Management of Pediatric Mitochondrial Disorder Patient: Case Report

粒線體異常兒童病人的牙科治療－病例報告

柯秀伶(Hsiu-Ling Ko) ； 蔡蔭玲(Aileen-I Tsai)

《臺灣兒童牙醫學雜誌》 5卷1期 (2005/03) Pp. 14-18

https://doi.org/10.6319/TJPD.2005.5(1).3

摘要

粒線體異常是一種最近幾年發現的罕見疾病，主要影響發生於粒線體上的氧化加磷氧基作用及ATP的合成。病灶多為全身性影響主要侵犯肌肉組織，引起餵食困難、乳酸中毒及眼部肌肉麻痺、雙眼下垂、聽覺神經受損，可能會產生甲狀腺、副甲狀腺功能低下及糖尿病。最常見為運動失調、肌肉無力。腦神經受影響的結果引起智能受損、類似中風型的癲癇。這類病人在接受牙科治療上會有許多臨床處置上的困難，尤其需要兒童牙科特殊病患式的處置例如全身麻醉、術前投藥或行為束縛器。運動失調可能引起牙齒外傷，而因吞嚥餵食困難，可能較易有口腔清潔問題及齲齒，然而由於文獻上對這類病患的病例報告不多，尤其是牙科方面的有關病例報告闕如，本病例報告旨在說明一位21個月大的粒線體異常幼兒因牙齒外傷及後續齲齒問題的治。並討論可能之病因與未來牙科研究之方向。藉此病例的討論可以有助於加強對此疾病的早期診斷及重視口腔可能有的症狀及治療時應注意的事項。

關鍵字

紅線體異常 ； 肌肉組織病變 ； 齲齒 ； 牙齒外傷

並列摘要

Mitochondrial disorder is a rare, congenital disorder characterized by physical and developmental problems including myopathy, stroke-like episodes, dysphagia, diabetes mellitus, and external ophthalmoplegia. It is a clinical entity associated with abnormalities of oxidative phosphorylation. Mitochondrial disease may present with single organ involvement or multi-system involvement. The patient with mitochondrial disorder may pose a problem for dental treatment. Pre-medication, physical restraint or general anesthesia may be indicated for these patients. The physical limitations may make the patient more vulnerable for dental trauma. Dysphagia may cause dental cleaning problems and increase the risks for caries. This case report documents the dental treatment of a 21 month-old boy with mitochondrial disorder who presented with an intruded primary maxillary incisor and carious lesions. Knowledge of these aspects of mitochondrial disorder may be helpful in the management of these patients.

並列關鍵字

Mitochondrial Disease ； Myopathy ； Caries ； Trauma