• Archives of Plastic Surgery
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• 제38권4호
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• pp.547-551
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• 2011

Purpose: Pierre Robin sequence is a congenital malformation in which micrognathia causes glossoptosis and airway obstruction. If conservative treatment fails, surgical procedures such as tongue-lip adhesion can be performed. However, this procedure remains a subject of debate, with favorable results being countered by reports of complications. To overcome the above limitations, we revised the traditional method of tongue-lip adhesion using an alveolar protector. Methods: Between 1992 and 2011, a total of eight patients were identified with Pierre Robin sequence and were treated with tongue-lip adhesion. Two of these eight tongue-lip adhesion procedures were performed with an alveolar protector. The operative technique for tongue-lip adhesion was similar to that described in other published reports. The alveolar protector was inserted between the ventral surface of the tip of the tongue and the lower labial sulcus. Results: Tongue-lip adhesion failed in two patients because of wound dehiscence. The primary surgical success rate was 66.7%. In the two tongue-lip adhesion procedures performed with the alveolar protector, we observed no postoperative complications. Conclusion: Resistance to traction of the tongue can be encountered with nonunionized symphysis menti, causing loosening of the traction suture through the symphysis menti. This can lead to backward positioning of tongue, resulting in dehiscence of tongue lip adhesion. The alveolar protector is a good adjunct to tongue-lip adhesion because this method avoids postoperative loosening of the traction suture and wound dehiscence. It is a simple and effective auxiliary method that yields functional improvement.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.349-353
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• 2008

Purpose: There are 3 well-known surgical procedures to treat Pierre Robin sequence: tongue-lip adhesion, distraction osteogenesis of mandible, and tracheostomy. The classical tongue-lip adhesion is an effective way to keep airway. The tongue, however, becomes quite non-mobile and appears dormant until the patient could control upper airway and the adhesion can be maintained for prolonged period. Most of all, this procedure does not provide the correction of the micrognathia. Distraction osteogenesis is a good technique to correct micrognathia and to prevent tracheostomies in patients with Pierre Robin sequence. But airway keeping procedure is needed during the distraction period. The purpose of this study is to determine the usefulness of temporary tongue-lip traction during the initial period of mandibular distraction in Pierre Robin sequence patients with severe airway problems requiring operative procedure. Methods: It was a prospective study of 2 Pierre Robin sequence patients aged between 4 months and 6 months requiring surgical procedure to correct recurrent and severe pulmonary complications. Two patients underwent distraction osteogenesis of mandible. During the operation, deep one tension suture was performed to tract the tongue and lip. When the patient gained control of upper airway at the initial period of distraction and micrognathia was corrected, the traction suture was removed. Results: All patients were followed up. No patients complained severe pulmonary complications and tracheostomy could be avoided. No patients had severe pulmonary complication. The pulmonary condition of patients was good. Conclusion: In severe Pierre Robin sequence case, temporary tongue-lip traction is a good assistant method in distraction osteogenesis because this method can avoid tracheostomy.

• 대한소아치과학회지
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• 제37권1호
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• pp.117-123
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• 2010

치아 맹출이란 치아가 치조골 내의 발생 장소에서부터 교합면쪽으로 이동하여 구강 내로 출현한 후 치아의 기능적 위치까지 이동하는 것을 말한다. 유치의 치근부에서 발육하는 영구치배는 천천히 유치의 치근과 지지하는 치조골 부위를 흡수하면서 맹출하고, 이와 동시에 영구 치배의 치근과 치조골 및 기저골을 성장시킴으로써 영구치의 지지부위가 확립된다. 대개 영구전치의 치배는 유전치의 치근단 설측에 위치하는데 잘 발달된 도대삭(gubernacular cord)을 따라서 교합면상으로 맹출하게 된다. 이소 맹출이란 일반적으로 치배가 본래 발생 위치에서부터 예상되는 정상 맹출경로에 이상이 있는 것을 말한다. 즉, 치아가 치조골 내 발생 위치에서 예측되는 정상맹출 경로를 벗어나 맹출하는 것이다. 그 중 하악 측절치의 이소 맹출의 경우 치아의 위치를 바로잡는데 있어서, 그 치료 시기가 중요한 요소로 여겨지는데 일반적으로 혼합치열기 초기가 바람직한 치료시기이다. 하악전치가 이소 맹출한 경우 적절한 시기에 치료를 시행함으로써 공간 소실의 문제나 하악 전치부의 설측경사 등의 문제가 발생하는 것을 예방할 수 있다. 본 증례는 만 8세 여아에서 혀 아래쪽의 구강저 부근에 수평방향으로 이소 맹출하는 하악 우측 측절치를 주소로 연세대학교 치과대학병원 소아치과에 내원하였다. 컴퓨터 단층촬영(CT)을 이용하여 문제 치아의 치근 만곡 정도를 확인한 후, 혼합 치열기 초기에 lip bumper와 buccal arch를 이용하여 26주간 적극적인 견인적 처치를 시행하였다. 결과적으로 이소 맹출한 측절치를 본래 위치로 이동시켰으며 나머지 영구치의 맹출에 대한 관찰 및 평가 후 전반적인 교정치료를 진행하기로 계획하였다.