中島 康経

症例は22歳男性で、中学生の頃より咬合異常を自覚していた。大学受験を終え、咬合の加療目的で近隣矯正歯科医院を受診し、顎矯正手術適応のため上顎両側側切歯抜去による術前矯正治療終了後に当科を紹介受診した。下顎骨の軽度左方偏位を伴う下顎前突症と診断し、両側下顎枝矢状分割術を施行した。テキストデータの収集は対象患者に手術室入室時から術後における心境や生活の変化について自由に記載した日記の作成を依頼し、入院中8日間、退院後9日間の計17日間記載したものを用いた。日記の形態素解析により抽出された総単語数は326語、異なる単語数は191語であった。共起ネットワーク解析では特徴語のまとまりから12グループに分類された。12のグループを解釈し、共通するタイトル「開口」「腫脹」「食事」「睡眠」「経鼻チューブ」「疼痛」「咬合」「知覚障害」「手術」「矯正」「食形態」「顎運動」とつけることが可能であった。

顎矯正手術直後の経口的栄養摂取を含めた食事内容について検討した。当科で顎矯正手術を行った14名(男性2名、女性12名、平均27.6歳)を対象に、食事の見た目等についてのアンケート調査と食事・栄養摂取状況の調査を行った。アンケート調査では、見た目、食べやすさ、量、味、栄養補助食品の味、満足感について、退院前に各対象者が記入した。食べやすさについては、「とても食べやすかった」と回答した者は46%、「まあまあ食べやすかった」が46%、「少し食べにくかった」が8%で、「食べにくかった」と回答した者はいなかった。見た目については、「良かった」と回答した者は25%、「まあまあ良かった」が31%であったが、「あまり良くなかった」と回答した者が44%みられた。残食量から推定した食事摂取率は主食、副食とも平均6割であった。これをもとに算出した患者ごとの3日間平均エネルギー摂取量は術式による差が明らかでなく、30～1250kcal、平均705kcalであり平均充足率は35%であった。

OBJECTIVES: Idiopathic scoliosis is an orthopaedic disease of childhood, with onset and progress occurring until adolescence. Here, the relationship between lateral displacement of the mandible and scoliosis was analysed quantitatively. METHODS: Seventy-nine non-syndromic Japanese patients (18 men, 61 women), who were diagnosed with jaw deformities and underwent surgical orthognathic treatment at Kyushu University Hospital from January 2011 to August 2014, were enrolled. Their mean age at the time of radiography was 25.3 ± 8.7 years. Postero-anterior cephalometric radiographs and chest radiographs were examined. In postero-anterior cephalometric radiographs, a horizontal baseline (X-axis) was drawn as a straight line that intersects both the zygomatic bases, and a vertical line (Y-axis) was marked perpendicular to the X-axis, with an intersection at the anterior nasal spine (ANS). Point A was defined as the intersection of the X- and Y-axes, and line A was defined as the line connecting point A to the menton. The angle made by the X-axis and line A (i.e., lateral displacement of the mandible) was measured. We designated an absolute value even if the mandibular menton was located on the right or left side. In chest radiographs, Cobb's method was used to measure scoliosis curves; the direction of the curve was designated similarly. RESULTS: Nine (11.4%) individuals had a Cobb angle >10°. There was a positive correlation between the Cobb angle and the degree of mandibular deviation (p < 0.05). CONCLUSION: Lateral displacement of the mandible and scoliosis are related.

An 18-year-old woman with mild Crouzon syndrome was referred with malocclusion and mandibular protrusion. Examination revealed Class III canine and molar relationships, hypoplastic maxilla, 1-mm overbite, and -2-mm overjet. Analysis showed 69° sella-nasion-A, 73.6° sella-nasion-B, and -4.6° A point-nasion-B point angles. Polysomnography revealed respiratory disturbance and 6.3% oxygen desaturation indices of 5.4/h and 9.0/h. We performed double-jaw surgery using high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy for midfacial deformity correction. Twelve months post-surgery, her measures were 70.8°, 72°, -1.2°, 3.0/h, and 6.1/h, respectively. Esthetics were satisfactory. High Le Fort I osteotomy is effective for midfacial deformity correction in patients with Crouzon syndrome.

目的:本研究の目的は、骨欠損部にヒト副甲状腺ホルモン(hPTH)局所間歇投与による骨増生の有効性を評価したものである。方法と材料:ビーグル犬8頭の下顎両側第4前臼歯と第1後臼歯を抜歯した。3ヵ月後、人工的骨欠損を作製しチタンブロックを固定した。6週後、チタンブロックを除去しチタンメッシュで骨欠損部を覆い、スペースメーキングを行った。hPTHは10μg/mLを0.5mL、骨増生処置部の被覆粘膜に処置前あるいは処置後2日おきに6回投与した。骨増生処置実験群は、処置前投与群(bB群)、処置後投与群(aB群)、処置前後投与群(baB群)に分けた。コントロール群(cB群)は、生理食塩水を実験群と同量投与した。最終投与後1週間で全下顎骨を摘出し、マイクロCT撮影を行い、パラフィン切片を作製し光学顕微鏡で観察した。結果:新生骨面積はbB群とbaB群がcB群より有意に高値を示した。bB群、aB群、baB群の新生骨量(BV)と新生骨塩量(BMC)は、cB群より有意に高値を示した。bB群とbaB群の新生骨密度は、cB群より有意に高値を示した。結論:hPTH10μg/mLの局所間歇投与が骨増生処置部へ早期の骨形成を誘導し、歯科インプラント治療を行う部位への確実な骨増生効果を提供できることが示唆された。(著者抄録)

OBJECTIVES: It is important to assess the mandibular morphology when orthognathic surgery, especially mandibular ramus osteotomy, is performed. Several studies on three-dimensional (3D) facial asymmetry have reported differences in linear and angle measurements between the deviated and contralateral sides in asymmetric mandibles. However, methods used in these studies cannot analyse the 3D morphology of the ramus. In this study, we aimed to evaluate the differences in mandibular ramus between the deviated and contralateral sides in asymmetric mandibles using traditional measurements as well as 3D shape analysis. METHODS: 15 Japanese females with jaw deformities treated by orthodontic surgery were enrolled. 3D CT images were reconstructed, and 14 landmarks were identified on the model surface. Ten linear and four angle measurements were calculated using these landmarks. Homologous ramus models were constructed for each sample, and after converting all homologous models to the right side, 30 homologous models of the ramus were analysed using principal component analysis. RESULTS: Firstly, eight principal components explained >80% of the total variance. Differences between the deviated and contralateral sides in measurements and scores of the eight principal components were tested. Significant difference at the 5% level between the deviated and contralateral sides was observed in five linear measurements, three angle measurements and the third principal component. The variance of the deviated side was significantly larger in the diameter between the mandibular notch and coronoid process, horizontal dilated angle of the mandibular ramus and vertical dilated angle of the mandibular ramus. The variance of the contralateral side was significantly larger in the height of mandibular ramus, height of posterior of mandibular ramus, condylar width, height of condylar head and mandibular angle. The squared multiple correlation coefficient adjusted for the degrees of freedom was 0.815. The third principal component showed the difference between the deviated and contralateral sides. Shape variation represented by the third principal component visually indicated that the contralateral side was larger and had inwardly directed coronoid process and the deviated side had a mandibular angle that was turned inwards to a greater extent. CONCLUSIONS: In conclusion, we successfully created a homologous model of the mandibular ramus and demonstrated the effectiveness of this model in the 3D comparison of the ramus morphology between the contralateral and deviated sides in asymmetric mandibles.