明海大学歯学雑誌 ３６‐２／１７．小林（Ｃ）
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1 J Meikai Dent Med 362, , Dubin-Johnson ! Dubin-Johnson Dubin-Johnson A Case of Severe Skeletal Mandibular Protrusion Indicating Simultaneous Corrective Surgery of the Maxilla and Mandible Including Discussion on Perioperative Management of the Dubin-Johnson Syndrome Satoru KOBAYASHI 1, Kimiko YASUI 1, Mikiko MANO 1, Hisao SHIGEMATSU 2, Una CHO 2, Keiichi HOSOKAWA 2, Hizuru MIYAMOTO 2, Seiji SUZUKI 2, Hideaki SAKASHITA 2 and Haruhide KANEGAE 1 1 Division of Orthodontics, Department of Human Development & Fostering, Meikai University School of Dentistry 2 Division of Oral and Maxillofacial Surgery, Department of Therapeutic & Diagnostic Sciences, Meikai University School of Dentistry Abstract : Herein, we present a favorable outcome obtained following corrective surgery for a patient with jaw deformities complicated by the Dubin-Johnson syndrome. In addition to summarizing the case, we discuss the perioperative management of patients complicated by constitutional jaundice. The patient was a male 23 years and 1 month of age. Although he had been aware of his mandibular protrusion for many years, he did not seek any medical assistance until At that timeat the age of 23 years, thepatient presented
2 206 36, 2007 at a nearby dental clinic with chief complaints of mandibular protrusion and asymmetry. The patient was referred to the Department of Orthodontics of Meikai University Dental Hospital, and in October 2003, he underwent thorough testing and treatment. Maxillary underdevelopment and mandibular overgrowth were confirmed as skeletal problems. Although the maxillary underdevelopment was mild, corrective surgery was indicated because of marked mandibular overgrowth, tilting of the maxillary occlusal plane in the left inferior direction, and excessive lower face height. Prior to orthognathic surgery, the patient s systemic condition was assessed, and simultaneous corrective surgery of the maxilla and mandible was planned in a conference involving the orthodontics and oral surgery departments. At present12 months post, thepostoperative orthodontic therapy has been completed, the patient s symptoms have improved, and a tight occlusal relationship has been achieved. When performing corrective surgery on patients with jaw deformities complicated by systemic diseases, it is essential to ascertain the patient s systemic condition. Furthermore, when planning therapy and orthognathic surgery, it is very important for orthodontics, oral surgery, anesthesiology, and related departments to work closely with each other. Key words : Dubin-Johnson syndrome, congenital jaundice, dentofacial deformity, orthognathic surgery 1 2, 3 Dubin-Johnson 1954 Dubin Johnson 4 Sprintz Nelson 5 6, Dubin-Johnson Dubin-Johnson Dubin-Johnson concave type Fig 1 Angle overjet 8.5 mm, overbite 1.5 mm 4.0 mm square taper coronal arch width 30.8 mm Arch length discrepancy 3.0 mm3.0 mm Fig 2 X
3 1 207 Fig 1 Facial views at initial. Fig 2 Intraoral views at initial. Fig 3 X mm X Fig 4Tables 1, 2 Facial angle 91.7Convexity 13.1SNA 75.0SNB 81.0ANB 6.0 Fig 3 Panoramic tomography at initial.
4 208 36, 2007 Fig 4 Lateral and frontal cephalograms at initial. Table 1 Cephalometric analysis1 Table 2 Cephalometric analysis2 Facial angle Convexity A-B plane Mandibular plane Y-axis Occlusal plane Interincisal L-1 to Mandibular FH to SN SNA SNB ANB U-1 to FH plane U-1 to SN plane Gonial angle Ramus inclination Mean SD Initial Fig 5 Gonial angle 132.4Gn-Cd mm, Pog -Gn 92.9 mm N-Me mm, ANS-Me 89.5 mm FH dental compensation N-S N-Me N-ANS ANS-Me S -Ptm A -Ptm Ptm -Ms A -Ms Is-Is Mo-Ms Is-Mo Gn-Cd Pog -Go Cd-Go Ii-Ii Mo-Mi Ii-Mo S-S FH Mean SD Initial Preoperation Postoperation Preoperation Postoperation mm click
5 1 209 Fig 5 Profilogram. 1 2 Angle Le Fort SSRO 1 2 Arch length discrepancy 3 4 MFT Fig 6 Treatment goalpaper surgery
6 210 36, 2007 Fig 7 Facial views at pre-operation. Fig 8 Intraoral views at pre-operation. Fig 9 Panoramic tomography at pre-operation x 025edgewise bracket MFT
7 1 211 Fig 10 Lateral and frontal cephalograms at pre-operation. Table 3 Result of blood test. Table 4 Change of bilirubin level. Value Unit Normal value Total protein A/G Total bilirubin Direct bilirubin ASTGOT ALTGPT γ-gtp ALP LDH Cholinesterase APTT PT g/dl mg/dl mg/dl U/l U/l U/l U/l U/l U/l sec sec Le Fort 4mm 4mm 2mm 5mm 11 mm 4 mm Fig 6 X Figs mg/dl 3.9 mg/dl APTT PT GOT, GPT Table PT APTT K15mg! 1 PT APTT
8 212 36, 2007 Fig 11 Facial views at after post-surgical orthodontics. Fig 12 Intraoral views at after post-surgical orthodontics.!! ml 10 mg mg/dl 4.7 mg/dl mg/dl, 2.9 mg/dl Table 4 3 APTT 34.5 PT L 7 2
9 MFT 11 1 SSRO Fig 13 Panoramic tomography after post-surgical orthodontics. Fig 14 Lateral and frontal cephalograms after post-surgical orthodontics. Fig 15 Cephalometric superimposition.
