組織の変位量比を算出した.Jie ら 9 )の方法に準じ,骨削
除範囲を縦方向と横方向に二分割して中線を引き,その
1 )菊池健太郎,佐藤 淳,高木 實,山口 朗:口腔
交点を中心点(y = 2 ,z = 2 )とした.長軸方向に 1 / 4
病理アトラス第 3 版.顎骨および顎関節の病変.高
のところでそれぞれ 2 か所計測点(y = 1 および y = 3 )
木 實(監)
,豊澤 悟,高田 隆(編)
,158,文光
を設定した.さらに上下それぞれ1.
5mm 移動したところ
堂,2018.
(z = 1 および z = 3 )にも同様に各 3 か所の計測点をと
2 )武田泰典,福田容子:歯原性腫瘍ならびに関連病変
り,合計 9 か所の計測点を設定した(図 6 a)
.各計測点
の病理 顎骨の非腫瘍性病変.病理と臨床,21( 5 )
において切除面に対し法線を設置し,法線上で硬組織の
523-530,2003.
変位量と軟組織の変位量を計測した(図 6 b)
.軟組織 / 硬
3 )Segal GP‚ Bloem JL‚ Cates JMM‚ Hameed M:Soft Tissue
組織の変位量比は表 1 に結果を示す.骨削除面の中心部
and Bone Tumours‚ WHO Classification of Tumours‚ 5th
では軟組織 / 硬組織の変位量比が小さく,周辺部では大き
E d i t i o n ‚ Vo l u m e 3 . F i b r o u s d y s p l a s i a ‚ W H O
い傾向にあった.また,9 点の軟組織 / 硬組織の平均変位
Classification of Tumours Editorial Board‚ 472-474‚
量比は,本症例において0.
50であった.Jie ら 9 )の報告に
World Health Organization‚ Lyon‚ 2020.
よると平均変位量比は上顎骨部で0.
52,頬骨部で0.
815で
4 )Wang Y‚ Sun G‚ Lu M‚ Hu Q: Surgical management of
あった.下顎骨体部は軟組織が比較的厚いため,頬骨部
maxillofacial fibrous dysplasia under navigational
よりも上顎骨部に近い軟組織 / 硬組織の変位量比になった
: 336-341‚
guidance. Br J Oral Maxillofac Surg‚ 53(4)
と考えられた.今後,下顎 FD の手術症例を蓄積すること
2015.
で,軟組織 / 硬組織の平均変位量比を示すことができれ
5 )Lee JS‚ FitzGibbon EJ‚ Chen YR‚ et al:Clinical guidelines
ば,オーバーコレクションすべき骨削除量が術前に予測
for the management of craniofacial fibrous dysplasia.
できるようになると思われる.
:S2‚ 2012.
Orphanet J Rare Dis‚ 7(Suppl 1)
5)
FDには成長期終了後も病変が増大するタイプがあり ,
長期経過後に再度骨削除術を行った症例も報告されてい
10)
る .また,悪性転化する確率は 1 %未満であるが,報
5)
告されている .本症例は術後 1 年が経過し,病変の増
大や悪性転化を疑う所見は認めていないが,今後の経過
観察は重要であると考えられた.
6 )杉山聡美,岩井俊憲,大橋伸英,矢島康治,大澤孝
行,藤内 祝:ナビゲーションシステムを用いて形
成術を施行した上顎線維性異形成症の 1 例.日口外
誌,64(10):618-623,2018.
7 )本田康二,岩井俊憲,藤田紘一,他:顔面非対称に
対するナビゲーション手術と二次的顎矯正手術を
行った下顎線維性異形成症の 1 例.日顎変形誌,28
(4)
:276-285,2018.
52
サージカルガイドを用いた下顎骨削除術
8 )Gui H‚ Zhang S‚ Shen SG‚ Wang X‚ Bautista JS‚ Voss PJ:
Region After Bone Contouring Surgery for Fibrous
Real-time image-guided recontouring in the management
Dysplasia-A Preliminary Study. J Oral Maxillofac Surg‚
of craniofacial fibrous dysplasia. Oral Surg Oral Med
77
(9)
:1904.e1-1904.e11‚ 2019.
Oral Pathol Oral Radiol‚ 116:680-685‚ 2013.
10)伊藤元貴,児玉泰光,大貫尚志,他:17年を経過し
9 )Jie B‚ Yao B‚ An J‚ Zhang Y‚ He Y: Correlation Between
Soft and Hard Tissue Changes in the Zygomaticomaxillary
て再減量手術を行った上顎骨線維性異形成症の 1
:79-85,2020.
例.新潟歯学会誌,50( 2 )
Abstract
MANDIBULAR FIBROUS DYSPLASIA TREATED WITH REDUCTION SURGERY
USING A NAVIGATION SYSTEM AND SURGICAL GUIDES: A CASE REPORT
Yasuharu YAJIMA 1 ), Toshinori IWAI 1 ), Koji HONDA 1 ), Satomi SUGIYAMA 1 ),
Soichiro ISHIKAWA 1 ), Yuka IDETA 1 ), Norihide YATANI 1 ),
Shuhei MINAMIYAMA 1 ), Junichi BABA 1 ), Nobuhide OHASHI 2 ),
Toshiaki KATAOKA 3 ), Satoshi FUJII 4 ), Kenji MITSUDO 1 )
1)
Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine
2)
Department of Oral Surgery, Sapporo Medical University
3)
4)
Department of Pathology, Yokohama City University Graduate School of Medicine
Department of Molecular Pathology, Yokohama City University Graduate School of Medicine
Fibrous dysplasia (FD) is a fibro-osseous neoplasm characterized by poorly organized bone and intervening
fibrous tissue resulting in bone expansion. Mandibular FD causes facial asymmetry and requires bone reduction
surgery. However, an intraoral approach often fails to achieve adequate facial symmetry because of limitations on
instrument use and poor visualization. Therefore, we manufactured surgical guides for mandibular FD and performed
bone reduction surgery using a navigation system and surgical guides. A 28-year-old woman was referred to our
department with a complaint of swelling in the left side of the mandible. The mandible was reconstructed using
three-dimensional (3D) imaging software from computed tomography images, and the decision was made to remove
bone with 3 mm overcorrection based on the mandible mirrored on the healthy side in the midsagittal plane. The
surgical guide for resection of the posterior and inferior borders of the mandible was designed with the software and
fabricated using a 3D printer in two parts so that it could be inserted in the mouth avoiding the mental nerve. The
lateral mandibular bone removal was performed under navigation guidance. The surgical guides were attached to the
mandible, and the inferior and posterior borders were resected. The postoperative computed tomography images
were superimposed and showed the removal of 3 mm more than the mirrored mandible, and the mandibular canal
was not injured. By using surgical guides in combination with the navigation system, the surgery was simplified, and
facial symmetry was obtained by overcorrection of the bone removal.
53
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