下顎前歯部歯槽骨切り術・オトガイ形成術施行後に癒合不全を呈した下顎前突症の１例

Abstract

A 40-year-old female visited our department in June 2008 with chief complaints of intraoral denudation of the canine root, occlusion anomaly, and mastication disorder. She had a history of mandibular anterior subapical osteotomy and genioplasty by removal of the mandibular margin of the mental region under general anesthesia in another hospital in June 2007. In December 2007, an aperture was found at the osteotomy site and plate fixation was performed in the same hospital in January 2008. However, denudation of the canine root was found in February 2008 with a mastication disorder that had persisted since the initial surgery, which led her to visit to our department.At her initial visit, denudation of the canine root was confirmed. The right molars were missing and no contact was found in the anterior teeth. Skin mobility in the mental region was limited, indicating oral food intake without mastication. The patient was diagnosed as fissure fracture of the mandibular bone at the distal region of the lower left canine and faulty union of the alveolar osteotomy site.Alveolar osteotomy was repeated and the mandibular fracture was fixed under general anesthesia in September 2008. The cortical bone of the former alveolar osteotomy site showed faulty union. Following repeated osteotomy, the dentures were reconstructed by supporting them with preoperatively prepared plate splints and wire splints to check the occlusion, and then the osteotomy site was fixed with a miniplate. Iliac bone was grafted in the bone gap, and intermaxillary anchorage was retained for 20 days postoperatively. Following treatment, the occlusion in the anterior teeth improved and the patient was able to take regular food. However, continuous follow-up is necessary because of persistent partial denudation of the canine root and denudation of the grafted bone.In the diagnosis and treatment of jaw deformities to correct occlusion and masticatory functions, we consider that preoperative and postoperative occlusal management is important, especially when it appears to be difficult to obtain stability of postoperative occlusion.