口唇裂・口蓋裂乳児の口蓋形態の特徴と口唇形成術の影響についての経時的分析

本論文の目的は,口唇裂・口蓋裂患者の上顎の劣成長が,生下時よりもともと存在するものであるかを明らかにし,さらに口唇形成術の口蓋に与える影響の様式と,その期間について,種々の破裂型毎に比較検討するものである,.材料は,口蓋裂単独を除く代表的な破裂型である片側性唇(顎)裂(UCL)32名,片側性唇顎口蓋裂(UCLP)22名,および両側性唇顎口蓋裂(BCLP)7名の,生後2か月目から口唇形成術後18か月目に至る経時的な上顎歯槽弓模型を用いた.分析は口蓋基準点問距離の計測とともに,口蓋の組織量を把握するための口蓋表面積計測や,立体的に口蓋を把握する目的で口蓋窩横断面図からの計測もあわせて行った. その...

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Published in日本口蓋裂学会雑誌 Vol. 8; no. 1; pp. 36 - 66
Main Author 甲斐, 貞子
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本口蓋裂学会 1983
Online AccessGet full text
ISSN0386-5185
2186-5701
DOI10.11224/cleftpalate1976.8.1_36

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Abstract 本論文の目的は,口唇裂・口蓋裂患者の上顎の劣成長が,生下時よりもともと存在するものであるかを明らかにし,さらに口唇形成術の口蓋に与える影響の様式と,その期間について,種々の破裂型毎に比較検討するものである,.材料は,口蓋裂単独を除く代表的な破裂型である片側性唇(顎)裂(UCL)32名,片側性唇顎口蓋裂(UCLP)22名,および両側性唇顎口蓋裂(BCLP)7名の,生後2か月目から口唇形成術後18か月目に至る経時的な上顎歯槽弓模型を用いた.分析は口蓋基準点問距離の計測とともに,口蓋の組織量を把握するための口蓋表面積計測や,立体的に口蓋を把握する目的で口蓋窩横断面図からの計測もあわせて行った. その結果,術前,UCLPとBCLPはsegmentの開大のため幅径が大きいばかりでなく,口蓋窩傾斜角の増加等の立体的な2次的変形を示していた.さらに術前には,口唇圧の不足から生じる付加的な成長量が各破裂型に加わっていると考えられ,UCLは正常群に比べて全体的に口蓋は大きかった.一方,破裂の重症度に従って口蓋表面積が減少する傾向があり,口蓋の裂は口蓋表面積の不足をもたらすことが示唆された. 口唇形成術は基本的には開大したsegmentを接近させ正常に近い口蓋形態に改善する作用を有しているが,同時に術後9-12か月目まで続く成長力の低下を伴っていた.術後のsegmentの接近はBCLPがUCLPより著明であり,両者ともに上顎結節付近を中心としてsegmentが正中に回転することにより生じていた.しかし,この成長抑制期間を過ぎた,術後9-12か月目から18か月目までの,各破裂型の口蓋は正常人に劣らない成長力を示し,口唇形成術の口蓋の成長への影響は,一時的で軽度であることが示唆された.
AbstractList 本論文の目的は,口唇裂・口蓋裂患者の上顎の劣成長が,生下時よりもともと存在するものであるかを明らかにし,さらに口唇形成術の口蓋に与える影響の様式と,その期間について,種々の破裂型毎に比較検討するものである,.材料は,口蓋裂単独を除く代表的な破裂型である片側性唇(顎)裂(UCL)32名,片側性唇顎口蓋裂(UCLP)22名,および両側性唇顎口蓋裂(BCLP)7名の,生後2か月目から口唇形成術後18か月目に至る経時的な上顎歯槽弓模型を用いた.分析は口蓋基準点問距離の計測とともに,口蓋の組織量を把握するための口蓋表面積計測や,立体的に口蓋を把握する目的で口蓋窩横断面図からの計測もあわせて行った. その結果,術前,UCLPとBCLPはsegmentの開大のため幅径が大きいばかりでなく,口蓋窩傾斜角の増加等の立体的な2次的変形を示していた.さらに術前には,口唇圧の不足から生じる付加的な成長量が各破裂型に加わっていると考えられ,UCLは正常群に比べて全体的に口蓋は大きかった.一方,破裂の重症度に従って口蓋表面積が減少する傾向があり,口蓋の裂は口蓋表面積の不足をもたらすことが示唆された. 口唇形成術は基本的には開大したsegmentを接近させ正常に近い口蓋形態に改善する作用を有しているが,同時に術後9-12か月目まで続く成長力の低下を伴っていた.術後のsegmentの接近はBCLPがUCLPより著明であり,両者ともに上顎結節付近を中心としてsegmentが正中に回転することにより生じていた.しかし,この成長抑制期間を過ぎた,術後9-12か月目から18か月目までの,各破裂型の口蓋は正常人に劣らない成長力を示し,口唇形成術の口蓋の成長への影響は,一時的で軽度であることが示唆された.
Author 甲斐, 貞子
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References_xml – reference: 20) Sillman, J. H.: Dimensional changes of the dental arches: Longitudinal study from birth to 25 y ears. Am. J. Orthod., 50; 824-842. 1964.
– reference: 16) Manchester. W. M.: The repair of bilateral cleft lip and palate. Br. J. Surg., 52; 878-882, 1965.
– reference: 60) Innis, C. O.: Some preliminary observations on unrepaired hare-lips and cleft palates in adu l t members of the Dusan tribes of North Borneo. Br. J. Plast. Surg., 15; 173-181, 1962.
– reference: 34)山本忠: 口唇形成術後における上顎歯列弓の経時的変化に関する研究. 両側性口唇裂について. 日口蓋誌, 1; 1-19, 197.
– reference: 66) Hagerty, R. F. and Hill, M. J.: Facial growth and dentition in the unoperated cleft palate. J. De n t. Res.. 42: 412-421 1963_
– reference: 49)野代悦生, 佐藤通泰: 実験的上口唇縮小後の上・下口唇圧の経日的変化- 咀囑時の口唇圧の変化. 日口蓋誌, 6; 30-39, 1981.
