習慣性顎関節脱臼に対する鎮静・局所麻酔下での骨切除術：症例シリーズ

Eminectomy for Habitual Luxation of the Temporomandibular Joint with Sedation and Local Anesthesia: A Case Series.

抄録

常習性顎関節脱臼に対する代表的かつ最も効果的な治療法のひとつである骨切除術は、1951年にMyrhaugによって初めて報告された。局所麻酔と意識下鎮静下で顎関節切除術を行ったという報告は少ない。われわれは、顎関節の習慣性脱臼に対して、局所麻酔、意識下鎮静、全身麻酔下で行われた顎関節切除術の症例シリーズを紹介する。5名の患者を診察し、顎関節脱臼の再発を認めた。患者の年齢は18歳から93歳であった。顎関節の両側摘出術が2人に、片側摘出術が3人に行われた。2例はプロポフォール静脈内鎮静法と局所麻酔で、3例は全身麻酔で行われた。1例は術後1ヵ月でイレウスにより死亡した。イレウスで死亡した症例を除く追跡期間は12ヵ月から33ヵ月であった。顎関節脱臼の再発は確認されていない。われわれの経験と文献にある他の2つのシリーズに基づくと、鎮静剤と局所麻酔を用いた顎関節切除術は、高齢の患者には良い選択肢であると考えられる。

Eminectomy which is one of the popular and most effective treatments for habitual temporomandibular joint luxation was first described by Myrhaug in 1951. There are few reports which described eminectomy being performed under local anesthesia and conscious sedation. We present a case series of habitual luxation of the TMJ treated by eminectomy performed under local anesthesia and conscious sedation and general anesthesia. Five patients were examined and found to have recurrent luxation of the TMJ. The age of patients ranged from 18 to 93 years. Bilateral eminectomy of the TMJ was performed for two patients, and unilateral eminectomy was performed for three patients. Two were examined under intravenous propofol sedation and local anesthesia, while three patients were examined under general anesthesia. One patient died from ileus one month after surgery. The follow-up period except for the case that died from ileus ranged from 12 to 33 months. No recurrent dislocation of the TMJ has been identified. Based on our experience and two other series in the literature, eminectomy with sedation and local anesthesia can be considered and might be a good option in elderly patients.