Al-Bazie Saleh A
Assistant Professor, Department of Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, 11545, Saudi Arabia, Phone: +96653 2092386, e-mail:
J Contemp Dent Pract. 2015 Jun 1;16(6):507-11. doi: 10.5005/jp-journals-10024-1713.
The aim of this paper was to report a case of orthognathic surgery successfully done in a patient with multiple sclerosis.
Multiple sclerosis (MS) is a chronic, progressive inflammatory disorder of the central nervous system affecting young adults, characterized by lymphocytic infiltration of the brain and spinal cord leading to demyelination and focal axonal damage. Clinically, MS patients present with reversible neurological dysfunction in the early stages, which progresses to irreversible neurological disability and deficit. Oral manifestations of MS include facial numbness or pain, neuralgias, facial paralysis, dysarthria and dysphagia. While dental treatment is not contraindicated in MS patients, it is, however, limited to preventive and supportive dental care.
A 23-year-old Saudi male patient with a diagnosis of MS since 2008 reported to the oral and maxillo-facial surgery (OMFS) department for correction of dentofacial deformity. The patient was under follow-up with the neurology department and was being treated with interferon beta-1a. Following consent from the neurologist and the patient, a Lefort 1 segmental osteotomy was done under general anesthesia. The patient was stable throughout the surgical procedure and during the postoperative period. The patient was discharged upon complete surgical recovery and no acute exacerbations of MS were reported during the perioperative period.
Based on our observations, orthognathic and maxillofacial surgical procedures can be safely carried out in patients with MS, provided a strict perioperative prophylactic regimen for stress reduction and prevention of acute attacks of MS is adhered to.
Due to the stressful nature of dental treatment and oral and maxillofacial surgical procedures, acute exacerbations of MS are very much likely. Hence, it is imperative that dental and oral surgical practitioners are aware of the manifestations of MS and are able to manage such patients with suitable treatment modifications.
本文旨在报告一例成功为一名多发性硬化症患者实施正颌手术的病例。
多发性硬化症（MS）是一种影响年轻人的慢性、进行性中枢神经系统炎性疾病，其特征是脑和脊髓的淋巴细胞浸润，导致脱髓鞘和局灶性轴突损伤。临床上，MS患者在早期表现为可逆的神经功能障碍，随后进展为不可逆的神经残疾和功能缺陷。MS的口腔表现包括面部麻木或疼痛、神经痛、面瘫、构音障碍和吞咽困难。虽然牙科治疗对MS患者并非禁忌，但仅限于预防性和支持性牙科护理。
一名自2008年起被诊断为MS的23岁沙特男性患者前往口腔颌面外科（OMFS）科室矫正牙颌面畸形。该患者在神经科接受随访，并接受β-1a干扰素治疗。在获得神经科医生和患者的同意后，在全身麻醉下进行了LeFort 1型节段性截骨术。患者在整个手术过程和术后期间情况稳定。手术完全恢复后患者出院，围手术期未报告MS急性加重情况。
基于我们的观察，只要严格遵守围手术期预防方案以减轻压力并预防MS急性发作，MS患者可以安全地进行正颌和颌面外科手术。
由于牙科治疗以及口腔颌面外科手术具有压力性，MS急性加重的可能性很大。因此，牙科和口腔外科医生必须了解MS的表现，并能够通过适当调整治疗来管理此类患者。
