軽度の半顔面小顔症患者に対する外科的治療の第一選択。症例報告と文献のレビュー

Surgery-first for a patient with mild hemifacial microsomia: A case report and review of literature.

• Ji-Yu Song
• Hua Yang
• Xi He
• Shuang Gao
• Guo-Min Wu
• Min Hu
• Yi Zhang

抄録

背景:

半顔面小顔症（HFM）は、口唇口蓋裂に次いで2番目に一般的な頭蓋顔面先天異常である。様々な表現型のスペクトルと奇形の重症度のため、幅広い治療法が提案されてきた。最近では、軽度から中等度のHFMの治療にSFA(Surgery-first approach)が導入され、バランスのとれた顔貌が得られるようになりました。SFAは、顔面の美学的改善を迅速に促進するだけでなく、治療時間を大幅に短縮することができます。

BACKGROUND: Hemifacial microsomia (HFM) is the second most common craniofacial congenital anomaly following cleft lip and palate. Because of the various phenotypic spectra and the severity of the deformity, a wide range of treatment approaches have been proposed. Recently, the surgery-first approach (SFA) was introduced to treat mild to moderate HFM, and it yielded a balanced facial appearance. The SFA not only promotes rapid improvement in facial aesthetics but also considerably reduces the overall treatment time.

ケースサマリー:

症例は25歳の女性で，歯列と顔面の非対称性を主訴に矯正治療を希望した．総合的な身体検査と画像解析を行った結果、上顎顎顎関節の片側発育異常を主な原因とする軽度のHFMと診断された。骨格変形を矯正するためにSFAを実施した。手術計画では上顎を中心にするために口蓋縫合を上顎の中心線として使用し、顎の位置も適切に設定して比較的対称的な顔貌を得た。術後4週間後、歯列の崩壊と咬合の安定化のために術後矯正歯科を紹介された。20ヶ月間の治療の後、すべての矯正器具は取り外された。治療後の患者と笑顔の写真を見ると、審美的にも咬合的にも良好な結果が得られた。

CASE SUMMARY: A female patient, aged 25 years old, sought orthodontic treatment with the chief complaint of dental and facial asymmetry. After a comprehensive physical examination and imaging analysis were performed, the patient was diagnosed with mild HFM that was primarily attributed to unilateral abnormal development of the maxilla-mandibular. The SFA was carried out to correct the skeletal deformity. The palatal suture was used as the midline of the maxilla in the surgical plan to center the maxilla, and the chin was also properly positioned to obtain a relatively symmetrical facial appearance. Four weeks after the surgery, the patient was referred for postsurgical orthodontics to decompensate the dentition and stabilize the occlusion. After 20 mo of treatment, all orthodontic appliances were removed. The posttreatment photographs of the patient and her smile confirmed good aesthetic and occlusal results.

結論:

軽度のHFMはSFAで矯正することができますので、顔の美貌の急速な改善を促進するだけでなく、全体の治療時間を大幅に短縮することができます。

CONCLUSION: Mild HFM can be corrected by SFA, which not only promotes rapid improvement in facial aesthetics but also considerably reduces the overall treatment time.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.