– reference: 32) Blake, G. B. and Wreakes, G.: Clefts of the lip and palate in twins. Br. J. Plast. Surg., 25; 155-163, 1972.
– reference: 65) Kaplan, E. M.: Clef palate repair at three months? Ann. Plast. Surg., 7; 179-190, 1981.
– reference: 64) Onizuka, T. and Isshiki, Y.: Development of the palate arch in relation to unilateral cleft lip a n d palate surgery: A comparison of the effects of different surgical approaches. Cleft Palate J., 1 2; 444-451, 1975.
– reference: 3) Schweckendiek, H.: Two-stage closure of cleft palate: Rationale for its use. In Kehrer, B., Slon go, T., Graf. B., et al., ed. Long Term Treatment in Cleft Lip and Palate. 254-263, Hans Huber, Bern, 1979.
– reference: 11) Huddart, A. G., MacCauley, F. J. and Davis, M. E. H.: Maxillary arch dimensions in normal an d unilateral cleft palate subjects. Cleft Palate J., 6; 471-487, 1969.
– reference: 57) Enlow, J. D.: The Human Face. 138-167, Haper &Row, New York, 1968.
– reference: 10)後藤昌昭: 頭部X線規格写真法による唇顎口蓋裂乳児の頭蓋顔面形態の多変量解析. 日口蓋誌, 6; 1-28, 1981.
– reference: 50) Berkowitz, S. and Pruzansky, S.: Stereophot(grammetry of serial casts of cleft palate. Angl Orthod., 38; 136-149, 1968.
– reference: 55) King, B. F., Workman, C. H. and Latham, R. A.: Ai anatomical study of the columella and protrudin g premaxilla in a bilateral cleft lip and pala t e infant Cleft Palate J., 16; 223-229, 1979.
– reference: 45) Wada, T. and Miyazaki, T.: Growth and changes in maxillary arch form in complete unilateral cleft li p and cleft palate children. Cleft Palate J., 12; 115-130, 1975.
– reference: 1 ) Mestre, J. C., Dejesus, J. and Subtelny, J. D.: Unoperated oral clefts at maturation. Angle Orthod., 30; 78-85, 1960.
– reference: 5) McNeil, C. K.: Orthodontic principles in the treatment of lip and palate clefts. In Hotz, R. e d. Early Treatment of Cleft Lip and Palate. 59-67, Hans Huber, Berne, 1964.
– reference: 19) Sillman, J. H.: Relationship of maxillary and mandibular gum pads in the newborn infant. Am. J. Orthod., 24; 409-424, 1938.
– reference: 61) Bishara, S. E., Krause, C. J., Olin, W. H., et al.: Facial and dental relationships of individuals wi t h unoperated clefts of the lip and/or palate. Cleft Palate J., 13; 238-252, 1976.
– reference: 4) P erko, M.: ln quest for a non-traumatic surgical technique in treatment of cleft lip and palat e Prevention of maxillary growth disturbance. In Keh r e r, B., Slongo, T., Graf. B., et al., ed. Long Term Treatment in Cleft Lip and Palate, 223-238, H ans Huber, Bern, 1979.
– reference: 7) Peyton, W. T.: The dimen sions and growth of the palate in the normal infant and the infant with gro ss maldevelopment of the upper lip and palate. A rch. Surg., 22; 704-737, 1931.
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Title 口唇裂・口蓋裂乳児の口蓋形態の特徴と口唇形成術の影響についての経時的分析
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ispartofPNX 日本口蓋裂学会雑誌, 1983/07/15, Vol.8(1), pp.36-66
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