保存的治療後のロビンシークエンス顔貌：長期追跡調査

Robin Sequence Facial Profile After Conservative Treatment: A Long-Term Follow-Up.

抄録

はじめに:

ロビンシークエンス（RS）は、小顎症、舌小帯症、呼吸困難を特徴とする先天性臨床疾患である。保存的治療が摂食障害および呼吸障害の解除に関与している可能性があるが、長期経過観察において下顎の成長に関する情報はほとんど知られていない。

INTRODUCTION: Robin sequence (RS) is a congenital clinical condition characterized by micrognathia, glossoptosis, and respiratory distress. Conservative methods could be responsible for releasing feeding and respiratory impairment but little information about mandibular growth is known in long-term follow-up.

目的:

保存的小顎症治療を受けた孤立性RS患者の顔貌の縦断的挙動を、頭蓋顔面全体の成長過程における写真を用いて評価する。

OBJECTIVE: Assessing the longitudinal behavior of the facial profile of individuals with isolated RS who underwent conservative micrognathia treatment using photographs during the whole craniofacial growth.

方法:

100人の患者の右顔面輪郭の写真を使用した（50人が孤立性RS、50人が頭蓋顔面異常なし）。RSを有する患者は、3つの異なる時期（T1：乳児期、T2：混合歯列期、T3：永久歯列期）に顔面凸角（FCA; G.Sn.Pog´）を測定することによって評価された。また、FCA、鼻唇角(Ls.Sn.Cm)、口唇溝(Li.Si.Pog´)、顔面下3分の1角(Sn.Gn´.C)、顔面中前高と顔面下前高の比を測定し、T3と対照群(C)の比較を行った。

METHODS: Photographs of the right facial profile of 100 patients were used (50 individuals with isolated RS and 50 individuals without craniofacial anomaly). The individuals with RS were evaluated at 3 different times (T1: infant, T2: mixed dentition, T3: permanent dentition) by measuring the facial convexity angle (FCA; G.Sn.Pog´). A comparison between T3 and control group (C), individuals without craniofacial anomalies and in permanent dentition, was also performed, checking the FCA, nasolabial angle (Ls.Sn.Cm), mentolabial fold (Li.Si.Pog´), facial inferior third (Sn.Gn´.C) angles and the ratio between middle anterior facial height and lower anterior facial height.

結果:

T3群では、対照群と比較して、顔面凸面の角度が増加し、顔面下第3角度と顔面中前高/顔面下前高比が増加した。孤立性RSの縦断的評価では、T1群とT2群、T1群とT3群の間に有意差が認められ、顔面凸部の増大は乳幼児で高く、混合歯列期と永久歯列期の間で有意な変化は認められなかった。

RESULTS: The T3 group showed an increased angle of facial convexity and increased facial inferior third angle and middle anterior facial height/lower anterior facial height ratio compared with the control group. In the longitudinal evaluation of individuals with isolated RS, significant differences were identified between T1 and T2 groups and T1 and T3 groups showing that the increased facial convexity was higher in the infants and that did not change significantly between the phases of mixed and permanent dentition.

結論:

RSは、評価されたすべての段階において顔面凸部の増加を示したが、その凸部は成長とともに減少した。頭蓋顔面異常のない個体と比較すると、この個体は永久歯列においても後顎症を示し続けた。下顎の突出がないため、不一致を矯正するためにかなりの数の顎矯正手術が行われてきた。

CONCLUSIONS: RS showed increased facial convexity in all phases evaluated, but their convexity decreased with growth. When compared with individuals without craniofacial anomalies, the individuals continue to exhibit retrognathism in the permanent dentition. The lack of a mandible projection has led to a considerable number of orthognathic surgeries for the correction of discrepancies.