目的：成長期の小児における慢性的な鼻呼吸障害は，顎顔面形態の発育に影響を及ぼすことが示唆されている。本研究では，鼻呼吸障害の原因である重度の下鼻甲介肥大と小児の顎顔面形態の関係を明らかにすることを目的とした。
方法：本研究では，下鼻甲介肥大群は鼻のクリニック東京で肥厚性鼻炎と診断され，下鼻甲介肥大を伴う患者50名（男児30名，女児20名，平均年齢8.9±1.7歳），対照群は昭和大学歯科病院に来院された患者50名（男児18名，女児32名，平均年齢8.7±1.4歳）であった。歯科用コーンビームCT画像を用いて上顎骨幅，上顔面の高さ，下顎骨幅，下顎体の長さ，下顎枝高，上顎歯列幅，下顎歯列幅，前頭蓋底長，後頭蓋底長，頭蓋底角，上顎歯槽基底部の前後的位置関係および下顎歯槽基底部の前後的位置関係を計測した。共分散分析を使用して，グループの違いを統計的に分析した。
結果：上顔面の高さの増大，下顎体の長さや下顎枝高の短縮および小さな頭蓋底角が有意に下鼻甲介肥大と関連していた。
結語：慢性鼻炎やアレルギー性鼻炎などが原因で生じる下鼻甲介肥大により，顎顔面形態に変化が生じる可能性が示唆された。顎変形症の予防のため，小児期において正常な顎の発達を促すことが重要である。

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Clinical and statistical analyses were performed on 416 patients who underwent orthognathic surgery at Yoshikawa Orthodontic Clinic from January 2011 to December 2020.
The results were as follows:
1．There were 81 male and 335 female patients （ratio 1: 4.13）. The mean age at first visit was 30.1 （male） years old and 28.3 （female） years old.
2．As the sources of referral of jaw deformity patients, 217 patients （52.2％） were referred by private general dental clinics.
3．The most common clinical diagnosis was mandibular prognathism （28.8％）, followed by mandibular prognathism and asymmetry （19.2％）.
4．The most frequently performed operation was the combination of Le Fort I osteotomy and sagittal split ramus osteotomy at 59.4％, followed by sagittal split ramus osteotomy （SSRO） at 16.6％.
5．Removal of the plate was performed on 381 patients （91.8％）.
6．Genioplasty was performed on 113 patients （27.2％）.
In surgical orthodontic treatment, an interdisciplinary approach with oral surgery allows a more flexible response to various cases.

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Patients diagnosed with jaw deformity after middle age often have periodontal disease and missing teeth. In such cases, periodontal and prosthetic treatment is required in addition to orthodontic treatment. Therefore, surgical orthodontic treatment for middle-aged patients requires a more careful approach than for younger patients. This is a report of two representative cases.
Case 1: A 51-year-old male patient with the chief complaint of masticatory dysfunction by anterior cross bite was referred to our hospital. A diagnosis of mandibular prognathism was made and surgical orthodontic treatment was initiated. This patient had severe periodontal disease and missing teeth, which required periodontal treatment combined with periodontal surgery and prosthetic treatment before the surgical orthodontic treatment. In the surgical orthodontic treatment, anchor screws were used to support the vertical occlusal stop lost due to the missing teeth. After the presurgical orthodontic treatment, sagittal split ramus osteotomy was performed. Finally, partial dentures for the upper and lower jaws were fabricated for the final prosthesis.
Case 2: A 62-year-old female patient with the chief complaint of masticatory dysfunction by anterior cross bite was referred to our hospital. A diagnosis of mandibular prognathism was made and surgical orthodontic treatment was initiated. The periodontal disease was mild, but multiple teeth were missing. To shorten the treatment period, presurgical orthodontic treatment was minimized and prosthetic treatment was also applied. In the surgical orthodontic treatment, anchor screws were also used in this case to restore the vertical occlusal stop lost due to the missing teeth. After the presurgical orthodontic treatment, sagittal split ramus osteotomy was performed. Finally, partial dentures on the left side for the upper and lower jaws were fitted for the final prosthesis.

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