例について報告する。患児は初診時生後16日目の女児で、上顎左側前歯部歯肉の腫痛を主訴に、朝日大学病院小児歯科に来院した。エプーリスは、赤く有茎性で柔らかいゴム様の弾性軟で直径8mmであった。エプーリスは外科的に治療せず、経過観察を行った。それから、エプーリスは徐々に大きさが縮小して、生後6ヵ月で完全に消失した。先天性エプーリスの治療法としては、大きく分けて外科的な切除と何もせずに経遇観癖することが考えられる。それを追跡すると、本症例で示すようにエプーリスの縮小と消失が報告されていた。従って、哺乳障害等の問題が起こらない阻り、新生児において診断後のすぐのエブーリスの外科的な切除は望ましくない場合もあり、経過観察を第一選択とすべきと考える。(著者抄録)