DOI QR코드

DOI QR Code

DENTAL TREATMENT IN A PATIENT WITH PIERRE ROBIN SYNDROME UNDER GENERAL ANESTHESIA : A CASE REPORT

피에르 로빈 증후군 환아의 전신마취 하 치아우식 치료 증례 보고

  • Ryu, Jiyeon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Shin, Teo Jeon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Hyun, Hong-Keun (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Young Jae (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Jung-Wook (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Jang, Ki-Taeg (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Chong-Chul (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Lee, Sang-Hoon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University)
  • 류지연 (서울대학교 치의학대학원 소아치과학교실) ;
  • 신터전 (서울대학교 치의학대학원 소아치과학교실) ;
  • 현홍근 (서울대학교 치의학대학원 소아치과학교실) ;
  • 김영재 (서울대학교 치의학대학원 소아치과학교실) ;
  • 김정욱 (서울대학교 치의학대학원 소아치과학교실) ;
  • 장기택 (서울대학교 치의학대학원 소아치과학교실) ;
  • 김종철 (서울대학교 치의학대학원 소아치과학교실) ;
  • 이상훈 (서울대학교 치의학대학원 소아치과학교실)
  • Received : 2016.10.27
  • Accepted : 2016.11.29
  • Published : 2016.12.30

Abstract

Pierre Robin syndrome (PRS) is characterized by the triad of congenital mandibular hypoplasia, glossoptosis and cleft palate. Infant PRS patients are frequently suffering from upper airway obstruction, gastroesophageal reflux and growth retardation caused by above mentioned problems. We report a dental caries treatment of 3-year old girl with Pierre Robin syndrome with multiple caries. The cause of multiple caries was mainly presumed as patient's eating habit caused by her general condition. She had some feeding problems and had history of gastric tube. She was still using milk bottle and took more than an hour to finish a meal. The treatment was performed under general anesthesia considering patient's condition; mild autism, poor cooperation and respiratory problem due to micrognathia. Severely affected upper incisors were treated with pulp treatment and restored with zirconia crown for esthetic purpose. Lower incisors were treated with pulp treatment and restored with composite resin. Upper right first primary molar was restored with stainless steel crown and other primary molars were treated with composite resin. There were no postoperative complications. According to her parents, the patient's compliance to oral hygiene management was greatly improved after the treatment since she was very pleased with the esthetic result and highly motivated by her looks. The treatment without sedation or general anesthesia would be possible once the airway is improved as the mandible grows.

저자는 소하악증으로 인해 기도유지가 어려우며 섭식 장애로 인한 다발성 우식을 보이는 피에르 로빈 증후군 환아의 증례를 보고하는 바이다. 환자는 소하악증 및 구개열, 심방중격 결손, 새끼 손가락의 측만지증(clinodactyly), 외사시(exotropia) 등의 증상을 동반하고 있었으며, 신체 발육이 매우 저하된 상태로 섭식 장애로 인한 구강내 침식 및 다발성 우식의 소견을 보이고 있었다. 환아는 가벼운 자폐 증상을 가지고 있으며 어린 나이로 협조를 구하기가 어려웠고 광범위한 치료가 필요한 상황이었으며 의식하 진정법시 하악의 발육 저하로 인한 기도 확보의 어려움이 예상되었기에 전신마취하 치과치료를 시행하였다. 피에르 로빈 증후군은 기도유지의 어려움과 섭식 장애로 구강위생 관리에 불리한 조건을 가지고 있지만 나이가 듦에 따라 점차 정상적인 하악의 성장이 이루어지므로 행동조절에 의한 일상적인 치과 처치도 가능할 것이다.

Keywords

References

  1. Benjamin B, Walker P : Management of airway obstruction in the Pierre Robin sequence. International Journal of Pediatric Otorhinolatyngology, 22:29-37, 1991. https://doi.org/10.1016/0165-5876(91)90094-R
  2. Marvin HG, Roger HE : The Treatment of the Pierre Robin Syndrome. Pediatrics, 30:450-458, 1962.
  3. Hoffman S, Kahn S, Seitchick M : Late problems in the management on the Pierre Robin syndrome. Plastic and Reconstructive Surgery, 35:504-511, 1965. https://doi.org/10.1097/00006534-196505000-00007
  4. Jakobsen LP, Knudsen MA, Tommerup N, et al. : The Genetic Basis of the Pierre Robin Sequence. Cleft Palate-Craniofacial Journal, 43:155-159, 2006. https://doi.org/10.1597/05-008.1
  5. Monasterio FO, Molina F, Ysunza A : Swallowing Disorders in Pierre Robin. The Journal of Craniofacial Surgery, 15:934-941, 2004. https://doi.org/10.1097/00001665-200411000-00009
  6. Kucukyavuz Z, Ozkaynak O, Tuzuner AM, Kisnisci R : Difficulties in anesthetic management of patients with micrognathia: report of a patient with Stickler syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102:33-36, 2006. https://doi.org/10.1016/j.tripleo.2006.06.002
  7. Heaf DP, Helms PJ, Dinwiddie R, Matthew D : Nasopharyngeal airways in Pierre Robin syndrome. The Journal of Pediatrics, 100:698-703, 1982. https://doi.org/10.1016/S0022-3476(82)80567-2
  8. Oh YJ, Park YW, Kim MK : Combination therapy using glossopexy and radiofrequency therapy in pierre robin sequence, J Korean Assoc Maxillofac Plast Reconst Surg, 32:242-245, 2010.
  9. Augarten A, Sagy M, Yahav J, Barzilay Z : Management of upper airway obstruction in the Pierre Robin syndrome. British Journal of Oral and Maxillofacial Surgery, 23:105-108, 1990.
  10. Denny A, Amm C : New technique for airway correction in neonates with severe Pierre Robin sequence. J Pediatr, 147:97-101, 2005. https://doi.org/10.1016/j.jpeds.2005.02.018
  11. Buchenau W, Urschitz MS, Poets CF, et al. : A randomized clinical trial of a new orthodontic appliance to improve upper airway obstruction in infants with Pierre Robin sequence. J Pediatr, 151:145-149, 2007. https://doi.org/10.1016/j.jpeds.2007.02.063
  12. Louise CL, Bayet B, Larocque Yvan : The Pierre Robin sequence review of 125 cases and evolution of treatment modalities. Plastic and Reconstruction Surgery, 93:934-942, 1994. https://doi.org/10.1097/00006534-199404001-00006