Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
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Dental Management of Pediatric Hydrocephalus

소아 수두증 환자의 치과적 관리

  • Kim, Mijun (Department of Pediatric Dentistry, Oral Science Research Center, College of Dentistry, Gangneung-Wonju National University) ;
  • Park, Howon (Department of Pediatric Dentistry, Oral Science Research Center, College of Dentistry, Gangneung-Wonju National University) ;
  • Lee, Juhyun (Department of Pediatric Dentistry, Oral Science Research Center, College of Dentistry, Gangneung-Wonju National University) ;
  • Seo, Hyunwoo (Department of Pediatric Dentistry, Oral Science Research Center, College of Dentistry, Gangneung-Wonju National University)
  • 김미준 (강릉원주대학교 치과대학 소아치과학교실 및 구강과학연구소) ;
  • 박호원 (강릉원주대학교 치과대학 소아치과학교실 및 구강과학연구소) ;
  • 이주현 (강릉원주대학교 치과대학 소아치과학교실 및 구강과학연구소) ;
  • 서현우 (강릉원주대학교 치과대학 소아치과학교실 및 구강과학연구소)
  • Received : 2016.07.19
  • Accepted : 2016.09.30
  • Published : 2017.05.31
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Abstract

Hydrocephalus is a condition in which the volume of cerebrospinal fluid in the cerebral ventricles is abnormally elevated. Hydrocephalus patients may show macrocephaly and delayed development. Ventriculoperitoneal shunt is the most commonly used treatment but ventriculoatrial shunt is another treatment option. This report discusses the dental management process employed for a 7-year, 6-month old patient with ventriculoperitoneal shunt-treated hydrocephalus. This patient showed dental caries on the deciduous molars, facial swelling, macrocephaly and delayed development. Pulpectomy was performed on the deciduous molars under nitrous oxide sedation and mild protective stabilization. This patient did not appear to have any specific complications until the latest follow-up and was scheduled for the management of overall oral hygiene, development of permanent teeth, and craniofacial asymmetry through periodic follow-up. During dental treatment of shunt-treated patients, care should be taken to avoid applying excessive force to the catheter running along the patient's neck to prevent the displacement of the catheter. A referral to a neurosurgeon is recommended for patients with ventriculoatrial shunts for prophylactic antibiotics. As hydrocephalus patients grow, they may show craniofacial asymmetry or differences in the calcification of the permanent teeth, and require periodic oral and craniofacial assessment.

수두증은 뇌척수액이 비정상적으로 뇌실 혹은 두개강 내에 축적되는 것으로, 큰 머리둘레와 성장 지연, 지능 발육 저하, 영구치의 발육 속도 차이, 악안면 비대칭 등이 나타날 수 있다. 뇌실 - 복강 단락술이 가장 많이 사용되는 치료법이고 복강에 문제가 있는 경우 다른 단락술이 시행될 수 있다. 본 증례는 소아 수두증으로 인하여 뇌실 - 복강 단락술을 받은 병력이 있는 7세 6개월 환자의 치과적 관리에 대하여 다루고 있다. 환자는 유구치의 깊은 우식과 하악각 부위의 안면 부종이 관찰되었으며, 큰 머리 둘레와 신체적 및 정신적 발달 지연을 보였다. 아산화 질소 흡입 진정과 가벼운 보호 안정 하에 치수절제술을 시행하였으며 예방적 항생제는 필요로 하지 않았다. 최근 검진 시까지 치료받은 부위는 잘 유지되고 있었으며 향후 전반적인 구강위생 및 영구치의 발육 정도, 악안면부의 비대칭 발생 여부를 주기적으로 검진 받을 예정이다. 단락술을 받은 병력이 있는 수두증 환자들은 치과 치료 시, 단락 장치의 도관에 과도한 힘이 가해져 도관의 변위가 발생하지 않도록 해야 하고, 뇌실 - 심방 단락술을 받은 환자의 경우 예방적 항생제의 필요성과 관련하여 신경외과로의 의뢰가 추천된다. 수두증 환자들은 성장하면서 악안면부의 비대칭과 영구치의 발육 수준에 차이가 발생할 수 있으므로 이에 대한 관찰이 요구된다.

Keywords

References

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