Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
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Self-inflicted Tongue Ulceration in a Patient with Tourette Syndrome: A Case Report

뚜렛 증후군 환자에서 자해로 인한 혀 손상 : 증례 보고

  • Lee, Kkotnim (Division of Pediatric Dentistry, Department of Dentistry, Ewha Womans University Mokdong Hospital) ;
  • Kim, Miae (Division of Pediatric Dentistry, Department of Dentistry, Ewha Womans University Mokdong Hospital) ;
  • Hwang, Inkyung (Division of Pediatric Dentistry, Department of Dentistry, Ewha Womans University Mokdong Hospital) ;
  • Park, Jihyun (Division of Pediatric Dentistry, Department of Dentistry, Ewha Womans University Mokdong Hospital) ;
  • Mah, Yonjoo (Division of Pediatric Dentistry, Department of Dentistry, Ewha Womans University Mokdong Hospital)
  • 이꽃님 (이화여자대학교 의과대학 목동병원 소아치과학교실) ;
  • 김미애 (이화여자대학교 의과대학 목동병원 소아치과학교실) ;
  • 황인경 (이화여자대학교 의과대학 목동병원 소아치과학교실) ;
  • 박지현 (이화여자대학교 의과대학 목동병원 소아치과학교실) ;
  • 마연주 (이화여자대학교 의과대학 목동병원 소아치과학교실)
  • Received : 2015.08.03
  • Accepted : 2015.12.16
  • Published : 2016.08.31
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Abstract

Tourette's syndrome is a chronic neuropsychiatric disorder characterized by the presence of vocal and multiple motor tics. Tics are defined as brief, intermittent, repetitive, unpredictable, purposeless, and stereotyped movements or sounds. Some patients experience physical pain from intense and complex tics. In addition, motor tics can result in self-injury which is a common feature of Tourette's syndrome. A 9-year-old boy was referred by the department of neuropsychiatry because of a severe tongue laceration. His parents reported that he had been biting his tongue irregularly for 2 months before referral and suffered from an intense burning sensation. The repeated biting resulted in ulcers on the tongue, which quickly worsened and led to progressive difficulty chewing and swallowing food. We offered to give him a two-piece removable appliance to limit tongue biting; it was made of soft silicone and fitted to both the maxillary and mandibular arches. As we emphasized that the device could help alleviate his pain, he agreed to accept it and adapted well. Just 3 weeks later, his tongue lesions had healed significantly.

틱이란 불수의적이고 갑작스러운 소리냄과 리듬이 없는 근육의 움직임을 말한다. 다수의 운동틱과 한 가지 이상의 음성틱이 모두 존재하는 경우 뚜렛 증후군으로 분류되며, 운동틱에 의한 자해 행위는 뚜렛 증후군 환자에서 흔히 나타나는 증상 중 하나이다. 본 증례에서 9세 소년이 혀의 심각한 궤양을 주소로 신경정신과로부터 의뢰되었다. 두 달 전부터 시작된 반복적인 혀 씹기에 의해 궤양은 빠르게 진행되었으며, 환아는 그로 인한 식이 및 연하의 어려움을 호소하였다. 우리는 부드러운 실리콘 재질을 이용하여 상, 하악이 분리된 가철성 장치를 제작하기로 결정하였다. 장치의 지속적 사용이 고통을 줄일 수 있는 방법임을 강조하였기 때문에, 환아는 장치 장착에 동의하였으며 잘 적응하였다. 3주 후 혀의 병소가 상당히 개선된 것을 확인할 수 있었다. 현재 구강 내 자해 행위를 치료하기 위한 표준화된 지침은 없다. 따라서 임상가는 약물 치료를 비롯하여 구강 내 장치 적용이나 관련 치아의 연마 등 다양한 접근 방법을 고려하여야 한다.

Keywords

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