Journal Article パーキンソン病の長期罹患中に発症した習慣性顎関節脱臼2例の治療経験

阿部, 貴惠  ,  松下, 和裕  ,  足利, 雄一  ,  濱田, 浩美  ,  鄭, 漢忠  ,  山崎, 裕

36 ( 2 )  , pp.142 - 149 , 2016-03 , 北海道歯学会
パーキンソン病の既往を持つ習慣性顎関節脱臼に対し,OK-432(ピシバニール®)による硬化療法を施行した.術後,咬合を安定させることが脱臼の予防に寄与することを考慮し,義歯の新製や旧義歯の調整を行い,その結果経口摂取の維持が可能となり,QOLが改善した2症例を経験したので,その概要を報告する.  症例1は68歳男性,顎関節脱臼により食事がとれないので治療をしたいとの主訴で当院を受診した.既往歴は14年前にパーキンソン病と診断され,在宅療養中であった.習慣性顎関節脱臼の診断にて,局所麻酔下で両側顎関節にOK-432(ピシバニール®)による硬化療法を施行し,術後義歯による咬合の回復を行い,経口摂取を維持することができた.症例2は89歳男性,食事や義歯の着脱時に顎が外れて困るとの主訴で当院を受診した.既往歴は18年前にパーキンソン病と診断され,在宅療養中であった.習慣性顎関節脱臼の診断にて,局所麻酔下で両側顎関節にOK-432(ピシバニール®)による硬化療法を施行し,術後義歯調整を行い咬合状態の回復を行った.術後ペースト食に変更し,経口摂取を維持した.術後2例とも再脱臼はなく経過良好である.  本症例のように,パーキンソン病が既往にある習慣性顎関節脱臼では,顎関節に対する口腔外科的アプローチと,咬合の回復に対する補綴的アプローチの両方を行うことで,良好な結果が得られることが示唆された.
We performed a sclerotherapy on two patients with a recurrent dislocation of the condyle using OK-432 (Picibanil®). After the treatment, under the assumption that the establishment of a stable occlusion greatly contributes to the prevention of repeated condylar dislocation, we adjusted the old denture in one case and made a new one in the other case. Fortunately, a desirable oral intake was achieved and maintained in both of the two cases. “Quality of Life” was finally restored. Therefore, we present herein the outlines of the treatment course.  Case 1 : A 68-year old male came to our hospital with a chief compliant of an eating disturbance due to the fear of recurrent condylar dislocation. He had been diagnosed with Parkinson’s disease 14 years ago, and was recuperating at his home. Under the diagnosis of the recurrent dislocation of the condyle, he underwent sclerotherapy with OK-432 (Picibanil®) bilaterally under local anesthesia. A new denture restored occlusion and appropriate oral intake could be maintained.  Casa 2 : An 89-year-old male came to our hospital with a chief complaint of recurrent dislocation when wearing his dentures. He had been diagnosed with Parkinson’s disease 18 years ago as well and was also recuperating at his home. Almost the same procedures as case 1 were undertaken, except for the final occlusal stabilization that could be achieved by the adjustment of the old denture. Pasty food could be taken sufficiently.  The post-operative course was not eventful in either of the two cases, and obvious amelioration of the oral function concomitantly with a general condition was obtained.  From the above two cases, a combination of an intervention to the condyle from the standpoint of oral surgery and that to the restoration of occlusion from the standpoint of prosthesis brought about favorable results in the treatment of a recurrent dislocation of the condyle due to concurrent Parkinson’s disease.

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