アパタイト骨補填材による唇顎口蓋裂症例の外鼻変形修正術の検討

Abstract

Apatite bone-filling material is an artificial biomaterial widely used today in re-constructive surgery in place of living body tissue. We studied the application of hydroxyapatite ceramics as bone and tissue occupying material in the oral-maxillofacial region. Herein, we present a summary of our study on patients with external nose deformities of cleft lip and palate.The subjects were 15 cases of marked external nasal deformity. In 6 cases, clefts were bilateral and in 9 cases, unilateral. Breakdown by sex was 10 males and 5 females. The oldest was 62 years and the youngest was 13, with a 23.4 year average. Course observation ranged from seven months to seven years and seven months. Surgical correction was at the nasal column, tip, dorsum, and base. Surgical procedure basically involved insertion of a preshaped apatite porous blocks into an ample filling cavity secured by making an incision from the lateral aspect of the column medial to the anterior nostril, which was followed by abrasion extending from the subcutaneous dorsum to the base of the nose, taking care to avoid the alar cartilage. Next, the external nose shape was corrected and the defect filled in with the block.The apatite porous block was readjusted, as necessary, and the incised part sutured to complete the procedure. The apatite porous block (Apaceram ® from Asahi Optical Co., Ltd) was used whole or divided into thirds, depending on the individual case. As a clinical result, postoperative infection occurred in 4 cases. In three patients in whom the block had been in the column, infection occurred within two weeks postoperativelly necessitating complete removal of the apatite porous block. In one patient in whom the block had been in the nasal tip and dorsum, the infected part of the block was removed, and the larger remaining portion fared well after being re-sutured.