顎顔面補綴
Online ISSN : 2435-0389
Print ISSN : 0389-4045
41 巻, 1 号
選択された号の論文の6件中1~6を表示しています
総説
  • 小野 高裕
    2018 年 41 巻 1 号 p. 1-3
    発行日: 2018年
    公開日: 2021/05/29
    ジャーナル フリー
    The outcome of maxillofacial prosthetics can be optimized by multidisciplinary collaboration in the rehabilitation of patients with maxillofacial defects and oro-pharyngeal functional disorders. In the 22nd Educational Symposium of the Japanese Association of Maxillofacial Prosthetics in 2017 in Tokyo, three lecturers (prosthodontist, oral surgeon and speech language pathologist) introduced the present state of multidisciplinary systems in their institutes, and discussed how the systems should be managed and improved. As an introduction of their review articles, the personal insight of the prosthodontist was presented based on the experience of collaboration with oral surgeons, dental technicians, dental hygienists, nurses, dietitians, speech language pathologists and caregivers in maxillofacial rehabilitation.
  • 西脇 恵子
    2018 年 41 巻 1 号 p. 4-7
    発行日: 2018年
    公開日: 2021/05/29
    ジャーナル フリー
    Speech-language-hearing therapists (ST) assist the millions of individuals with communication disorders and swallowing problems. We provide assessments, treatment, and other assistance necessary to maximize our clients’ communication capacities. We provide services to improve our clients’ impaired functions, and maintain and/or improve their residual functions. In rehabilitation, we need to adapt methods to suit the patients; dental prostheses are a good way to improve their speech and swallowing. Though not many ST cooperate with dental staff in terms of numbers, this article describes three cases of cooperation with ST dentists, the effectiveness of the treatment method, and finally what is necessary in cooperation.
  • 生木 俊輔
    2018 年 41 巻 1 号 p. 8-11
    発行日: 2018年
    公開日: 2021/05/29
    ジャーナル フリー
    At the Nihon University School of Dentistry Dental Hospital, we cooperate with various occupational specialists before performing operations to improve the quality of life of patients who undergo resection and reconstruction of the head and neck. We therefore attend a cancer board meeting every week in our hospital. The Nihon University School of Dentistry Dental Hospital is a hospital specialized in dentistry, and so most of the board members are dentists, along with co-dental staff. Our multi-occupation collaborative team medicine includes experts on oral function. Oral and maxillofacial surgeons perform tumor resection and reconstruction, maxillofacial prosthodontists prepare maxillofacial prostheses including immediate surgical obturators (ISO), dentists perform oral rehabilitation, dental hygienists perform oral care, and nurses perform general care. These specialists share the tasks from their respective positions, cooperate with each other, complement each other, and have prepared a system for responding appropriately to the patient’s situation. Each department intervenes from the first visit to hospitalization, during hospitalization, and after discharge in an effort to improve the patient’s quality of life. This study reports the details of the multi-occupational team approach we are using in our hospital.
  • ―顎顔面領域における疾病マネージメント―
    小山 重人
    2018 年 41 巻 1 号 p. 12-16
    発行日: 2018年
    公開日: 2021/05/29
    ジャーナル フリー
    It is necessary to assess patients by a multidisciplinary approach, create a treatment plan in accordance with the medical resources of the hospital, and monitor the outcomes of treatment in order to manage maxillofacial diseases. A treatment plan that considers the final prosthetic restoration to restore the patient's oral function is desirable from the outset, and team medical care by a multidisciplinary approach is the basis of treatment for maxillofacial diseases. For this purpose, the dental division should actively work with related medical departments and implement comprehensive treatment including rehabilitation, that is, medical care at the level of university hospitals.
    The advantages of collaboration between medical and dental divisions at university hospitals are that almost all necessary medical staff can be arranged. However, there are some disadvantages such as the difficulty of sharing medical information, the necessity of transferring patients to multiple clinics, and differences in insurance claim methods between medical and dental divisions. There are also many problems involved in interprofessional collaboration.
    This paper summarizes the present situation, knowledge and improvement points obtained through the cooperative experience at Tohoku University Hospital, and recommends a practical model for multi-occupational collaboration at university hospitals.
研究論文
  • 波田野 典子, 山越 典雅, 大木 明子, 髙戸 毅
    2018 年 41 巻 1 号 p. 17-25
    発行日: 2018年
    公開日: 2021/05/29
    ジャーナル フリー
    A palatal augmentation prosthesis (PAP) is applied in patients with tongue defects, where the volume and reconstructed tongue movement are too small to apply adequate tongue pressure during swallowing, and it results in improved swallowing, mastication, and speech functions. Since heavy PAPs often lead to dislodgement of prostheses and shortened survival of abutment teeth, it is important to make PAPs as light as possible. Herein, we report the application of PAP in a 26-year-old patient who underwent marginal mandibulectomy, subtotal glossectomy, and reconstructive surgery using flap and received postoperative chemoradiotherapy. Trismus, dysphagia, and impaired speech articulation caused by a subtotal tongue defect were observed at the first visit. After jaw-opening exercises, maxillofacial prosthetic rehabilitation with PAP was started. In addition, speech therapy and direct training of swallowing for dysphagia were performed by a speech therapist. After the chemoradiotherapy, the score of the speech intelligibility test with the PAP was improved from 3 to 1.5. Despite severe dysphagia, Fujishima’s grade for eating and swallowing capability with the PAP showed improvement from Grade 2 to 7. The patient could ingest slightly viscous food orally with the PAP, and quality of life was improved considerably.
認定医症例報告
  • 木村 尚美
    2018 年 41 巻 1 号 p. 26-32
    発行日: 2018年
    公開日: 2021/05/29
    ジャーナル フリー
    A 78-year-old female patient underwent right-side maxillary resection. In 2005, during her initial treatment, a resin-base obturator prosthesis was delivered after preprosthetic treatment. In 2012, she came back to the clinic complaining of speech disability and discomfort due to thickness of the resin palatal plate. Because a clasp had broken, it was considered necessary to improve the stiffness of the obturator. A metal plate obturator prosthesis was fabricated for her dento-maxillary rehabilitation, and oral care was performed. The plaque control record (PCR) improved from 25.8% before the dento-maxillary rehabilitation to 10% currently through instruction by a dental hygienist. The metal plate obturator has demonstrated a good postoperative course for 5 years. In addition, the complaints of discomfort due to the prosthesis, speech disability and esthetic dissatisfaction have improved.
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