Department of Otolaryngology, National Sanatorium Oku-Komyoen, Setouchi City, Okayama, Japan.
Department of Otolaryngology, National Sanatorium Nagashima-Aiseien, Setouchi City, Okayama, Japan.
PLoS Negl Trop Dis. 2018 Mar 9;12(3):e0006341. doi: 10.1371/journal.pntd.0006341. eCollection 2018 Mar.
Facial deformation as a sequela of leprosy is caused not only by a saddle nose but also by regression of the maxilla, as well documented in paleopathological observations of excavated skeletal remains of patients with leprosy. However, maxillary changes in living patients have been evaluated only by the subjective visual grading. Here, we attempted to evaluate maxillary bone deformation in patients with leprosy using three-dimensional computed tomography (3D-CT).
Three-dimensional images centered on the maxilla were reconstructed using multiplanar reconstruction methods in former patients with leprosy (n = 10) and control subjects (n = 5); the anterior-posterior length of the maxilla (MA-P) was then measured. The difference between the MA-P of the patients and those of controls was evaluated after compensating for individual skull size. These findings were also compared with those from previous paleopathological studies.
Three former patients with lepromatous leprosy showed marked atrophy of the maxilla at the prosthion (-8.6, -11.1 and -17.9 mm) which corresponded with the visual appearance of the maxillary deformity, and these results were consistent with paleopathological findings of excavated skeletal remains. Additionally, the precise bone defects of the maxilla could be individually calculated for accurate reconstructive surgery.
We have successfully illustrated maxillary bone deformities in living patients with leprosy. This study also confirmed the maxillary regression described in paleopathological studies.
麻风病的后遗症不仅会导致鞍鼻，还会导致上颌骨萎缩，这在对麻风病患者挖掘出的骨骼遗骸的古病理学观察中得到了充分证实。然而，对于活的患者，上颌骨的变化仅通过主观视觉分级进行评估。在这里，我们尝试使用三维计算机断层扫描（3D-CT）来评估麻风病患者的上颌骨变形。
从前麻风病患者（n = 10）和对照组（n = 5）的上颌骨中心重建了三维图像；然后测量了上颌骨的前后长度（MA-P）。在补偿个体颅骨大小后，评估了患者的 MA-P 与对照组之间的差异。这些发现也与之前的古病理学研究进行了比较。
3 名瘤型麻风病患者的上颌骨在切牙点（-8.6、-11.1 和-17.9mm）处明显萎缩，与上颌骨畸形的视觉表现一致，这些结果与挖掘出的骨骼遗骸的古病理学发现一致。此外，还可以为精确的重建手术单独计算上颌骨的确切骨缺损。
我们已经成功地说明了麻风病患者的上颌骨畸形。这项研究还证实了古病理学研究中描述的上颌骨萎缩。