10 214 36, , mm SSRO concave type straight type 17 overjet 8.5 mm 3.5 mm, overbite 1.5 mm 2.0 mm Angle Figs 11, 12 X Fig 13 IMF X 4mm 8mm ANB Table 1N-Me ANS-Me Table 2 X dental decompensation dental decompensation Figs 14, 15 2 Crigler-Najjor Gilbert Rotor Dubin-Johnson 4 Gilbert Rotor Dubin- Johnson Dubin-Johnson mg/dl ICG Mandema BSP black liver 6, Dubin- Johnson C
11 Dubin-Johnson K PT APTT PT APTT 27 Selingsohn 27 K PT APTT APTT PT APTT mg/dl 10 mg/dl 8, 18, 24, 26, Dubin-Johnson mg/dl mg/dl , 30, 31 Dubin-Johnson 20 mg/dl 10, Dubin- Johnson Dubin-Johnson 1 Dubin-Johnson K 16, ,
12 216 36, , , , 42 50, 2007 Dubin IN and Johnson FB : Chronic idiopathic jaundice with unidentified pigmentin liver cells. Medicine 33, , 1954 Sprinz H and Nelson RS : Persistent non-hemolytic hyperbilirubinemia associated with lipochrome-like pigment in liver cells. Ann Intern Med 41, , 1954 Dubin-Johnson 21, , , , 1983 Dubin-Johnson 1 63, , 2002 Dubin-Johnson 3, 33 36, 1995 Dubin-Johnson Gilbert 40, , 1991 X 4, 87 95, , 26 34, , , , 77 83, 2002 Obwegeser H : Der offene Biss in chirurgischer Sicht. SSO Schweiz Monatsschr Zahnheilkd 74, , 1964 Malakouti B : Combined procedures in corrective surgery of prognathism and associated deformities. J Oral Surg 28, , 1970 Le Fort 1 12, 85 93, 2002 Dubin-Johnson 1 66, , 2005 Dubin-Johnson 1 8, , 2003 Dubin-Johnson 1 30, , 1995 Dubin-Johnson 1 17, , 2000 Dubin-Johnson 48, 27 31, 1988 C Dubin-Johnson 2 34, , 1993 Dubin-Johnson 1 61, , 2000 Dubin-Johnson C 1 23, , 1995 Dubin-Johnson 38, , 1976 Seligsohn U, Shani M, Ramot B, Adam A and Sheba C : Dubin-Johnson syndrome in Israel. Q J Med 39, , 1970 Taylor S : Gilbert s syndrome as a cause of postoperative jaundice. Anaesthesia 39, , 1984 Dubin-Johnson 1 59, , 1997 Riely CA : The use of plasmapheresis in patients with liver disease. Am J Gastroenterol 82, 882, 1987 Ueno S, Tanabe G, Hanazono K, Ogawa H, Yoshidome S, Aikou T and Yoshida A : Postoperative management following massive hepatectomy in a patient with Dubin-Johnson syndrome : report of a case. Surg Today 28, , , 39 42,
1 63 the mandibular Spee curve was removed by using a mono-block and a vertical rubber at the premolar site. The dynamic treatment period was 23 month
62 J Meikai Dent Med 37 1, 62 70, 2008 1 1 2 1 1 1 1 1 1 3 3 1 1 2 3 23 2 concave profile Spee 3 tripod Spee 1 11 11 2 10 tripod A Case of Severe Skeletal Mandibular Protrusion Complicated with Deep Overbite
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