2020 Volume 41 Issue 4 Pages 353-358
Congenital anomaly syndrome is the general name for disorders where there are anomalies in multiple organs, and the patients often require respiratory care with tracheotomy due to complications of respiratory disturbance caused by congenital anomalies at birth. This article reports on a case of congenital anomaly syndrome that we experienced, which presented with intellectual disability and tracheal stenosis due to a medical history of tracheotomy during childhood, and which made it difficult to select the behavior modification method as it was impossible to use intravenous sedation or general anesthesia in providing dental treatment.
The patient was a 20-year-old male with congenital anomaly syndrome and severe intellectual disability, and who had received tracheotomy to treat hypoxic encephalopathy at birth. The tracheal cannula was removed when he was 4 years old. The history of his present illness included treatment of multiple dental caries at his regular dentist in January 2009 under manual restraint. However, he was referred to the dentistry department of a general hospital due to large body motions. He was then referred to a university hospital as treatment had been difficult even in the hospital, and was transferred to the dental surgery department of a prefectural general hospital with a request for tooth extraction. Although tooth extraction was scheduled with general anesthesia in September 2011, it was discontinued during tube insertion, since the tracheal tube could not be inserted from the subglottis due to tracheal stenosis. The severity of the dental disorder advanced subsequently, and so the patient was referred to and visited the dentistry department for handicapped individuals of a university hospital in December 2013. Dental treatment was provided successively in outpatient visits under physical restraint. The dental treatment consisted of caries treatment with resin filling for 8 teeth, prosthetic treatment after pulp extirpation for 4 teeth, and tooth removal for 13 teeth. By incorporating behavior therapy as much as possible even under physical restraint, adaptability eventually improved to a favorable level, and treatment with normal methods became possible.
