第一、二腮弓综合征所致的单侧颜面短小症的正畸治疗：病例报告

Hemifacial Microsomia Caused by First and Second Brachial Arch Syndrome Treated with Orthodontic Approach: A Case Report.

机构信息

Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Hospital, Tokushima, Japan.

Department of Orthodontics and Dentofacial Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

出版信息

J Contemp Dent Pract. 2020 Oct 1;21(10):1189-1195.

PMID:33686045

Abstract

AIM AND OBJECTIVE

To present a growing patient with unilateral mandibular hypoplasia and microtia involved in the first and second branchial arch syndrome (FSBAS) treated with functional appliance.

BACKGROUND

The FSBAS comprises several developmental facial hypoplasia in ear and maxillofacial bones, resulting in hemifacial microsomia. Treatment for hemifacial microsomia varies greatly depending on the grade of mandibular deformities. Functional appliance treatment during growth period is available for mild to moderate mandibular deformities. However, there are few reports of hemifacial microsomia treated with functional appliance.

CASE DESCRIPTION

The patient, an 8-year-and-5-month-old girl, had a chief complaint of mandibular deviation. She had been diagnosed with the FSBAS at birth. Her facial profile was straight and panoramic radiograph indicated that the mandibular ramal height of the affected side was about 60.4% compared to the unaffected side. The occlusal cant was 6°, and the right maxilla and mandible showed severe growth deficiency. At the age of 10 years, functional appliance with expander was used; for 2 years 6 months, the maxillomandibular growth was controlled and from panoramic radiograph, the ramus height of the affected side was increased to 65.0% compared to the unaffected left mandibular ramus. At the age of 12 years and 8 months, multibracket treatment was initiated. After 32 months of active treatment, proper occlusion with functional Class I canine and molar relationships was obtained, although facial asymmetry associated with the difference of ramus heights still existed. The resulting occlusion was stable during 1.5-year retention period.

CONCLUSION

Our results indicated the importance of orthopedic treatment during growth period in the patient with hemifacial microsomia involving the FSBAS.

CLINICAL SIGNIFICANCE

This report proposes an efficacy of conventional orthodontic treatment for growing patients with hemifacial microsomia involved in the FSBAS.

摘要

目的

报道一例单侧下颌骨发育不良伴小耳畸形的患者，该患者患有第一和第二鳃弓综合征（FSBAS），采用功能矫治器治疗。

背景

FSBAS 包括耳和颌面骨的几个发育性面骨发育不全，导致半侧颜面短小。半侧颜面短小的治疗方法因下颌畸形的严重程度而异。生长期的功能矫治器治疗适用于轻度至中度下颌畸形。然而，用功能矫治器治疗半侧颜面短小的报道较少。

病例描述

患者，女，8 岁 5 个月，主要诉下颌偏斜。她出生时被诊断为 FSBAS。她的面型为直面型，全景片显示患侧下颌支高度约为健侧的 60.4%。咬合倾斜 6°，右侧上颌和下颌均有严重的生长不足。10 岁时，使用带扩弓器的功能矫治器；2 年 6 个月后，上下颌生长得到控制，从全景片上看，患侧下颌支高度增加到健侧左侧下颌支的 65.0%。12 岁 8 个月时，开始多曲方丝弓矫治。经过 32 个月的主动治疗，获得了功能Ⅰ类正常的尖牙和磨牙关系，尽管仍然存在与支高度差异相关的面部不对称。在 1.5 年的保持期内，咬合稳定。